Errors and Omissions: How Healthcare and Aviation Compare

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If there’s one common trait aviation and healthcare share, it’s the notion that both are expected to function without error. We expect pilots and the planes they fly to operate flawlessly, to get us safely to our intended destination. The same is true for physicians. We expect them to treat us accurately and effectively and get us up and moving again. Perhaps more importantly, we expect the participants in both industries to not kill us.

Aviation has done a superlative job over the past several decades or so of living up to that expectation. For example, in the United States from 2000 to 2010 there were about 0.2 deaths per 10 billion passenger-miles. In the years since then, the safety record is even better.

In contrast, a 2016 study in the number of deaths in the U.S. that were a result of medical error placed the yearly death rate at 251,454 deaths.

Healthcare continues to address the causes and preventative techniques that will reduce medical errors. But a group of researchers wanted to know—is there something to be learned by comparing aviation and healthcare? Specifically, they wanted to know how attitudes concerning error, stress and teamwork compared.

To help answer these questions, questionnaires were distributed to cockpit crew members from 40 different airlines and operating room personnel in urban teaching and non-teach hospitals in Italy, Germany, Switzerland, Israel and the United States. Four surveys were administrated, all of which measured attitudes towards stress, status hierarchies, leadership and interpersonal interaction issues.

Here’s a summary of the results.

Perceptions of Stress and Fatigue

Sixty percent of all medical respondents agreed with the statement – “Even when fatigued, I perform effectively during critical times.” Meanwhile, only 26% of all pilots agreed with the same statement.

Attitudes to Teamwork and Hierarchy

According to the results of the study, 70% of respondents did not agree that junior team members should not question the decisions made by senior team members. Consultant surgeons were least likely to advocate flat hierarchies. By contrast, 94% of cockpit team members advocated flat hierarchies.

Teamwork in Medicine

When it came to working with their colleagues in medicine, the research indicated that those individuals in surgery reported good teamwork with those in anesthesia, but anesthesia staff do not necessarily hold a reciprocal attitude. Similarly, although 77% of intensive care doctors reported high levels of teamwork with nurses, only 40% of nurses report high levels of teamwork with doctors.

Attitudes About Error and Safety

More than half of the medical respondents reported that they find it difficult to discuss mistakes. The reasons for not discussing mistakes included: personal reputation (76%), possible disciplinary actions by licensing boards (64%), threat to job security (63%), and expectations or egos of other team members (61% and 60%). The most common recommendation for improving patient safety in intensive care was to acquire more staff to handle workload, while the most common recommendation in the operating theatre was to improve communication.


According to researchers, aviation has made tremendous progress in developing a culture that deals effectively with error. On the other hand, in medicine “substantial pressures still exist to cover up mistakes, thereby overlooking opportunities for improvement.”

The researchers also said that medical staff play down the effects of stress and fatigue, while tired pilots acknowledge their own limitations to manage fatigue and have strategies to deal with it. They also say research in aviation has shown that individuals can be trained to recognize stress as an “error inducer” and continue to improve with recurrent training, which they say is typically non-punitive and proactive. Medicine, they say, doesn’t have comparable training.

 2000 Mar 18;320(7237):745-9. Error, stress, and teamwork in medicine and aviation: cross sectional surveys. Sexton JB1Thomas EJHelmreich RL.