01:00 AM EST on Sunday, February 13, 2005

KALAMAZOO, Mich.

THE HEALTH-CARE system is mired in a sea of distrust, fear and malpractice claims. But all is not lost; salvation can be found in an unlikely model -- the airline industry.

Surprisingly, the two operations are very similar: Health care, like aviation, depends heavily on human performance in time-pressured, technologically and sociologically complex environments.

The major difference is that the aviation industry's safety record is based on accurate, forthright and candid reporting of mishaps.

By contrast, health care sustains a culture and practice of secrecy, denial and cover-up, with no existing organized system of reporting.

The result is that errors, system weakness and adverse outcomes are likely to be ignored, denied or buried, and never get reported for deeper analysis, forcing each provider and patient to discover the problem over and over again. System quality and safety improvement cannot occur in such an environment.

However, there is hope. Congress is in the preliminary stages of passing two proposed bills, which take significant first steps toward encouraging medical reports. If enacted, these bills would allow providers to report errors in an open and truthful manner. The bills would also shelter certain safety-related information from "discovery" for use in malpractice cases.

The resulting system would rapidly accelerate the understanding of health-care results and lead to quality and safety enhancements like those in the aviation industry. It is essential that the public and its representatives understand the significance of these bills and the problems they would resolve.

All patients and potential patients stand to benefit from the processes this legislation would unleash.

Let's put this into perspective: We are currently safer in large aluminum tubes attached to tanks filled with thousands of gallons of kerosene than we are lying stationery in a hospital bed.

In 2000, the nonpartisan Institute of Medicine reported that almost 100,000 hospital patients die each year because of human error. Current figures indicate that actual deaths are at least double this amount. This would be the equivalent of 10 commercial jets' crashing and killing everyone aboard every day, 365 days a year.

But we don't have airplanes falling out of the sky, in part because the aviation industry devised a system to report errors. We wouldn't have nearly as many "human-error" deaths in hospitals if health-care providers were given the same system.

That's what these bills would provide, an open and secure forum for health-care providers to discuss mistakes and potential safety issues.

If health care is to use these bills to replicate airline aviation's enviable safety record, some elements of the aviation system can and must be emulated. The list should start with accurate, unedited, candid reporting of system performance and errors.

Reporting of aviation mishaps has been part of the airline industry from its inception.

This requirement has created a system wherein participants can report their own and "system" errors without expectation of punishment, compile these data, and disseminate the accumulated wisdom across the industry. Because of the system, aviation has learned much from studying accidents that occurred and those that might have happened but didn't. Through the NASA Aviation Safety Reporting System (ASRS), developed in the mid '70s as an airline reporting clearinghouse, more than 50,000 voluntary reports are received annually.

Substantive, visible changes in aviation operations that directly improve passenger safety were the result, making commercial aviation the safest means of travel. Aviation has built a tradition of safety that should be the envy of any profession that deals with life-and-death decisions.

Medicine has one of the world's oldest traditions -- one that includes the ancient dictum: "First, do no harm." It's time to give that ethical directive some teeth for the 21st Century by borrowing a system from one of the world's younger industries.

The process unleashed by the adoption of these two pieces of legislation would make all of us safer. Our children, our grandchildren and generations to come would look back on this era as the time when medicine was transformed as a profession.

It's time for take-off on the journey to a future of safe medical care.

William Rutherford, M.D., is a physician and was a United Airlines pilot, supervisor and executive for over 30 years. He is a professor at Western Michigan University's College of Aviation.