No commercial airline pilot would ever take off without completing the routine pre-flight checklist, even though he may run through the same checklist hundreds of times. The preflight checklist is considered fundamental to airline safety, preventing the type of momentary mental lapse that could prove deadly once the plane were airborne. For quite some time, many professionals studying medical errors, especially in the operating room, have been advocating a safety model based on the airlines’ experience.

Under the airline model, the surgeon could not begin to cut until after the prescribed checklist had been completed and all items successfully checked off. It is not difficult to imagine how such a checklist might avoid the not-as-rare-as-one-might-think, wrong-site surgery. One of the items on any pre-surgical checklist would certainly be to be sure that the site of the patient to be operated on squares with the patient’s medical records. A routinized checklist would also seem to be a powerful tool in preventing miscommunication between key members of the operating team, such as, for example, the surgeon and the anesthesiologist.

No checklist, however detailed and well-conceived, will achieve its purpose unless it is used every time, no questions asked, without exception. While that has long been the culture, embodied in FAA regulations, in the airline industry, resistance may be expected within the medical profession. Old habits are dropped reluctantly and it may be difficult to convince a veteran surgeon, that he must ask himself every single time before he operates, if he is sure he is operating on the correct site, sure that he has the right patient, knows the surgery he is about to perform, and is in agreement with the anesthesiologist about the type of anesthesia to be administered or that has been given.

While there is a good deal of enthusiasm amongst medical professionals studying error prevention, some believe that the airline model has only limited application to medicine – though even these critics see the benefit of routine checklists in the operating room. For example, Eric J. Thomas, MD, MPH, writes in the journal of the Agency for Healthcare Research and Quality that some of the similarities between the airline industry and medical profession are superficial and that more study is needed before the airline model is adopted throughout the medical profession. There can be little doubt, however, that the hospital industry and health care professionals have a long way to go toward reducing medical errors – with errors and omissions of communication being amongst the most serious. The airline industry has many good lessons to offer.