Flight plans, patient safety and American hospitals – is it time to check the baggage of private sector oversight?

Abstract

A recent JRSM paper1 compared efforts to improve healthcare quality with various aspects of the aviation industry. Although there are similarities between the airline industry and surgery, key differences also exist in exchange of safety data, particularly in the United States. At institutional levels, the National Transportation Safety Board publishes detailed reports on air crashes investigated in USA. But reports and recommendations concerning inspected American hospitals are the property of private certifying groups like the Joint Commission. That crucial information is kept secret; it is left to the hospital to decide what, if anything, is disclosed to the general public. At the individual level, the most junior team member in the cockpit can advise and correct a senior pilot.1 When aviation safety problems go beyond the cockpit, a US government programme legally shields the whistleblower from any retaliation.2 Yet, a hospital staff member who reports a breach of hospital policy in good faith can find their own safety complaint simply handed over to the hospital and used against them in a civil trial.3 Since hospital accreditation remains the exclusive province of the private sector, the ‘best hospitals in America’ can turn out to be most any hospital that can pay for a Joint Commission site survey.4 There is no parallel to this in the aviation industry. Vigilant and unbiased monitoring of institutional quality systems by public forums and meaningful certification has become a hallmark of aviation safety. The Institute of Medicine (USA) estimates that over 90,000 patient fatalities occur every year from preventable medical error – the equivalent of a catastrophic jumbo jet crash each day.5 As quality management structures are compared across hospital surgery and aviation, increased transparency in US hospital inspection and accreditation processes would be a welcome step to address this problem.