An announcement made the news last week that some, “pioneering,” National Health Service trusts are to adopt aviation methods to cut the death rate of patients in their care by up to 22%. This headline caught my eye but I was not prepared for what came next.

It seems that among the procedures due to be implemented are pre-operation checks. Surgeons are to ensure that they have the right patient and that they are clear about what they are intending to operate for. Other measures to be implemented are closer monitoring of drug dispensing and specific procedures to track a patient’s condition. Are patients deteriorating or making progress? And, yes, medical staff will be encouraged to wash their hands too.

If you are as close to falling off your chair as me, and are amazed that this has not been automatic and standard practice for decades, then maybe my next point will resonate too. Do you rely on your memory, somebody else’s, or simply realising that something may need doing when running vital parts of your life?

I’ll bet you don’t. I’ll bet you have lists. Shopping lists are the obvious example but any busy mother will have a routine, which ensures all the loose ends get covered, so pilots don’t own exclusive rights to checklists.

What pilots know – and they know it so completely that it is never questioned – is that relying on other people, memory, or simple common sense, kills people. That the surgeon who may cut me open doesn’t follow carefully considered and thought out procedures is, frankly, terrifying. Now I understand stories like the one about the wrong kidney being removed.

Another shocker was the gleeful announcement from the Conway and Denbighshire NHS Trust that nurses have new procedures for patients on ventilators; they ensure their position is correct and adjust their headboards more carefully to ensure secretions don’t accumulate in their lungs. I should hope so too! 

This list of improvements is the aviation equivalent of an airline announcing that they’ve issued instructions to pilots to try and put the wheels down for landing.

The new NHS plan tells us something else pretty important too. If standard operating procedures (what pilots call SOPs) are absent in life-threatening situations such as these, then we should not be surprised that our personal HM Revenue and Customs data is lost in the post or MOD secrets are left on trains.

Yet for a pilot SOPs are almost an unconscious process. It is not a question of reading a list with a furrowed brow but the complete atmosphere in which you work. It is disciplined and professional and all members of the team are included and their input valued.

Are surgeons and medical staff so arrogant that they think they are superhuman? That they are not subject to fallible human traits from which we all suffer? Of course they make mistakes, we all do. It is using that knowledge that has made flying safe. If it can go wrong, it will go wrong and do so at the worst possible moment; so do I have a fallback plan? Have I checked and then checked again before doing anything critical?

Pilots well know that they can get it wrong. That’s why strict procedures are a part of everyday life on the flight deck; we know we are all human. The day of the autocratic captain who knows everything and is never wrong is long past. He’s as dead as all the people that his attitude killed.

That this philosophy is only now creeping into medicine is not just shocking but is not what we were led to believe following an earlier scandal. The tragedy I refer to was of the high mortality rates at the children’s cardiac unit at Bristol’s Royal Infirmary in the 1990s. 

Two surgeons were struck off for failing to heed concerns over abnormally high death rates among babies receiving open-heart surgery. Finally consultant anaesthetist, Dr Stephen Bolsin, leaked the figures showing that Dr James Wisheart’s operations carried 4 times the risk of other surgeons. It was later found that the whole unit was high risk but Dr Bolsin lost his NHS career as a result of his actions, which came after all warnings went unheeded. How disgraceful for a doctor’s career to die whilst attempting to save lives.

Bristol eventually tightened procedures and reduced its death rates from 29% to 3%, below the national average of 4%. Thereby demonstrating how important good procedures are; but it seems the lessons have still not been fully learned. 

Following the Bristol enquiry we were told that the General Medical Council would be adopting, “aviation style, no-blame, open reporting,” to ensure that safety concerns were addressed and not covered up as they had been in this case. It seems that aviation practices have not yet spread widely enough in the medical world.

It also emerged last week that the lost Revenue and Customs data resulted from sloppy procedures too. Maybe it is time for those in all safety and security sensitive areas to copy another practice from the professional pilot’s life; a competency check every 6 months. 

The test to be conducted in realistically simulated conditions over 2 days and include a written paper covering all aspects of the job. All necessary studying and revision will be in the candidate’s own time.

Failure to know your stuff or perform to standard means you’ve failed and will face the consequences. These will take the form of more training, demotion or worse. I’m pretty sure we would see a reduction in medical and security “wheels-up landings,” if officials, surgeons and managers knew their careers were on the line twice each year.

This is not a culture of painting by numbers or excessive control it is a carefully considered system. One designed to ensure that everything is done as it should be, even when things get difficult and we are under pressure. 

To put it another way, it’s doing your job properly.

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