airplane hospitals versus car crash hospitals

Whenever a plane crashes, whether by mechanical failure or operator air, airlines and regulatory bodies immediately assume something went wrong — something that needs to be fixed on every plane that will ever fly again.

The reaction to fatal plane crashes is markedly different from the reaction to fatal car crashes. About 90 people each day died in car accidents in 2013, adding up to 32,719 in the entire year.  Unlike airlines, car companies don’t see each car crash as a failure that needs to be fixed – and even if they did, they don’t have the manpower to investigate each crash. Fatal car accidents are seen as sad but inevitable with hundreds of millions of Americans driving every day.  Instead of looking at each crash as its own failure, car manufacturers look at large numbers of crashes to detect whether there are repeated failures.

Car companies admit that some accidents are unavoidable no matter how much work goes into preventing them.  Airlines and airplane manufacturers, on the other hand, treat each crash as potentially preventable, working backward to find out what went wrong.  These so called “one-off” events don’t exist, because each event has the potential to kill hundreds of people.

Tragically – the health care system operates more like the automobile industry than the aviation industry when it comes to patient harm.  Throughout the health care industry, there is a pervasive view that some complications of medical care are sad by inevitable.  This view has lead to thousands of potentially preventable injuries and deaths due to medical errors in the United States.  The Institute of Medicine’s landmark report in 1999, To Err is Human, estimated that as many as 100,000 patients die each year in hospitals due to medical errors that were preventable.  Updated research suggests that number was grossly underestimated.  And yet, most hospitals respond to these errors like the automobile industry – most complications are views as inevitable “one off” events that can’t be prevented.

That viewpoint is starting to change though.  Johns Hopkins was a pioneer starting in the early 200o’s of systematically looking at central line infections and figuring out how to prevent them.  Hopkins ultimately designed a checklist for placing and caring for central lines, in addition to other measures, that brought their infection rates down to zero.  Many hospitals have now instituted similar measures, and any infection that occurs is highly scrutinized (although truthfully, a lot of the impetus came from Medicare and Medicaid who refuse to pay for these so called “never events”).

But the divide still exists in modern medicine – and with each hospital experiencing only a handful of events affecting only a few patient in a given year, it’s hard to be like the aviation industry.  Yet with medical errors as the third leading medical cause of death in the United States – the time has long passed to stop treating each of these events as inevitable.


About justgngr

the ramblings of a medical professional by day, judgmental ginger by night
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