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Contrasting healthcare with other safety-critical industries
The number of adverse events in healthcare far outnumber those in other safety-critical industries. Andia Toomari’s research compared safety-management processes in healthcare, nuclear energy, and aviation, revealing gaps in healthcare processes that could lead to serious harm for patients and healthcare workers.
Project Type
Master's Thesis
InCollaboration With
CSA Group
University of Toronto
University Health Network
Challenge
Aviation, nuclear energy, and healthcare can each be characterized as safety-critical industries. However, healthcare has a higher number of preventable serious adverse events in comparison to aviation and nuclear energy. In Canada alone, more than 138,000 acute care hospitalizations in 2014–2015 involved occurrences of harm.
A safety management system is a systematic approach to managing safety, including necessary organizational structures, accountabilities, policies, and procedures. In aviation and nuclear energy, there are explicit regulatory requirements to implement safety management systems and quality management systems at the organizational level. These industries have standardized processes to execute high-risk tasks and perform operations and have a high degree of reliability built into their systems. This is unmatched in healthcare delivery.
Although healthcare has attempted to learn from aviation and nuclear energy, there are still many safety practices and systems implemented in aviation and nuclear energy that healthcare hasn’t investigated or implemented.
Process
Discovery
For two years, Andia Toomari studied the state of safety management in healthcare by comparing it to other safety-critical industries. Her work revealed how the safety processes followed in the nuclear energy and aviation industries are not consistently implemented in healthcare, which could have serious implications for healthcare workers and patients.
Through a literature review and interviews with healthcare stakeholders and subject-matter experts, key themes were revealed as they relate to healthcare delivery:
- Lack of explicit safety management
- Lack of control processes to ensure uniform, consistent practice
- Lack of proactive risk assessment and mitigation effectiveness verification
- Lack of fatigue management practices
- Lack of reliability of safety-critical tasks
The review of regulations, standards, and guidelines in aviation, nuclear energy, and healthcare service delivery showed that all three industries require the implementation of a quality management system (QMS). However, only aviation and nuclear energy have explicit requirements, stated in regulations and/or standards, for implementation of a safety management system (SMS).
These shortcomings in healthcare delivery could directly lead to adverse events and preventable harm to millions of patients and healthcare providers worldwide.
...many of the safety practices of aviation and nuclear energy for ensuring safety are largely unknown or unused in healthcare
Outcomes
The outcome of this study is a recommendation that a safety management standard needs to be developed and implemented for healthcare delivery in order to reduce the number of preventable injuries and death. Given the safety-critical nature of healthcare delivery and the lack of explicit safety management systems, the findings of this study make it clear that developing such a standard could address the noted safety deficiencies in the healthcare organizations and the regulation of practitioners. As in other safety-critical industries, there is no room for error in healthcare delivery.