May 13, 2013By Lance Baily

What Healthcare Simulation Can Learn from The Nuclear Power Industry

Continuing to showcase learning from other industries that have already fully adopted simulation, today we are sharing a link to a report recently published by the Advancing Safety in Medical Technology (AAMI) group entitled “Risk and Reliability in Healthcare and Nuclear Power: Learning from Each Other“. This monograph covers a 2-day event which brought together nuclear and healthcare industry representatives in July of 2012. This 120-page PDF, free for members, features eight chapters written by respected industry experts, who examine the similarities and differences between the fields in four topic areas:

  • Dependability of safety-critical software
  • Diagnostic and prognostic technologies
  • Human factors
  • Event analysis and corrective action

The AAMI website explains:

While nuclear power and healthcare might not appear to be complementary industries, they both are “complex, tightly coupled, high-hazard sociotechnical systems that serve a public good.” Furthermore, they both “rely on highly trained and skilled professionals working in interdisciplinary teams,” the publication read.

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In terms of regulatory oversight and organizational structure, however, there are a number of differences, as detailed by David Gaba, MD, professor of anesthesia and associate dean for Immersive and Simulation-based Learning at the Stanford School of Medicine, in a chapter titled “Thorniest Issues in Healthcare.” There are about 100 nuclear power reactors owned by 30 to 40 firms in the United States, and they face intense scrutiny by the U.S. Nuclear Regulatory Commission, particularly since the 1979 incident at Three Mile Island. By contrast, there are 4,000–6,000 hospitals, owned by 1,000–2,000 firms, as well as a large number of standalone surgical centers and physician’s offices. Unlike the nuclear power industry, healthcare lacks a single regulatory entity; oversight is spread across state and federal bodies.

“It is true that healthcare cannot strive for the same level of standardization within a facility, or especially between facilities having the same basic technology, as is achieved in nuclear power or the aviation industry,” Gaba wrote. “However, as for many things in healthcare, the pendulum is currently too far to the side of insufficient standardization.”

A recent copy of Inside Stanford Medicine includes a Q&A with David Gaba, MD, ‘Godfather of Simulation’ and professor of anesthesia and the associate dean for immersive and simulation-based learning at the School of Medicine, discussing his participation in this meeting from last year and what health-care providers can learn from the nuclear industry.  Gaba suggests:

“One big one is the need for standard operating procedures, where possible, which also retain flexibility as needed. A major spinoff of this principle, used extensively in nuclear power, is to provide graphically enhanced written protocols for emergency situations. It is long recognized that nuclear power operators cannot remember everything they need to know in managing an adverse event in a nuclear plant — memory is too fallible. Thus, the use of written procedures is a mainstay in this setting. Health care has long depended largely on the individual skill and memory of physicians and nurses. Protocols and checklists or emergency manuals were decried as cheat sheets or cribs. We now know that the best people use these kinds of supports — not because they are stupid but because that is the best way to get the best results in tough situations. My lab and other colleagues at Stanford have been working for some time on written cognitive aids and emergency manuals for anesthesia professionals. These have now been disseminated to all the anesthetizing locations in Stanford’s hospitals and those of its close affiliates. This lesson has clearly come from the nuclear industry and from others such as aviation.

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Another lesson from the nuclear industry is the importance of the safety culture in an organization. When the organization favors throughput so heavily that people cut corners on safety, or when personnel are afraid to speak up when they see something unsafe, the risk climbs.”

Read the rest of the Stanford Q&A with Dr. Gaba, and the AAMI Publication Highlighting Similarities, Differences In Healthcare and Nuclear Industries.

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