Matching up to the airline industry

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The airline industry has provided a model and much of the impetus for the patient safety movement in health care, including the introduction of ‘safety alerts’. These are the subject of a paper in this issue of JAN (pp. 567–575). It reports a study that was undertaken in England by Lankshear and colleagues to evaluate whether effective action is being taken in the National Health Service (NHS) in response to safety alerts.

Up to the end of last year, 365 alerts had been issued in the UK by the Safety Alert Broadcast System (SABS) introduced in 2004 by the National Patient Safety Agency for the NHS (p. 568). Lankshear et al.’s paper focuses on three alerts, these pertaining to (1) latex allergy, (2) naso-gastric tube placement and (3) needle-free intravascular connectors.

Their study was large in scale. A total of 41 healthcare provider organizations in England took part, including 20 acute hospital units and 15 primary care services. A variety of data collection methods were employed, including taped interviews with senior managers, brief interviews with ward staff, observation of equipment and patient records, and scrutiny of policy documents.

Their findings, in short, were that safety alerts had been fairly widely disseminated but, on the whole, very poorly implemented. For example, with regard to latex allergy, all of the nurses surveyed were aware of the dangers for staff of latex-containing disposable gloves, but very few (19%) were aware that patients too may need to be protected from latex allergy. Neither did the nurses seem to know whether latex-free versions of common equipment, such as oxygen masks and syringes, were readily available (p. 570) when, in fact, over 70% of wards were found to have latex-free oxygen masks in stock. However, as the researchers also observed, the latex-free labelling of equipment was rarely obvious, often buried in the small print, or not provided at all (e.g. on bed mattress covers). Some of the staff simply worked under the reasonable assumption that ward equipment should be safe. While this would be a foolish assumption if held in blind faith, it seems to me a perfectly reasonable stance for individual ward staff to take. But Lankshear et al. do not take a sympathetic view, instead describing the nurses’ lack of awareness of the naso-gastric tube safety alert as ‘disappointing’ although they do add that ‘the profession is not alone in failing to grasp the opportunity to make patients safer’ (p. 573).

I do not believe, however, that primary responsibility for patient safety rests with the professions. Yes, of course, every healthcare professional must take personal responsibility for their every action in terms of patient safety. But does the airline industry rely on pilots and air stewards to keep abreast individually with every safety alert that is issued? And does it leave each crew to ensure that their plane is stocked with the latest safety devices? No, of course it does not. Frontline staff who are charged with keeping people safe, whether air travellers or patients, reasonably should expect that they are fully informed ‘from above’ about changes in practice that need be made as a result of each new safety alert. And they reasonably should expect to be provided with the systems, equipment, resources and training that are required in order to make– and maintain – these changes in practice.

Lankshear et al. conclude that the NHS has thus far failed to match the achievements of the airline industry (p. 574). We have learned from that industry how to recognize, report and analyse adverse events, and how to turn that knowledge into safety alerts. We now need to learn from the airline industry about how an organization leads and supports its staff to achieve the reliable and consistent implementation of practices that will keep patients safe.

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