For the last several weeks, I have been watching the haphazard response to the appearance of Ebola in the U.S. through the eyes of a professional pilot. With limited federal control over matters related to public health, elected officials around the country are rushing to enact emergency measures to prevent Ebola’s spread, resulting in major disagreements about how best to do that. We saw the limits of that approach in New Jersey, and then in Maine, when the first person subjected to forced isolation called her treatment “inhumane” and defied quarantine orders, setting off a debate among public health experts, civil liberties groups and even the White House.
I have devoted my entire professional life to the pursuit of the safety of the public. Aviation and medicine are both high-stakes endeavors with little margin for error. All complex systems are different, but they all abide by similar rules and need a coordinated system of protocols and uniformity to bring into play under situations that can be very different. Over many decades, aviation has developed a systems approach to manage the complexity and interrelatedness of an endeavor that involves inherent risk, and an effective culture of safety that can, in substantive ways, be transferred to medicine.
When an accident occurs in aviation – often resulting in mass casualties and widespread media attention – the National Transportation Safety Board (NTSB) immediately conducts a thorough investigation into the accident or incident as the U.S. body responsible for recommending systemic changes and making sure that the right lessons are drawn and disseminated widely to all in the industry. In medicine there are too many entities that have a hand in quality and safety and whose efforts are not effectively coordinated. The Centers for Disease Control and Prevention (CDC) lacks the high degree of regulatory authority of an agency like the Federal Aviation Administration (FAA), so there is no single domestic agency that oversees all of medicine and promotes and mandates agreed upon best practices uniformly. And Ebola aside, in medicine, accidents and incidents tend to occur singly, largely without getting much attention.
Without a systems approach, medicine is fragmented. Without sufficient widespread implementation of best practices and effective training, medical personnel and government leaders are forced to scramble, making critical decisions and developing protocols in real time to respond to an evolving crisis. With states and hospitals left to their own devices, no one consistent policy emerges, causing gaps in execution. The result, as we have seen, can lead to chaos and confusion among medical professionals and a loss of confidence by the public.
In aviation we also face complexity, ambiguity and situations we have never specifically trained for, but airline pilots train for the unknown. It is our job to anticipate potential issues and, when faced with the unexpected, to adapt, and to respond calmly, quickly and effectively. The ability to make split-second decisions becomes infinitely easier when the effective protocols, training, equipment and human team skills are already in place as part of the robust and resilient safety system and culture in which we operate. Every day pilots and flight attendants face new situations for the first time at 35,000 feet, but they perform successfully because they know how to execute after years of preparedness training. They’re not trying to use duct tape to solve the problem.
Medical professionals are as dedicated as any. They grapple with imperfect information, highly complex systems and ambiguities that far outweigh those of a Boeing 747. But that’s all the more reason to create a culture of consistent application of best practices and effective communication. In order to establish and maintain public confidence, officials have to handle uncertainty well, acknowledge the limits of their knowledge and have the courage to level with people. Every time I made an announcement from the cockpit, whether it was about a delay or an in-flight emergency, I told my passengers everything that I knew and that I would keep them updated. That kind of transparency is the only way to maintain the public’s trust.
The aviation industry has made great strides in safety over the past 40 years by teaching critical skills some call “soft” skills, which are really human skills, giving crews the tools they need to take a team of experts and make them an expert team. In an overall systems approach, there are real incentives aligned with the public good, and we’ve found that a long-term approach to safety pays for itself by avoiding accidents and bad outcomes.
In medicine, there is so much uncoordinated individual effort on the part of thousands of entities, it is hard to align public health incentives and take the long-term approach. There were candidate Ebola vaccines ready to go to human trial almost 10 years ago. As we’ve learned in aviation, safety is cost-effective in the long term, and for that reason we have for decades used government-industry partnerships to do the hard work and proactively mitigate risks.
Adopting some of these practices may help avoid the systemic gaps we’ve seen over the last few weeks, resulting in better alternatives for those tasked with the heavy burden of managing the Ebola response – and for the public at large.
Sully Sullenberger is an expert in the fields of aviation and patient safety; he is an author, speaker and consultant, and serves as the CBS News Aviation and Safety Expert. He is also the founder and chief executive officer of Safety Reliability Methods, Inc., a company dedicated to management, safety, performance and reliability consulting.
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