Comparing the Healthcare and Airline Industries

An analogy whose time has passed. A Sensible Medicine guest post.

We had planned this trip for months. A fortuitous change in my clinical schedule gave me more than a week off. I wanted to take advantage and go somewhere special with the family: Hawaii.

After a long stretch of clinical shifts, the day finally arrived. We all loaded ourselves and our luggage into the SUV that was taking us to the airport. On the way, I got a text: "Your flight has been cancelled."

Frantic, I searched for other flights. None could be found. In fact, none were available for days. My heart sank with the realization that my long-planned vacation might also be cancelled. I decided to still go to the airport, hoping we could figure something out. It was nothing short of a miracle that got us to Hawaii that day, albeit several hours late.

"Why was the flight cancelled?" I asked at the airport. "Bad weather," was the reply.

The healthcare field has often been compared to the airline industry, especially with respect to safety measures and protocols. Air travel is one of the safest modes of transportation. To some extent, this is because airlines do not sacrifice safety for the sake of customer satisfaction. If it is not safe to fly, the airline will not fly the plane, period; customer satisfaction be damned.

Indeed, I have written in the past that we in the healthcare field should take some lessons from the airline industry. We should not bypass patient safety protocols for the sake of "clinician well-being" or "patient satisfaction." Indeed, partly inspired by the safety checklists followed by airplane pilots, Dr. Atul Gawande encourages checklists prior to surgical procedures.

And yet, there is a huge caveat, and it is one I discussed with Dr. Adam Cifu during a recent conversation on the Healthcare Musings podcast:

"I heard someone once who...[said] 'you're flying the same plane, to the same airport, and conditions change a little bit...to compare that to medicine, we randomly change the plane every time, we move around the airport constantly, we also change the conditions.'"

Exactly right. Healthcare is not like commercial aviation. Planes are not human beings with different genetics, different manifestations of disease, and different physiologic processes. What's more, with a commercial flight, if there is any deviation from the routine, any change in the circumstances of the flight, then the airline simply cancels the flight, often without warning. We cannot do that in healthcare.

If a patient presents to our hospital with a chief complaint of chest pain and then decompensates — for reasons unknown — I can't tell the patient, "Wait, you are not following the rules. Please go home and come back tomorrow when your chest pain starts to radiate down your left arm."

I once saw a patient admitted to the hospital for "pneumonia". I was asked to see her in consultation. When I evaluated her, she was in respiratory distress. I ordered a CT chest, which did not look typical for pneumonia. I recommended to the primary physician that we check a troponin level. The next phone call I received was from the Cardiologist, who told me she had been taken emergently to the cath lab where she was found to have severe, mitral regurgitation. Her "pneumonia" was actually an acute myocardial infarction. She had never experienced chest pain.

I couldn't "cancel" her hospital stay because she her MI was was challenging, atypical.

Of course we need to focus on safety processes in the hospital. There may well be things that we can learn from other industries. We should follow our processes and not bypass safety checks for the sake of convenience. However, human beings are not airplanes; hospitals are not airports. There is only so far we can travel with this analogy.

Hesham A. Hassaballa, MD is a medical intensivist and an Associate Regional Medical Director at Sound Physicians. He has a podcast Healthcare Musings.