Operating Room and Flight Deck: What Do These Places Have in Common?
Keywords:
Aviation, patient safety; pilot, safety, surgeon, surgeryAbstract
This review article grounds itself into the advent of aviation safety concepts that share some aspects into
healthcare industry, practically and theoretically. These concepts are originally invented for aviation-related
operation to ensure safety in flight but there are some aspects that can be related to healthcare context especially
in surgery. Because aviation and healthcare are high reliability industries and neither patients nor passenger safety
are compromised, safety concepts from aviation may prove useful for healthcare. The objective of this review was
to scrutinize the concepts of aviation safety that may be applicable to healthcare. Data collection was based upon
a review of literatures. This review article contributes to a broader knowledge from both fields of work regarding
operational safety. The review shows that there are several practical concepts including Crew Resource Management,
checklists and readbacks, sterile cockpit, and human factors of fatigue and stress that healthcare professionals can
adopt and adapt them into their daily operation. Moreover, theoretical concepts such as Swiss cheese model and
Threat and Error Management can be applied into healthcare context. This review invokes scenarios of each concept
from both industries. The results show that communication is the key to promote safer operation and those concepts
can be adopted to promote better safety at work. Future studies should extend the concepts of this review into an
experimental research to analyze the effect of concepts on actual healthcare settings or utilize qualitative study to
investigate the application of concepts in healthcare environment.
References
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12. Hawkins FH, Orlady HW. Human factors in flight. Routledge; 2017.
13. Hosseinian SS, Torghabeh ZJ. Major theories of construction accident causation models: A literature review. Int J Adv Eng Technol 2012;4:53.
14. McKenna FP. The human factor in driving accidents An overview of approaches and problems. Ergonomics 1982; 25:867-77.
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25. Hales BM, Pronovost PJ. The checklist—a tool for error management and performance improvement. J Crit Care 2006;21:231-5. 720 Volume 73, No.10: 2021 Siriraj Medical Journal https://he02.tci-thaijo.org/index.php/sirirajmedj/index
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31. Stahel PF. Learning from aviation safety: a call for formal “readbacks” in surgery. Patient Saf Surg 2008;2(1):1-2.
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33. Boyd M, Cumin D, Lombard B, Torrie J, Civil N, Weller J. Read-back improves information transfer in simulated clinical crises. BMJ Qual Saf 2014;23:989-93.
34. MacLeod CM, Gopie N, Hourihan KL, Neary KR, Ozubko JD. The production effect: Delineation of a phenomenon. J Exp Psychol Learn Mem Cogn 2010;36:671.
35. Wiener EL. Beyond the sterile cockpit. Hum Factors 1985;27:75-90.
36. Broom MA, Capek AL, Carachi P, Akeroyd MA, Hilditch G. Critical phase distractions in anaesthesia and the sterile cockpit concept. Anaesthesia 2011;66:175-9.
37. Hohenhaus SM, Powell SM. Distractions and interruptions: development of a healthcare sterile cockpit. Newborn Infant Nurs Rev 2008;8:108-10.
38. Federwisch M, Ramos H, Shonte’C A. The sterile cockpit: an effective approach to reducing medication errors? AJN Am J Nurs 2014;114:47-55.
39. Bennett SA. Flight crew stress and fatigue in low-cost commercial air operations-an appraisal. Int J Risk Assess Manag 2003;4:207-31.
40. Powell D, Spencer MB, Holland D, Broadbent E, Petrie KJ. Pilot fatigue in short-haul operations: Effects of number of sectors, duty length, and time of day. Aviat Space Environ Med 2007;78:698-701.
41. Lockley SW, Landrigan CP, Barger LK, Czeisler CA. When policy meets physiology: the challenge of reducing resident work hours. Clin Orthop Relat Res 2006;449:116-27.
42. Caldwell JA. Fatigue in aviation. Travel Med Infect Dis 2005; 3:85-96.
43. Staender SE. Patient safety in anesthesia. Minerva Anestesiol 2010;76:45-50.
44. Sinha A, Singh A, Tewari A. The fatigued anesthesiologist: A threat to patient safety? J Anaesthesiol Clin Pharmacol 2013; 29:151.
45. Friend TH. Behavioral aspects of stress. J Dairy Sci 1991;74:292-303.
46. Taylor LA, Rachman SJ. The effects of blood sugar level changes on cognitive function, affective state, and somatic symptoms. J Behav Med 1988;11:279-91.
47. Maneechaeye P. Factors Affecting Burnout in Out-of-Office Workers in Thailand: a Moderated Multiple Regression Approach. ASEAN J Manag Innov [Internet]. 2020;7:108-18. Available from: https://ajmi.stamford.edu/index.php/ajmi/ article/view/139/139
48. Dahlqvist V, Söderberg A, Norberg A. Dealing with stress: Patterns of self-comfort among healthcare students. Nurse Educ Today 2008;28:476-84.
49. Lyckholm L. Dealing with stress, burnout, and grief in the practice of oncology. Lancet Oncol 2001;2:750-5.
50. Otto K, Schmidt S. Dealing with stress in the workplace: Compensatory effects of belief in a just world. Eur Psychol 2007;12:272-82.
51. Peltomaa K. James Reason: Patient safety, human error, and Swiss cheese. Qual Manag Healthc 2012;21:59-63.
52. Reason J, Hollnagel E, Paries J. Revisiting the Swiss cheese model of accidents. J Clin Eng 2006;27:110-5.
53. Perneger T V. The Swiss cheese model of safety incidents: are there holes in the metaphor? BMC Health Serv Res 2005;5:1-7.
54. Collins SJ, Newhouse R, Porter J, Talsma A. Effectiveness of the surgical safety checklist in correcting errors: a literature review applying Reason’s Swiss cheese model. AORN J 2014; 100:65-79.
55. Helmreich RL, Musson DM. Threat and error management model: Components and examples. Br Med J 2000;9:1-23.
56. Brennan PA, De Martino M, Ponnusamy M, White S, De Martino R, Oeppen RS. Avoid, trap, and mitigate–an overview of threat and error management. Br J Oral Maxillofac Surg 2020;58: 146-50.
57. Jackson CA, Earl L. Prevalence of fatigue among commercial pilots. Occup Med (Chic Ill) 2006;56:263-8.
58. Ruskin KJ, Stiegler MP, Park K, Guffey P, Kurup V, Chidester T. Threat and error management for anesthesiologists: a predictive risk taxonomy. Curr Opin Anaesthesiol 2013;26:707.
59. Thomas MJW. Predictors of threat and error management: Identification of core nontechnical skills and implications for training systems design. Int J Aviat Psychol 2004;14:207–31.
60. Dekker SWA, Lundstrom J. From threat and error management (TEM) to resilience. Hum Factors Aerosp Saf 2006;6:261.
61. Marušić Ž, Alfirević I, Radišić T. Analysis of the aviation safety issues using TEM framework. Teh Vjesn 2009;16:79-84.
62. Kalra J, Kalra N, Baniak N. Medical error, disclosure and patient safety: A global view of quality care. Clin Biochem 2013;46:1161-9.
63. Eisenberg EM, Murphy AG, Sutcliffe K, Wears R, Schenkel S, Perry S, et al. Communication in emergency medicine: implications for patient safety. Commun Monogr 2005;72:390-413.
64. Nadzam DM. Nurses’ role in communication and patient safety. J Nurs Care Qual 2009;24:184-8.
65. Lingard L, Espin S, Whyte S, Regehr G, Baker GR, Reznick R, et al. Communication failures in the operating room: an observational classification of recurrent types and effects. BMJ Qual Saf 2004;13:330-4.
66. Christian CK, Gustafson ML, Roth EM, Sheridan TB, Gandhi TK, Dwyer K, et al. A prospective study of patient safety in the operating room. Surgery 2006;139:159-73.
67. Rissmiller R. Patients are not airplanes and doctors are not pilots. Crit Care Med 2006;34:2869.
68. Thomas EJ, Helmreich RL. Will airline safety models work in medicine. Med error what do we know. 2002:325.
2. Sox Jr HC, Woloshin S. How many deaths are due to medical error? getting the number right. Eff Clin Pract ECP 2000;3:277-83.
3. Kao LS, Thomas EJ. Navigating towards improved surgical safety using aviation-based strategies. J Surg Res 2008;145:327-35.
4. Maneechaeye P. The Commodification of Idol Culture with a Loot-Boxes-Style Marketing Strategy Practice in Thai Idol Culture and Aspects of Consumer Psychology toward Uncertainties. Humanit Arts Soc Sci Stud [Internet]. 2021;21:179-87. Available from: https://so02.tci-thaijo.org/index.php/hasss/article/view/239553/168245
5. Day D V, Gronn P, Salas E. Leadership in team-based organizations: On the threshold of a new era. Leadersh Q 2006;17:211-6.
6. Entin EE, Serfaty D. Adaptive team coordination. Hum Factors 1999;41:312-25.
7. Endsley MR, Robertson MM. Situation awareness in aircraft maintenance teams. Int J Ind Ergon 2000;26:301-25.
8. Adams MJ, Tenney YJ, Pew RW. Situation awareness and the cognitive management of complex systems. Hum Factors 1995;37:85-104.
9. Ericsson KA, Kintsch W. Long-term working memory. Psychol Rev 1995;102:211.
10. Hazlehurst B, McMullen CK, Gorman PN. Distributed cognition in the heart room: how situation awareness arises from coordinated communications during cardiac surgery. J Biomed Inform 2007;40:539-51.
11. Wickens CD. Situation awareness and workload in aviation. Curr Dir Psychol Sci 2002;11:128-33.
12. Hawkins FH, Orlady HW. Human factors in flight. Routledge; 2017.
13. Hosseinian SS, Torghabeh ZJ. Major theories of construction accident causation models: A literature review. Int J Adv Eng Technol 2012;4:53.
14. McKenna FP. The human factor in driving accidents An overview of approaches and problems. Ergonomics 1982; 25:867-77.
15. Briggs CL. Rethinking the Public: Folklorists and the Contestation of Public Cultures. J Folk Res 1999:283-6.
16. Salas E, Burke CS, Bowers CA, Wilson KA. Team training in the skies: does crew resource management (CRM) training work? Hum Factors 2001;43:641-74.
17. Powell SM, Hill RK. My copilot is a nurse—using crew resource management in the OR. AORN J 2006;83:178-202.
18. Helmreich RL. Does CRM training work? Air Line Pilot 1991; 60:17-20.
19. Flin R, Yule S, McKenzie L, Paterson-Brown S, Maran N. Attitudes to teamwork and safety in the operating theatre. Surg 2006;4:145-51.
20. Makary MA, Sexton JB, Freischlag JA, Holzmueller CG, Millman EA, Rowen L, et al. Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder. J Am Coll Surg 2006;202:746-52.
21. de Leval MR, Carthey J, Wright DJ, Farewell VT, Reason JT. Human factors and cardiac surgery: a multicenter study. J Thorac Cardiovasc Surg 2000;119:661-72.
22. Ricci MA, Brumsted JR. Crew resource management: using aviation techniques to improve operating room safety. Aviat Space Environ Med 2012;83:441-4.
23. Pizzi L, Goldfarb NI, Nash DB. Crew resource management and its applications in medicine. Mak Heal care safer A Crit Anal patient Saf Pract 2001;44:511-9.
24. Allard J, Bleakley A, Hobbs A, Coombes L. Pre-surgery briefings and safety climate in the operating theatre. BMJ Qual Saf 2011;20:711-7.
25. Hales BM, Pronovost PJ. The checklist—a tool for error management and performance improvement. J Crit Care 2006;21:231-5. 720 Volume 73, No.10: 2021 Siriraj Medical Journal https://he02.tci-thaijo.org/index.php/sirirajmedj/index
26. Weiser TG, Haynes AB, Lashoher A, Dziekan G, Boorman DJ, Berry WR, et al. Perspectives in quality: designing the WHO Surgical Safety Checklist. Int J Qual Heal Care 2010;22:365-70.
27. Catchpole KR, Dale TJ, Hirst DG, Smith JP, Giddings TAEB. A multicenter trial of aviation-style training for surgical teams. J Patient Saf 2010;6(3):180–6.
28. Prinzo OV, Morrow DG. Improving pilot/air traffic control voice communication in general aviation. Int J Aviat Psychol 2002;12(4):341-57.
29. Prabhakar H, Cooper JB, Sabel A, Weckbach S, Mehler PS, Stahel PF. Introducing standardized readbacks to improve patient safety in surgery: A prospective survey in 92 providers at a public safety-net hospital. BMC Surg 2012:12.
30. Greenberg CC, Regenbogen SE, Studdert DM, Lipsitz SR, Rogers SO, Zinner MJ, et al. Patterns of communication breakdowns resulting in injury to surgical patients. J Am Coll Surg 2007;204(4):533-40.
31. Stahel PF. Learning from aviation safety: a call for formal “readbacks” in surgery. Patient Saf Surg 2008;2(1):1-2.
32. Stahel PF, Mauffrey C. Patient safety in surgery. Patient Saf Surg 2014:1-513.
33. Boyd M, Cumin D, Lombard B, Torrie J, Civil N, Weller J. Read-back improves information transfer in simulated clinical crises. BMJ Qual Saf 2014;23:989-93.
34. MacLeod CM, Gopie N, Hourihan KL, Neary KR, Ozubko JD. The production effect: Delineation of a phenomenon. J Exp Psychol Learn Mem Cogn 2010;36:671.
35. Wiener EL. Beyond the sterile cockpit. Hum Factors 1985;27:75-90.
36. Broom MA, Capek AL, Carachi P, Akeroyd MA, Hilditch G. Critical phase distractions in anaesthesia and the sterile cockpit concept. Anaesthesia 2011;66:175-9.
37. Hohenhaus SM, Powell SM. Distractions and interruptions: development of a healthcare sterile cockpit. Newborn Infant Nurs Rev 2008;8:108-10.
38. Federwisch M, Ramos H, Shonte’C A. The sterile cockpit: an effective approach to reducing medication errors? AJN Am J Nurs 2014;114:47-55.
39. Bennett SA. Flight crew stress and fatigue in low-cost commercial air operations-an appraisal. Int J Risk Assess Manag 2003;4:207-31.
40. Powell D, Spencer MB, Holland D, Broadbent E, Petrie KJ. Pilot fatigue in short-haul operations: Effects of number of sectors, duty length, and time of day. Aviat Space Environ Med 2007;78:698-701.
41. Lockley SW, Landrigan CP, Barger LK, Czeisler CA. When policy meets physiology: the challenge of reducing resident work hours. Clin Orthop Relat Res 2006;449:116-27.
42. Caldwell JA. Fatigue in aviation. Travel Med Infect Dis 2005; 3:85-96.
43. Staender SE. Patient safety in anesthesia. Minerva Anestesiol 2010;76:45-50.
44. Sinha A, Singh A, Tewari A. The fatigued anesthesiologist: A threat to patient safety? J Anaesthesiol Clin Pharmacol 2013; 29:151.
45. Friend TH. Behavioral aspects of stress. J Dairy Sci 1991;74:292-303.
46. Taylor LA, Rachman SJ. The effects of blood sugar level changes on cognitive function, affective state, and somatic symptoms. J Behav Med 1988;11:279-91.
47. Maneechaeye P. Factors Affecting Burnout in Out-of-Office Workers in Thailand: a Moderated Multiple Regression Approach. ASEAN J Manag Innov [Internet]. 2020;7:108-18. Available from: https://ajmi.stamford.edu/index.php/ajmi/ article/view/139/139
48. Dahlqvist V, Söderberg A, Norberg A. Dealing with stress: Patterns of self-comfort among healthcare students. Nurse Educ Today 2008;28:476-84.
49. Lyckholm L. Dealing with stress, burnout, and grief in the practice of oncology. Lancet Oncol 2001;2:750-5.
50. Otto K, Schmidt S. Dealing with stress in the workplace: Compensatory effects of belief in a just world. Eur Psychol 2007;12:272-82.
51. Peltomaa K. James Reason: Patient safety, human error, and Swiss cheese. Qual Manag Healthc 2012;21:59-63.
52. Reason J, Hollnagel E, Paries J. Revisiting the Swiss cheese model of accidents. J Clin Eng 2006;27:110-5.
53. Perneger T V. The Swiss cheese model of safety incidents: are there holes in the metaphor? BMC Health Serv Res 2005;5:1-7.
54. Collins SJ, Newhouse R, Porter J, Talsma A. Effectiveness of the surgical safety checklist in correcting errors: a literature review applying Reason’s Swiss cheese model. AORN J 2014; 100:65-79.
55. Helmreich RL, Musson DM. Threat and error management model: Components and examples. Br Med J 2000;9:1-23.
56. Brennan PA, De Martino M, Ponnusamy M, White S, De Martino R, Oeppen RS. Avoid, trap, and mitigate–an overview of threat and error management. Br J Oral Maxillofac Surg 2020;58: 146-50.
57. Jackson CA, Earl L. Prevalence of fatigue among commercial pilots. Occup Med (Chic Ill) 2006;56:263-8.
58. Ruskin KJ, Stiegler MP, Park K, Guffey P, Kurup V, Chidester T. Threat and error management for anesthesiologists: a predictive risk taxonomy. Curr Opin Anaesthesiol 2013;26:707.
59. Thomas MJW. Predictors of threat and error management: Identification of core nontechnical skills and implications for training systems design. Int J Aviat Psychol 2004;14:207–31.
60. Dekker SWA, Lundstrom J. From threat and error management (TEM) to resilience. Hum Factors Aerosp Saf 2006;6:261.
61. Marušić Ž, Alfirević I, Radišić T. Analysis of the aviation safety issues using TEM framework. Teh Vjesn 2009;16:79-84.
62. Kalra J, Kalra N, Baniak N. Medical error, disclosure and patient safety: A global view of quality care. Clin Biochem 2013;46:1161-9.
63. Eisenberg EM, Murphy AG, Sutcliffe K, Wears R, Schenkel S, Perry S, et al. Communication in emergency medicine: implications for patient safety. Commun Monogr 2005;72:390-413.
64. Nadzam DM. Nurses’ role in communication and patient safety. J Nurs Care Qual 2009;24:184-8.
65. Lingard L, Espin S, Whyte S, Regehr G, Baker GR, Reznick R, et al. Communication failures in the operating room: an observational classification of recurrent types and effects. BMJ Qual Saf 2004;13:330-4.
66. Christian CK, Gustafson ML, Roth EM, Sheridan TB, Gandhi TK, Dwyer K, et al. A prospective study of patient safety in the operating room. Surgery 2006;139:159-73.
67. Rissmiller R. Patients are not airplanes and doctors are not pilots. Crit Care Med 2006;34:2869.
68. Thomas EJ, Helmreich RL. Will airline safety models work in medicine. Med error what do we know. 2002:325.
Published
01-10-2021
How to Cite
Maneechaeye, P. ., Maneechaeye, W. ., & Potipiroon, W. . (2021). Operating Room and Flight Deck: What Do These Places Have in Common?. Siriraj Medical Journal, 73(10), 710–720. Retrieved from https://he02.tci-thaijo.org/index.php/sirirajmedj/article/view/254007
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