Aviation and Health Care: Quality and Safety Systems

Aviation and health care have much in common. Both fields are extremely complex, requiring that highly trained personnel function ably under considerable stress. In both, human beings are entrusted with the safety of others, and the available literature is replete with evidence that human factors cause the vast majority of harmful mistakes.

As in aviation before the advent of CRM, the healthcare system is grappling with its own significant gap. Despite the best intentions and efforts of all concerned, and the staggering sums of money spent, an acknowledged quality gap — a "quality chasm" — persists.

For health care, the quality problem is compounded by spiraling costs. Healthcare decision-makers must somehow find a way to simultaneously improve quality and reduce costs in today’s volatile economy. See, for example:

1. Closing the Quality Gap: The Role and Importance of “True Benchmarking.” The MCM Group, February 2005, 1. www.themcmgroup.com/PDFs/Closing_the_Qualty_Gap.pdf (accessed January 14, 2009).
   
2. Agency for Healthcare Research and Quality (AHRQ). Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies, Volume 1. Rockville, MD: U.S. Department of Health and Human Services; 2004. Available at: http://www.ahrq.gov/downloads/pub/evidence/pdf/qualgap1/qualgap1.pdf.
   
3. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001.

As a practical matter, the debate has ended about how to best attack health care’s quality/cost conundrum. According to the overwhelming consensus of authority, the ultimate solution lies in evidence-based practices—sustainable best practices that are backed by credible research.

Moreover, it is now recognized that evidence-based practices apply not only in the clinic, but also to the business of delivering health care. More pointedly, an expanding reservoir of evidence shows that continuously improving quality across an entire healthcare enterprise inherently saves money. Politics and geographic boundaries aside, this concept is a pillar of global healthcare reform initiatives. See, for example:

1. Office of Management and Budget. “President Obama’s Fiscal 2010 Budget: Transforming and Modernizing America’s Health Care System, FY 2010 Fact Sheet.” http://www.whitehouse.gov/omb/fy2010_key_healthcare