Nathaniel Sims: Aviation’s Lessons for Healthcare Technology

In the wake of the deadly crash landing of the Asiana Airlines jet in San Francisco, there have been several reports in the news media examining whether pilots rely too much on technology.

It’s a fair question, and the broader issue of potential hidden dangers in technology is worth keeping in mind for healthcare as well. As both a medical doctor and pilot—and as someone who has been intimately involved in the development and application of healthcare technology in hospitals—I have perhaps a unique perspective to offer.

The risk that arises in any industry, including aviation and healthcare, when automation is introduced, is the potential for basic skills to grow rusty. Before automation, such professionals engaged routinely in the “arts-and-crafts” aspect of their activities. As such, they were adept at recognizing and responding to unusual circumstances. Automation and technology can remove professionals from regularly employing and exercising their basic skills. The danger? When the unexpected happens, professionals may not know how to react.

After accidents such as the Asiana crash, there is renewed attention on management’s (or regulators’) responsibility to ensure that the workforce has sufficient time to train and maintain:

  • Basic skills
  • An understanding of basic principles
  • Crisis-management skills
  • Effective teamwork and communication skills

There is also a fresh appreciation for the role of human factors in the design of machines. Inevitably, there are surprises, and there will likely be a need to manage or monitor that automation or technology.

These kinds of discussions are healthy and appropriate. But we have to be careful not to overreact to any one incident with overly prescriptive fixes, such as new rules about how a crew is paired, or how many hours of simulator training in stall prevention should be required. It may take some time to identify the right balance of changes and responses required in the wake of any one incident.

I know some pilots who devote time each year to flying a glider. This would seem to be an ideal way for pilots to maintain basic stick-and-rudder skills. But should all airline pilots be required to fly in gliders once a year? If all pilots spent 10 hours annually flying a glider, would we reduce the risk of future plane accidents? I don’t know.

So, how might the Asiana crash landing and other aviation incidents apply to healthcare? They could provide crucial opportunities to learn. I’d encourage healthcare educators and leaders to study the lessons in the “human-machine” issues apparent in aviation tragedies, and see how they might best be applied in their medical world.

Nathaniel Sims, MD, is physician advisor for biomedical engineering at Massachusetts General Hospital in Boston. He serves as vice chair for medical device research on the AAMI Board of Directors.

One thought on “Nathaniel Sims: Aviation’s Lessons for Healthcare Technology

  1. One big difference between healthcare and the commercial airline industry is that in general clinical technology users are not required to have specific make and model certification . To make matters worse , for many years , hospital based biomeds have not been proactive in encouraging point-of-care user troubleshooting , an essential requirement to maintain basic technology skills specific to a make and model and so it’s not uncommon to have clinical staff who use a device everyday and have the skills of an entry level amateur .

    I have been pushing manufacturer supplied IFU troubleshooting as an essential step in the process of in-service training for dealing with point-of-care issues and it’s been incredible the amount of resistance I have received . Troubleshooting , in any environment , is one of the key aspects of learning and moving from a device user to a device expert and over the years manufacturers have made a much greater effort to upgrade the quality of their IFUs than hospitals have made an effort to getting staff to use this reference documentation. The May 2013 ECRI PSO confirms this observation

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