From the cockpit to the operating theatre.

Claudia Hammond investigates how aviation psychology has transformed medical and surgical practice. Aviation safety has led the way with regards to reporting all minor errors and not creating a blame culture. Human error is what leads to disaster; a terrible air crash in Tenerife where 583 people died in an accident in 1977 is revisited. For most aviation disasters, the black box voice recorder reveals the quality of communication between the pilot and his co-pilot and air traffic control which is one reason why it's possible to dissect the sequence of events. It is the authority gradient which can be a key issue; people not speaking out and deferring to authority. Another air crash in 1989 in Kegworth (London-Belfast), revealed that the cabin staff could sometimes be in a position to overrule the pilots (who closed down the wrong engine, the plane then crashed). The entire flight crew have now systematically been trained in assertiveness. Hammond visits the control centre at London City airport. Communication has to be clear. NHS staff are now being trained in safety from the aviation industry. The hierarchical structure of both sectors is similar; anecdotes are provided from aviation. Elaine Bromiley died as a result of medical malpractice due to a lack of situational awareness amongst the three principals [this case is covered in 'How to avoid mistakes in surgery', 2013]. Hammond goes to Dr Stephen Jay at St Thomas' London Teaching Hospital where there are realistic surgical simulations using mannequins and pig blood. The idea is to test peoples' stress levels - the learning is dynamic and the trainees are pushed hard as the physiology of the patient is changed. In another case, a junior doctor noticed that a girl in surgery was being operated on the wrong hand; her concerns were ignored. Junior staff are trained to use trigger words to flag their concern. There is also a WHO checklist which has been rolled out Worldwide. The training when presented to medical staff has proved useful. Rhona Flin, psychologist, thinks the skills are highly transferrable from aviation to medicine.