Defense, aviation processes could improve healthcare

Users tend to view new technology as foreign and contrary to established habits and associations, said Robert J. Szczerba, PhD, director of Lockheed Martin’s global healthcare initiatives. So, the underlying cultural environment must change and accept new technologies for those technologies to successfully improve healthcare. Szczerba spoke during a Nov. 20 webinar presented by the Institute for Health Technology Transformation.

As the parent of a special needs child, Szczerba’s experience with healthcare made him realize that the system is not optimized and that the adoption of several processes from the aerospace and defense industries could dramatically improve healthcare.

Aviation checklists came into popular use in the 1930s, said Szczerba. Prior to that, aircraft were fundamentally unsafe. Unfortunately, healthcare’s use of checklists is about 70 years behind aviation. The best explanation for the delay, Szczerba said, is that a pilot has a personal stake in the use of a checklist since he or she would go down with the plane and its passengers.

Simulation is another tool healthcare can borrow from aviation and defense. In aviation, simulation is software-based, while medicine’s simulation is mannequin-based. That results in extremely limited amount and quality of training, he said. Plus, it helps train people for only certain conditions and certain problems.

“In many critical areas, healthcare significantly lags behind other industries,” Szczerba said. For example, healthcare is in the data collection phase of decision support while defense and aerospace have moved from that to information processing. Once data are collected, users can fuse it to determine what’s usable, he said. Data collection is “the first of a necessary sequence of steps that has to happen before you get to intelligent information processing.”

The multiple information systems, monitors and other equipment used in healthcare all need to talk to each other but they don’t, he said. That increases the chances for mistakes. “In defense and aerospace, everything is integrated together and tested in an integrated manner.” That’s one reason the number of plane crashes has decreased but patient safety has not improved.

The medical industry assumes clinicians will perform perfectly since a human life is at stake but the engineering world, for example, “assumes people are flawed and are going to make errors.” Therefore, there are safeguards in place to catch errors as quickly as possible.

Another difference between healthcare and many other industries is how mistakes are handled. When there is a plane crash, the National Transportation Safety Board brings in a wide range of experts in a fairly public investigation. The problem is identified, explained to others and opportunities to improve are addressed. With a medical error, a group of peers convene, “more looking for someone to blame,” Szczerba said. If aerospace solved problems the same way as doctors, “they would just bring in pilots” rather than including meteorological experts, engineers and more. “People who don’t have a stake in outcome are desired.”

Healthcare is starting to use virtual clinical environments (VCEs) in which avatars are controlled by individuals or by intelligent algorithms for realistic modeling of clinical environments. If a child can learn to pilot a jet by playing a video game, why must a nurse make do with a 150-page manual to learn how to use a new pump, Szczerba asked. VCEs allow exploration of “what if” scenarios in a low-risk, low-cost environment.

Hospitals should be using the same processes that were used to design and build the structures to maximize department workflow efficiency. Executive dashboards should tell the state of the hospital at any time. “By using these simulation and modeling tools throughout the entire lifecycle of a healthcare organization, healthcare can save so much on efficiency and costs,” he said. “Right now, each process is severely siloed.”

Technology improvements without cultural change can have limited impact, Szczerba pointed out. He cited a study in which 58 percent of clinicians said they felt unsafe to speak up about a problem they observed or were unable to get others to listen. How do you introduce new technologies and capabilities into a system where there’s a culture of fear, he asked.

He provided an example in which a nurse observes a doctor make an error in the operating room. “No new technology to alert the nurse of the error is going to change that,” he said. Perhaps an automated system scans the environment and can detect when a surgeon makes an error and records and documents it in the EHR. “The nurse could be viewed as a hero if she alerts someone before the system can. She can go from tattletale to hero. This is a contrived, simplistic example but there are ways that technological improvements can bring about cultural change.”

Whether or not some of these processes from other industries will be put to use to improve healthcare, the current trends are unsustainable, Szczerba said. “The adoption of existing technologies and best practices from other industries can reduce costs, improve quality of care and patient safety.”