The leading commercial airlines have created a culture of safety that includes protecting the jobs and legal status of those who provide information about near misses and accidents. The aviation industry knows it cannot rely on perfect performance by individuals to ensure safety for passengers. Robust safety systems ensure that human and mechanical errors occur less often, and when they do, they are less likely to result in tragedy. The culture of medicine embraces the expectation of perfect performance. This is a dangerous assumption.
Medicine operates in a culture of blame, founded on malpractice and public accountability practices.
Finally, and perhaps most important, passenger safety has been the central issue for consumers, commercial aviation companies, and aviation-related policy and regulation. The public debate in health care has thus far focused on choice, access, and financing. We must change the way health care works for most Americans. High-performing multispecialty group practices enable physicians to share data, stay more current, monitor their quality, and provide more care continuity for patients. Well-organized, integrated care delivery systems bring together the structure, expertise, experience, services, support systems, and incentives required to improve safety and care outcomes.