Understanding Health Care's Safety Culture Transformation: A Phenomenological Study of Error Mitigation through Aviation Teamwork

Safety culture transformation in the United States health care system is a strategic imperative to mitigate medical errors. In a breakthrough Institute of Medicine study published in 1999, researchers suggested healthcare improvements, in part, could be achieved through adaptation of aviation-based safety methods. The specific problem under exploration was a lack of understanding regarding learning and application of aviation teamwork methods in health care settings to mitigate root causes of errors. Fieldwork included semi-structured interviews with 10 purposively selected respondents from Northern California health care organizations using two core research questions. Q1: How do health care personnel describe their experiences with learning aviation teamwork methods? Learning aspects of health care teamwork include implicit learning styles and real-time learning for relevance; however, pedagogy lacks deliberate focus, leading to management and staff frustration. Q2: How do health care personnel describe their experiences applying aviation teamwork methods in health care settings to mitigate root causes of medical errors? Disclosure initiatives yield transparency and foster community accountability; however, lingering traditions of autonomy and hierarchy influence ego-driven behavior, presenting opportunities for medical errors. The researcher executed interpretive phenomenology to discern a Heideggerian essence of Befindlichkeit in three emergent themes: transformation, marked by struggle, conflict and division across disciplines and communities moving toward an outlook of hope, improvement and safety; teamwork, an essence of expert groups working together in a committed sense of trust and community with effectiveness and cohesion; and leadership, lean practice to optimize productivity and enhance the financial bottom line, but marked by perplexity, frustration and busyness to maintain staff alignment. Health care professionals desire to learn and apply innovative teamwork for error mitigation, but community research perspectives remain divided between anecdote and evidence. Academia must emphasize transforming health care delivery, similar to study of disease and biology in medical schools and pharmacological and therapy research in laboratories. Aviation and health care should recognize influences of generational differences; inherent lessons may transcend across communities in a hermeneutical spiral of shared understanding. Increased study of health care's transformational framework will lead to more patient-centered care, thereby saving lives, decreasing injuries and reducing costs.