Another Look at Aviation as a Healthcare Model

It has been popular to compare aviation’s safety record and procedures to similar processes in healthcare, usually with the notion that healthcare lags aviation in adopting a firm safety-oriented methodology (Carr, 2006; Pronovost et al., 2009; AHA, 2011). There can be considerable challenges when making such cross-discipline comparisons including staffing, training, mission scope, and perhaps personal risk. If these challenges are not adequately met, the lessons supposedly learned may not actually be transferable from one profession to another. Or worse, thinking that they are readily transferable may lead to a false sense of accomplishment when one or more safety “fixes” are implemented.

One aspect of the aviation-versus-healthcare comparison that has not received sufficient attention is a direct comparison of the task structures and responsibilities of pilots versus nurses. As shown in the table below, there are very substantial differences between the work and work environment of each. Further, these differences appear to be put nursing at a considerable disadvantage with respect to being able to consistently accomplish their work without identified adverse incidents. Thus the relative deficit in healthcare safety compared to aviation is likely a result of major staffing, system and work design issues that is not likely to be adequately addressed without significant effort and change. However this is not an excuse not to do it, rather it is a call for an level of effort that is commensurate with the risk.



Work is primarily stationery – at the controls

Work is mobile

Primarily a single task – although that task has multiple components

Multiple often relatively unrelated tasks

Dedicated assistant – the co-pilot

Informal assistance when called upon

Standardizes staffing levels – no exceptions

Variable staffing levels, including working even below local standards

Equipment in use configured and certified by a central integrator

Associated substantial system feedback to operator

Independent equipment from multiple vendors

Limited and non-integrated feedback

Tasks highly standardized

Variable tasks depending on patients and other duties

Highly trained and certified on specific equipment

Mandatory refresher and emergency training

Variable training – often on multiple versions of the same devices

Limited refresher and adverse event training

Mandatory near miss (close call) reporting


Haphazard reporting

Activity is partly under direct and continuous observation by third party (FAA)

No supervisor/third party observation

Pilot shares physical risk with passengers

Physical risk not shared

Clear outcome expectations – including by public

Possibly variable expected outcomes depending on patients, making it hard to identify untoward outcomes

Extensive external accident investigations

Primarily internal accident investigations – if at all

William Hyman is professor emeritus of biomedical engineering at Texas A&M University. He now lives in New York where he is adjunct professor of biomedical engineering at The Cooper Union. Hyman may be contacted at This email address is being protected from spambots. You need JavaScript enabled to view it. .


AHA Resource Center. (2011, April 11). Aviation and patient safety, American Hospital Association. Available at

Carr, S. (2006). The joy of cross-fertilization. Patient Safety & Quality Healthcare, 3(2). Available at

Pronovost, P. J., Goeschel, C. A., Olsen, K. L., et al. (2009). Reducing health care hazards: Lessons from the commercial aviation safety team. Health Affairs, 28, 479-489.


ABQAURP American Society for Quality American Society for Quality Healthcare Division Consumers Advancing Patient Safety
EMPSF Institute for Safe Medical Practices
Medically Induced Trauma Support Services (MITSS) Medication Safety Officers Society NPSF Partnership for Patient Safety Society to Improve Diagnosis in Medicine