In a stirring presidential address, outgoing ASCRS President Dr. Michael J. Stamos drew an analogy to the aviation industry, as he challenged the Society not to rest on its laurels as leaders in quality and safety, but “be engaged as active participants” in continuing to change the health care system for the better.
“Consider how many lives are lost each year due to medical errors…It’s certainly not as low as the number of airline fatalities which are at an all-time low over the past 10 years. We can and must do better. The real issue is that our hospitals have not been held to task for safety,” Dr. Stamos said.
Like surgery, the aviation industry has four main players—the airlines themselves, the pilots/crew, the passengers, and the government, according to Dr. Stamos. Surgery has the hospitals/ambulatory care centers, the surgeons/team, the patients, and the government/other payers.
Flight safety improved markedly during the middle of the last century, after a series of mostly mechanical improvements and the introduction of the jet airplane. A similar evolution of technology improved safety in operating rooms. However, there were important differences between the two fields.
“Simulation, begun in the 1950s, has been richly developed in the aviation industry. We similarly need to embrace it. Why has it not happened in surgery? Simple, no mandate and no deep pockets. This is an area that we can have influence…as we push for this to be mandated, at least in training programs, and for hospitals to pay for it (government is not going to!),” he told his Annual Meeting audience.
The players in the aviation industry have worked together to share concerns through voluntary programs. “These reports are reviewed by a committee made up of pilots, airline reps, and the FAA (Federal Aviation Administration). This has spawned an attitude that allows errors and hazards to be identified before accidents occur. These ‘Non-Jeopardy’ reporting programs have become ingrained in their culture, while the culture in many/most medical centers is to ‘cover’ for each other (Team/bunker mentality), and incident reports are often perceived as punitive rather than constructive,” Dr. Stamos said.
“In the airline industry, near misses are an area of intense concern, but until very recently they barely got noticed in medicine…with comments like ‘better lucky than good’ being commonplace,” he said. “The Flight Operations Quality Assurance system …automatically captures these outlier events, and they can be analyzed for significance. These are the real main efforts that have made the safety of U.S. airlines what it is today, the use of these processes and that of failure analysis…akin to a root cause analysis.”
The title of the address, “No time to rest,” he explained “is meant to reflect on how far we have come as a society and specialty, but to realize that with the current environment we indeed cannot rest on our laurels.” The title could also be “a metaphor for my presidential year,” he added, as he sought to balance the demands of a “formidable” job with the help of family, colleagues, associates, and many others he took time to thank.
Dr. Stamos had some harsh words for the Affordable Care Act (ACA), but went on to say, “There are certainly things to dislike about the ACA, [but] make no mistake, the efforts to emphasize and incentivize quality embedded in the ACA is LONG overdue, and we need to embrace it as we have for the past 115 years! Our Society has always embodied the notion of improving the care of our patients regardless of our own economic stake…”
“Obviously, the current situation is non-sustainable…a family of four now spends more on health care annually than they do on groceries…This is a huge problem for much of America…and it certainly is impacting our overall economy,” he said.
“In these tumultuous times, our litmus test should be a simple one…is this good for the patient? Not ’is it good for me’? This is not new for us, as our Society has long been at the forefront of quality and safety efforts.”
“The aviation industry had multiple problems and through a process of identification, ownership and collaboration, they have made measureable progress. We need to learn from their mistakes as well as their successes, and adopt our own philosophy of identification, ownership, and collaboration. The Affordable Care Act will expose all of our outcomes and safety records and will and should make each of us look inside and decide what and where our scope of practice is…and redefine it based on our strengths and training and NOT on any economic pressures.”
He concluded: “We have much to be proud of. However, there’s much more to do and no time to rest on our laurels.”