Academic journal article Creative Nursing

Partnerships with Aviation: Promoting a Culture of Safety in Health Care

Academic journal article Creative Nursing

Partnerships with Aviation: Promoting a Culture of Safety in Health Care

Article excerpt

According to the Institute of Medicine (IOM, 1999, p. 1), "Medical errors can be defined as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim." The current health care culture is disjointed, as evidenced by a lack of consistent reporting standards for all providers; provider licensing pays little attention to errors, and there are no financial incentives to improve safety (IOM, 1999). Many errors in health care are preventable. "Near misses" and adverse events that do occur can offer insight on how to improve practice and prevent future events. The aim of this article is to better understand underreporting of errors in health care, to present a model of change that increases voluntary error reporting, and to discuss the role nurse executives play in creating a culture of safety. This article explores how high reliability organizations such as aviation improve safety through enhanced error reporting, culture change, and teamwork.

Keywords: nurse executive; patient safety; aviation safety; quality tools; error reporting

Teamwork is vital to improved safety in organizations. The Institute of Medicine (IOM, 1999) explains that medical errors are often not simply related to one individual action but rather to complex systems. These complex systems lead to details being missed as a result of decreased communication amid intricate processes. System errors can be reduced through teamwork and voluntary error reporting.

The World Health Organization states, "In the United States medical error resulted in at least 44,000 (and perhaps as many as 98,000) unnecessary deaths each year and one million excess injuries" (2014, p. 81). Underreporting of medical errors results in several problems for health care organizations, including decreased information about what causes patient harm, lack of knowledge about how to address issues of harm and patient safety, misunderstanding of the extent of patient harm, and inability to plan and prepare for the future.

Preventable medical errors raise not only concerns about human life but also financial concerns. The IOM (1999) reports that, nationally, medical errors cost an estimated $17-$29 billion a year. These costs are related not only to the supplementary patient care needed but also to the disability and loss of income resulting from the injury.

The aviation industry has been able to improve voluntary error-reporting rates by creating a team culture with a focus on reducing authoritarian autonomy and hierarchy. The U.S. Department of Transportation states, "Safety issues are resolved through corrective action rather than through punishment or discipline" (U.S. Department of Transportation, 2002, p.1). The interprofessional aviation team, including company leadership, regulators, unions, and airline employees (including pilots, flight attendants, aircraft mechanics, and dispatchers) all collaborate to improve safety. All the members of this interprofessional aviation team bring their knowledge, experience, and expertise to assure best aviation outcomes within a culture that supports open and trustworthy communication and reduces authoritarian practice. This reduction results in fewer mistakes, improved task sharing, increased error reporting, and better understanding of why errors happen (Amalberti, Auroy, Berwick, & Barach, 2005).

Reducing hierarchy and authoritarian behaviors fosters a culture of trust. Copilots consider it their duty to speak up and ask questions, regulators are seen as partners of the interprofessional aviation team, and the airline is seen as a safe place to express concern. Instead of focusing only on individual issues, system issues are explored; everyone is provided the opportunity to learn so systemic issues can be addressed.

The opposite approach is often seen in health care. The current culture in health care is one of individuality rather than an expert team. Burke, Salas, Wilson-Donnelly, and Priest (2004) describe this individualism as a team of separately functioning experts. …

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