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A recent article in the Washington Post recounted how a fatal airline crash some years ago prompted fundamental changes in the airline industry. The black box tape revealed that the co-pilot had noticed something amiss, but that the pilot ignored his concerns, reflecting the military-style chain of command. In the modern airlines industry, any individual involved in the flight, from co-pilot to flight attendant to baggage loader, who notices something amiss, is encouraged to speak up and will not likely be ignored.

The notion of a team approach to communication and safety, has been adopted in the best hospitals, especially in the operating room where operating room miscommunication can result in disaster. Checklists are used to insure accuracy in such essential matters as identity of the patient, part of the body being operated on, anesthesia and other medications given, and any other information regarding the patient that might affect surgical decisions. Where once the surgeon was the undisputed leader and solely responsible for the surgery under the “captain of the ship doctrine,” now all members of the operating team are encouraged to speak up, and indeed, may be guilty of surgical negligence if they fail to do so. Habits, including bad ones, can take a long time to be abandoned. While the airline-style use of checklists and team notions are well-recognized and encouraged within the medical profession, the profession and the hospital industry have a long way to go in universal implementation.

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