Table 4 Complexity of healthcare. The complexity issues when comparing safety between healthcare and aviation

The environment

The airplane structure varies only slightly between models—mostly this is about size.

The cockpit is separate and distinct from the main part of the plane accessed by the public. In large airplanes, there is a separate staff area.

Healthcare delivery takes place in the community and in hospitals. In the community primary/family medicine is available in health centres. Hospitals consist of outpatient clinics, wards, high dependency/intensive care units, emergency care and specific care sites such as maternity. Clinical units for procedures and theatres for operations; these areas have pre- and post-assessment zones. There are specific staff areas/rooms.

The workforce

The main workforce on the airplane includes the captain and his deputies from one to a possible 4 others and cabin crew from one to a maximum of 27. There is also the ground staff at airports who welcome passengers and those who supply and support the mechanics of the airplane and equipment and resources for passengers.

The healthcare systems globally employ a vast range of staff. Trained healthcare professional includes doctors, nurses, pharmacists and allied health professions in a range of different positions of responsibility. These professional practitioners work with a plethora of support workers from receptionist to administrators, scientists and many others. Health care involves social care, policing, housing and other external support public organisations including the voluntary sector, families and/or carers.

Working timeframes

Air transport offers travel from place A to place B. This line of flight never varies, unless in an emergency, although each route is different and each airport. The line is always the direction of travel. The main risks are take-off and landing but can include incidents during or before and immediately after flight.

In healthcare, patients may have similar conditions but there is never a clear pathway or journey of care for any one individual as everyone is different. No two people are the same and no two families/carers. The possibilities are endless for involvement of different practitioners and support staff.

Policy

Set and adhered to and overseen by a few international or national governing bodies including International Civil Aviation Organisation (ICAO), European Authority in Safety Aviation (EASA) and the UK Civil Aviation Authority (UKCAA).

Each country operates different healthcare systems some in the public domain (the NHS in the UK—small private sector) some mainly private (USA) and others are a mix of public and private. Policies vary between systems and within systems. In some systems, each hospital or unit runs its own policies, which remain local to them.