Thursday, May 26, 2016

Airline NHS

29th February really started at a whim. Blogging. Sitting in a cafe in Paris...looking back,it was supposed to be sort of like a personal diary- reading that blog suggests there never was any great expectations that many would read it but over time, some have taken the time to read the rants, pontifications, lectures, it any which way you want- whoever you are- thank you for reading and passing on your thoughts- it has been much fun indeed...or at the very least, cathartic.

Time moves at pace..and when you are having fun, before you know, 4 years and a bit of blogging have whizzed by..and here today, I pen my 200th blog. And this one is dedicated to one of my pet bugbears (No, it's not the HSJ- behave yourself!) but the airline analogy the NHS uses when it comes to patient safety. And it's frustrating to no you ask why? It's because the airlines really do have much to teach us but unfortunately the lessons which we can learn are lost in vacuous sound bytes and tokenism towards patient safety.

To begin with, if you are going to use airlines as a barometer for safety, then one cannot pick and choose which bits are to be used and what not. The culture of learning from mistakes is one to be admired and learnt from but without forgetting the professional approach taken by the airline industry towards it.

Let's begin with training. There isn't a single airline in the world which allows its planes to be flown by those not trained. Imagine the sheer emotions if your pilot casually mentioned that he hadn't actually trained in flying the plane or indeed got a certificate to prove his or her training. There's a sheer belief as a passenger that the person flying the plane is trained. So let's turn to the NHS- are WE sure we follow this? Are YOU sure the person you are seeing is trained in the pathology you have presented with? Thereby lies the split and dichotomy.
Let's say you need your gall bladder surgery- you wouldn't expect anyone to "just do it"- in fact if it's not a surgeon, you would like to know that the person wielding the knife is would like to know and believe that the anaesthetist putting you to sleep and in charge of waking you up wasn't a Diabetologist who had wandered into the operating theatre. When we start extending that analogy to specialty areas such as Type 1 diabetes ( I know, sorry to bang on about it..but it's a safety thing- so bear with me) there is little to no quality control and very little of the rigour applied to let's say, a hip replacement.

Let's clarify myself here,this isn't just about the GP or practice nurse...if you think every single diabetes specialist is trained in insulin pumps, you must be having a laugh. But across the country, many do indeed have a go at it. Let's not point the finger at primary care regards rigour of training if we specialists ourselves haven't quite got our house in order or at the least aren't able to offer primary care the support they need. If you start using the airline as a comparator, then in many cases, clinics should be shut down till training is complete. It's another matter we can't do that in health- thus the analogy crumbles a bit.

The problem as ever is with sheer capacity- the response of the aviation industry with increased demand has not been to ask flight attendants to fly planes but also to increase number of planes and trained pilots- simply as that is key to safety. So what do we do? Do we simply brush aside examples of good practice from the aviation industry or do we have something to learn? My gut feeling is there is much to learn- but a genuine move away from sound bytes may need to be the first step. Patient safety champions are quick to point out errors, exhort learning from aviation yet slow to respond to what aviation teaches us. Human factors is an important issue for aviation- Martin Bromleys work on this is much to learn from- do we use that enough? Do we want to or do we simply want to use a cheaper workforce as part of cutting corners?

Challenging questions which need to be answered...need to be looked at genuinely. Till that happens, we will continue to have a system where a Type 1 diabetes patient, in 2016, in a first world country gets admitted to ITU because somebody didn't quite realise that insulin is what that patient needs to survive. Or forgot because it wasn't a priority. Or didn't ask someone who were trained. Or didn't have access to someone who was trained. Take your pick but either way you cut it..that patient is left wondering how someone who isn't trained to fly a plane is actually doing so.

Aviation has much to teach us- if only we are willing to look at it properly.  It will challenge not only politicians and policy makers but us as healthcare professionals as a whole. If patient safety is genuinely something important, then maybe worth opening up that can of worms. If that results in even 1 less error, even 1 less admission to ITU..then it's all worth it for sure.


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  2. On speaking with a former airline steward now working at a hotel, I thanked him for his great hospitality and kindness to all delegates. He replied that as a former British Airways steward, he'd had good training in looking after passengers who hated flying, and were terrified of being confined in a small space and unable to get off. Patients in hospitals experience the same feelings but not many medical staff recognise this. Boarding a recent flight I noticed that videos of baby animals were running on the cabin screens as a means to allay the fears of boarding passengers, these having been shown to help people smile and relax. These could be shown in many hospital waiting areas. Passengers or patients, the NHS needs some tips from the airlines.