In the early morning darkness of August 27, 2006, a Comair flight crashed when it attempted to take off from the wrong runway in Lexington, Kentucky. All but one of the 50 people on board died.
The flight was cleared for takeoff on Runway 22, a well lighted, 7000 foot runway. But, it departed from Runway 26, a narrow, dimly lit, 3500 foot runway. The diminutive appearance of the runway was not completely unnoticed by the crew. At the midpoint of the takeoff roll, the copilot stated, "That is weird, with no lights," to which the pilot responded, "Yeah." The comments were apparently related to the absence of lighting on what they believed was the second half of the runway. Despite the visual cues, the take off was not aborted; the jet hit an embankment at the end of the runway; and, it crashed. Although both pilots had been trained in the airline's Crew Resource Management ("CRM") program, the NTSB determined that the accident was caused by pilot error.
Despite the high profile tragedy, many proponents of the patient safety movement continue to assert that the medical profession should emulate the airlines, and that medical errors can be reduced if we incorporate CRM into the practice of medicine. As a physician and instrument rated pilot, I believe that using CRM to address medical errors is simply a gimmick.
Although patients from all over the world regularly seek medical care in our country, it is politically popular to argue that the American healthcare system is suffering from an "epidemic of errors." The infamous Institute of Medicine report, suggesting that as many as 100,000 patients die each year as a result of our mistakes, is now quoted as fact, despite being based on non-reproducible, crude extrapolations and twenty year old data. But, regardless of the actual numbers, suffice it to say that medical errors are a problem that is worthy of our attention. However, we will never arrive at a satisfactory solution unless we employ the same scientific process that is used with any "epidemic." Specifically, the nature of the problem must be identified and understood; contributing factors isolated; interventions studied; and finally, solutions enacted.
Unfortunately, our understanding of medical errors is still very early in the scientific process, and we do not have a good grasp on either the problem or its solution. But, with so many people allegedly being "killed" by our errors, there is no time for science. We are being pushed to immediately enact a solution, which unfortunately, we do not yet have. So, in the frantic rush to stop the epidemic, we are urged to adopt a solution from another industry.
Crew Resource Management training originated from NASA research showing that the primary cause of aviation accidents was human error, and that the main problems were failures of communication, leadership and decision-making (the root causes of all human errors). In response, team training programs, which emphasized communication and group problem-solving, were implemented. But, despite the fact that CRM programs have been in use for more than 25 years, they have never been shown to reduce the rate of human errors or accidents. In fact, an extensive U.S. Navy study showed that CRM training had no effect on mishap rates. (1)
Although CRM has been proven to be ineffective at reducing errors in the industry for which it was developed, we spend millions of dollars applying it to a medical error problem that we do not even adequately understand. From a scientific perspective, this is completely unacceptable.
Why then do we waste our time and money on CRM? The answer is that airplanes are cool. If the Philadelphia Sanitation Department developed a CRM program, we would be unlikely to adopt it, even if it had been proven to reduce errors, eliminate accidents and save lives. After all, it would be ridiculous to suggest that the practice of medicine has anything in common with a garbage truck. But landing a fighter plane on an aircraft carrier? Now that is something to which we can all relate (sort of).
Although we have the best healthcare system in the world, human errors will exist any time humans are present. As a profession, we are obligated to address our shortcomings. And, as scholars we must approach the problem in a scientific manner. Unfortunately, our understanding of medical errors is still in its formative stages and a considerable amount of work is yet to be done. In the interim, we should avoid wasting our resources on interventions that have been proven to be ineffective.
1. Wiegmann DA, Shappell SA. Human error and crew resource management failures in Naval aviation mishaps: a review of U.S. Naval Safety Center data, 1990-96. Aviat Space Environ Med 1999; 70:1147-51. 
