Zeljko Ferencic‚MD
Zeljko Ferencic‚MD

For now, all I can do is putting my nose close to the airport window waiting for boarding and looking at the pilots in their cockpit preparing for the flight. When I was a young doctor serving in the navy I had an opportunity to sit in a cockpit of an An-12 (Antonov) transporter, being fascinated with the instruments in the cockpit. The second time I had a similar opportunity was a flight from Denver to Santa Fe in a probably the smallest liner I had ever flown. (I had the seat number 1A, sitting behind the pilot looking over his shoulders at the cockpit instruments – it was a night flight, the instruments in the cockpit were lighted as a Christmas tree).

There are many opportunities for safety measures and concepts in high-risk industries such as aviation to be considered for adoption in healthcare, with a need for actions to be proactive and generative, rather than solely reactive to adverse events. Comparisons have often been made between safety management in aviation and healthcare. As my fascination with planes is still alive, and working as a surveyor for AACI (https://aacihealthcare.com/), recently I read an interesting article where a journalist was allowed to enter and inspect the Boeing B-777 cockpit simulator. What he was explained, I found interesting and comparative with the AACI standard for hospital accreditation (https://aacihealthcare.com/services/accreditation/). Hospital accreditation is an internationally recognized evaluation process used to assess and improve the quality, efficiency, and effectiveness of healthcare organizations. Simply put, accreditation is based on the premise that adherence to evidence-based standards will produce higher quality health care services in an increasingly safe environment. Usually, the nonconformities found during the accreditation survey are graded as: critical, major, minor and opportunities for improvement.  So, what this has to do with a plane cockpit?

The highest in the hierarchy of alerts that pilot may see in the B-777 cockpit are red lights, red text message, voice warning and activation of the “stick shaker,” meaning that the steering wheel vibrates violently, meaning “The plane is going to fall out of the sky if you don’t do anything.” What does the AACI standard say comparing to this situation?

“Critical nonconformity is interpreted as a situation in which the health and safety of individual(s) are at risk. A situation in which the healthcare provider’s noncompliance with one or more requirements of the AACI standard has caused, or is likely to cause, serious injury, harm, impairment, or death to an individual.”

Further down in the hierarchy in the B-777 cockpit are “warnings” that require immediate pilot awareness and rapid action, although they may not threaten the flight path. The conventions for warnings are red lights, text and a voice alarm, but no stick shaker.

This situation compares with the hospital accreditation major nonconformity when “there is either an absence of one or more required system elements or a situation which raises significant doubt that the services will meet specified requirements”.

Back to the cockpit, the next level down is a “caution,” and there are about 150 such situations. Cautions require immediate pilot awareness but may not require instant action. With cautions, the lights and text are ambers, and there is only one alert modality, usually visual. In the hospital situation, nonconformity will be categorized as a minor “when the healthcare organization has a lapse of either discipline or control during the implementation of system/procedural requirements, which does not indicate a system breakdown or raise doubt that services will meet requirements. Overall system requirement is defined, implemented and effective”.

The final level in the B-777 cockpit is an “advisory.” Advisories trigger an amber text message — now indented — on the cockpit screen, and no warning light, which equals to the opportunity for improvement in the hospital accreditation standard.

I think expert observers/accreditation surveyors in the cockpit/hospital/ during normal flights can detect safety threats on time, reducing the number of searching for the black box after the plane had crashed.

So, fasten your seatbelts, have a pleasant flight, and thank you for flying AACI.