What Hospitalists Can Really Learn from Aviation


The aviation safety model is often discussed in a healthcare context but in a way that may miss the most important points, a new article in BMJ Quality & Safety suggests.

The article, “Learning from Near Misses in Aviation: So Much More to It Than You Thought” by Robert Wears, MD, PhD, MS, of University of Florida’s Department of Emergency Medicine, suggests healthcare still has important lessons to learn from aviation. The article focuses on a book called Close Calls: Managing Risk and Resilience in Airline Flight Safety by Carl Macrae.

“Although the book itself is about airlines, it has important lessons for improving safety in healthcare, especially with respect to management of incidents or ‘near misses,’” Dr. Wears writes. “Its rich descriptions and detailed explanation of the practical, everyday work of flight safety investigators should be required reading for anyone interested in patient safety. It will destroy many of the myths and misconceptions about reporting systems and learning from incidents that have caused us to expend so much effort for such meager results; it will also overturn the normative model of safety prevalent in healthcare.”

Dr. Wears says he wanted to write the article for two reasons.

“First, the patient safety orthodoxy has been obsessed with systems for reporting incidents, accidents, hazards, general ‘hiccups’ in clinical work for years, but almost nothing of value has come from this effort despite frequent badgering of physicians to report more,” he says. “Second, mainstream patient safety has also been enamored of the aviation safety model, but its ideas about how aviation safety is actually accomplished are naive and simplistic.”

He emphasizes that patient safety efforts to date have focused on the wrong things: too much on acquiring and storing reports and too little on analyzing them to develop an understanding of the systems in which hazards to patients arise.

“Making sense of incidents is far more important than classifying, counting, or trending them,” Dr. Wears says.

Hospitalists are on the front line of these issues, of course.

“Hospitalists regularly encounter hazards to patients in their daily work and, for the most part, successfully manage to mitigate or work around them, but the hazards remain in the system, only to pop up again sometime later. … A rich description of how a successful and effective safety reporting and analysis effort really works—not how we imagine it to work—could help us exchange our current wasteful and ineffective approach for something better,” he says.


  1. Wears R. Learning from near misses in aviation: so much more to it than you thought [published online ahead of print September 1, 2016]. BMJ Qual Saf. doi:10.1136/bmjqs-2016-005990.

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