CRM, he said, changed a culture in aviation much like the change that is needed in medicine. “Thirty plus years ago, before CRM, captains could be alternately Gods or cowboys, ruling their cockpits by preference or whim with insufficient consideration of best practices or procedural standardization.
“And first offers trying to do the right thing would never quite know what to expect. Some captains didn’t bother with checklists,” and it was unclear whose responsibility it was to extend or retract flaps or landing gear.
He said that although air disasters are mass accidents shown with ghastly footage on CNN, they are relatively rare.
“But medical mishaps, on the other hand, happen one by one. But as every one in this room knows, all too well, the mortality in America’s hospitals from accidents and hospital acquired infections is nearly 200,000 people per year in the U.S., or 548 lives a day, the equivalent of two large passenger jets crashing daily with no survivors.”
If that happened in aviation, he said, “the airline industry would come to a screeching halt; airplanes would be grounded and airports shut down. There would be Congressional inquiries and companies would go out of business.”
He listed numerous improvements to airline safety that have reduced accidental death in an aircraft from one in two million between 1967 to 1976 to one in 10 million today.
But improvement still eludes acceptance among the healthcare profession, he continued. A recent federal study said 48,000 people die a year in U.S. hospitals just from pneumonia and blood borne infections, many of which are preventable. That, he said, “shows that prevention has failed to become part of the (medical) culture.” Checklists are important in medicine, he said. “But I know many of you have been a surprised, as I have been, by the resistance of some physicians in adopting the use of checklists. (They) believe that relying too heavily on checklists will turn them into procedural robots or they equate it to cookbook medicine, but that is simply not true.”