Lessons in safety from another industry

By Dr Andrew Dayani

Force Medical Advisor, West Yorkshire Police

The pandemic has brought enormous changes, perhaps most noticeably to the commercial aviation industry.   From is origins as a low volume, expensive and high-risk means of transportation, it has developed into a world-shrinking, global enterprise with incredible safety records. The result is that travel has become cheap. The consequences for the environment are perhaps a subject for another day.

The aviation industry has provided many excellent leads which medicine has followed. Crash data analysis led to engineering, design and materials changes which improved the hardware and mechanics of flying. But what was of most interest to us as doctors was the variability of human processes, in particular how psychology and culture affected outcomes. We have introduced checklists, familiarity with ‘human factors’ training and we are removing some of the hierarchical control to allow errors to be pointed out (allegedly) without recrimination. There is still progress to be made.

We have also adopted the notion of currency. It is not sufficient to have trained as a pilot, or indeed a doctor. In aviation, it is expected that you maintain and update your skills and are periodically tested to ensure you achieve safe practice. In medicine, we have adopted the system of appraisal and revalidation, with more flexibility and an emphasis on reflective learning, but the same recognition that medical knowledge has an expiry date. Provision of evidence over a cycle is sufficient to revalidate and maintain a licence to practice.

Of course, the aviation industry has had some recent headline-grabbing failures of regulation. The 737 Max, as it was once known (and since rebranded) is a cursory tale. The rapid modification of a successful model to bring it to market was driven by purchaser requests for higher seat numbers with greater fuel-efficiency. For the regulator to clear the aircraft initially and subsequently not ground the model after the first crash in 2018, is a shocking failure.

At the start of the pandemic, our regulator requested doctors on the medical register who had retired, to be reinstated, unless they objected. It is commonly estimated that a cycle of medical knowledge is four to five years. My father, 16 years post-retirement, received such a letter. That is three to four cycles behind. I understand the sense of urgency which the pandemic brought; however, we have introduced safety systems through appraisal and revalidation to safeguard the public, so suspending these in March this year ‘until further notice’ was a cause for concern.

NHSE/I have since announced that it will restart appraisals in view of workload issues in primary care and the new focus on how doctors maintain their own health and wellbeing, and any support they might need. This is good news. The pandemic has brought many casualties. Good governance and support within our profession must not be another.