Table 1

Contrasts between aviation and healthcare

Aviation examples29Healthcare examples30
Equipment designA cockpit is designed to minimise perceptual and control errors,31 security systems have been developed to reduce operator fatigue and boredom and enhance training opportunities32Equipment predisposes to control33 and perceptual errors,34 often poorly maintained, with significant gaps in engineering for safety35
Task designDesign based on a thorough understanding of what is needed to get an aircraft safely from A to B36Lack of standardisation,37 professional autonomy, differences between practice settings, and differing prioritisations of competing goals gave rise to widespread variation in individual behaviours and institutional protocols,38 making task definition a challenge
Communications and teamworkStructured communications are embedded within tasks that are well defined, trained and practiced39Safety communications40 and tasks41are highly variable and tasks can be intermittently performed41
Selection and trainingSpecific scientific approach,42 including simulation and recurrent training30Training follows the apprentice model, with little attention to rigorously establishing which skills are essential or even for evaluating the degree to which these skills have been successfully acquired43
Incident reporting systemsEncouraged reporting behaviours.44 ‘Black box’ flight recorders allow the detailed independent reconstruction of accidents45Usually ineffective,46 with reconstruction of incidents rarely possible,47 and ‘black boxes’ culturally difficult to employ.48 Only the most tragic of events are investigated independently49