In this week’s must-reads in patient safety, we have been reading some recent articles and so not so recent articles about the need for a National Patient Safety Board.
Aviation and National Patient Safety Board
When a plane crashes, the National Transportation Safety Board investigates and, based on their investigation, makes recommendations to prevent future accidents.
When a patient has an adverse event or a death, there is no patient safety board to investigate and recommend remedial action.
In his article, “What Can Healthcare Learn From Aviation Safety?”, Stephen Rice writes Forbes:
Medical errors are the third leading cause of death in the United States, just behind heart disease and cancer. According to a study conducted by Johns Hopkins, more than 250,000 people die every year from preventable medical errors. Other studies claim this number could be as high as 440,000. Countless others are unnecessarily injured or maimed.
Many of these deaths are caused by doctor/hospital errors, while others are caused by prescription/pharmacy errors. These mistakes are due to a variety of reasons, including errors in judgment, skill, coordination, diagnostics, system or automation defects. Occasionally, malpractice rears its ugly head. In a letter to the U.S. Centers for Disease Control and Prevention, Dr. Martin Malarky and colleagues assert that this problem has more to do with the system than the individuals in that system. As a human factors expert with twenty years of experience in safety, I agree with this assessment. I also believe that healthcare, and many other fields, could learn a lot from aviation safety.
Commercial aviation is safer than you think. The number of accidents is very low. In fact, it is often said that the most dangerous part of commercial flight is the drive to the airport. You are much more likely to die in a car accident than in a commercial airplane. In many years, we see zero deaths in aviation. Even in 2018, which was a particularly bad year for aviation, there were only around 500 fatalities, compared to 3287 deaths per day in road accidents. The previous year recorded only 13 deaths in commercial aviation.
Why is it that aviation is so safe? Obviously, there are differences between aviation and healthcare. For example, aviation emergencies tend to be well-defined, while every healthcare patient crisis is unique. Despite these differences, I believe that examining what aviation does correctly can provide valuable information to healthcare advocates.
National Patient Safety Board
Recently, a bipartisan bill was introduced by U.S. Reps. Nanette Barragán (CA-44) and Dr. Michael Burgess (TX-26) to establish a National Patient Safety Board.
This legislation would “establish a National Patient Safety Board (NPSB), a nonpunitive, collaborative, and independent board within the Department of Health and Human Services to address safety in health care modeled in part after successful entities in the transportation industry.”
Support Legislation to Establish a National Patient Safety Board
What can you do to support the establishment of a National Patient Safety Board?
- Email your government representative by completing this form.
- Share your support on social media.