Patient Safety Tip of the Week

May 15, 2007


Communication, Hearback and Other Lessons from Aviation



Analogies between the aviation industry and healthcare are well-known in patient safety circles. The types of problems encountered in aviation accident investigations are eerily similar to those encountered in root cause analyses of adverse events in healthcare. One exercise we recommend is reading some of the detailed investigation reports available through the NTSB (National Transportation Safety Board). As you read them, you can usually visualize a situation in healthcare in which almost identical issues occur.



A good case to start on is the investigation of the Avianca Airlines flight from Medellin, Columbia to JFK airport in New York in 1990. Multiple factors and events cascaded to result in this fatal crash, similar to the typical cascade seen in healthcare incidents. However, this investigation illustrates several of the key communication problems encountered in either an aviation or healthcare setting. It is an excellent example of both “language” and “lingo” problems and also shows how non-content verbal features can play a role in context.



Basically, the plane ran out of fuel after weather and air traffic led to a prolonged holding pattern and an unsuccessful approach to JFK. Though an issue with fuel was noted on several occasions in conversations between the cockpit crew and air traffic control, the urgency of that fuel shortage was never properly conveyed in the verbal interactions. Some of the issues had to do with the “language” barrier (the pilot spoke little English and communicated primarily via the first officer). Others had to do with different interpretations of the word “priority”, the air crew apparently thinking it meant emergency but the air traffic controllers not appreciating that specific term as meaning an emergency situation existed. One might even speculate from occasional small talk and occasional laughter in the cockpit whether “priority” being taken in the appropriate context by all involved.



The team approach to training known as Cockpit Resource Management (CRM) training is now used not only in the airline industry but is being used to improve teamwork in healthcare as well. Important communication techniques, such as hearback, are used to ensure that all members of the healthcare team clearly understand the intent and urgency of specific verbal communications. Simulation is another technique borrowed from aviation and used by healthcare teams to look at how teams communicate and respond in scenarios such as the operating room or emergency room. Loudness, intonation, and body language are also important determinants of effective communication. We highly recommend organizations serious about patient safety consider investing time and resources in training their various teams using CRM or simulation training. Also, a lot can be learned from simply recording or videotaping an operating room session and then having all relevant parties sit down and constructively critique their communication and team interactions.



Another good program for team training is TeamSTEPPS™, developed by the Department of Defense (DoD) in collaboration with the Agency for Healthcare Research and Quality (AHRQ). 








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