Patients Aren’t Planes: Translating Human Factors Practices Across Industries

I've been fascinated by human factors for most of my life. As a teenager, I saw a PBS NOVA documentary called Why Planes Crash, which introduced the emerging field of human factors engineering – the study of how people interact with the systems around them. What intrigued me wasn't aviation itself, but the realization that highly skilled, highly trained people can still make catastrophic mistakes – not because they're careless or incompetent, but because the systems they're working in set them up to fail. Relying on technical expertise alone isn't enough in high-risk environments. 

Human Factors in Aviation

My first professional exposure to human factors came when I entered the aviation world: we lived by our checklists, standard operating procedures, crew resource management, simulation training, and standardized communication. Those tools are all rooted in human factors principles, but we didn’t necessarily think of them that way – they were just how we operated as professional pilots. It wasn't until I transitioned into healthcare that I started formally studying the field, and I realized there was an entire body of science and language behind what I had been doing in my flying career. 

Human factors isn't only about catastrophic failures. It encompasses the everyday decisions, assumptions, and interactions that reveal whether our systems were built to support humans when they inevitably fail. Commercial aviation depends on humans to successfully navigate innumerable systems, both small and large, and so has designed those systems to support their success. Risk factors like stress management, fatigue, automation, and challenging interpersonal dynamics were mitigated through standardized training, terminology, crew responsibilities, and checklists, which offered a structure to rely on to ensure a safe flight.

Pilots have such high confidence in the efficacy of these standard operating procedures because they’ve been developed and evolved over long periods of time, and are thoroughly reviewed and revised after all incidents. During my time as a pilot, a plane from a different airline took off on the wrong runway, resulting in an accident that killed all but one person onboard. Immediately following this event, all of our checklists were amended to include a runway verification step before takeoff – a step that had previously been implicit. This accident revealed the importance of making implicit safety practices explicit and required. 

Humility is Proficiency

What I appreciated about aviation was that I was never operating alone. In addition to the copilot, there’s an entire network of people who are supporting the flight behind the scenes. If weather became an issue, I could work with air traffic controllers to navigate around it. If we had a mechanical issue, we could get maintenance experts on the radio. If we had to divert the flight, our dispatch coordinated with the new airport to ensure our focus as pilots could remain entirely on flying the plane. We had access to an incredible depth of expertise across these countless teams and were encouraged to utilize them rather than trying to solve every problem ourselves. 

I think there’s an important leadership lesson in that. These high-performing teams are not made up of people who always have the right answers, but who know when to defer to the expertise of others. This takes a degree of humility. Humility doesn’t fit with the archetype of the daring pilot or brave surgeon, but it is one of the most underrated qualities in any safety-critical industry.

Patients Aren’t Planes

I know healthcare practitioners sometimes take issue with the ubiquity of the cockpit as the image to represent the human factors field, and the over-reliance on aviation to inform our human factors applications more broadly. There is a false assumption that if we simply bring aviation into healthcare, healthcare will naturally become safer.

Early in my healthcare career, I assumed that simply replicating the human factors practices I applied in aviation would seamlessly translate into healthcare settings. Many of the human factors are remarkably similar: fatigue, workload, communication, teamwork. We see them play out regardless of the industry, but while the principles can be applied across industries, we must adapt the practical application to suit our current setting. The value of cross-industry learning comes from translating the core principles, rather than copying the practices.

Aviation became safer because it spent decades studying how human beings perform under pressure and then designing systems that support them, not because it merely began adopting checklists or simulators. Healthcare has the same opportunity, but the solutions must fit the realities of the field. 

Patients aren't planes, and clinicians face an incredible degree of variability, uncertainty, and complexity. Healthcare must strike a balance between standardization and individualization, something aviation doesn't have to contend with. Rather than trying to make healthcare look like aviation, we should be interrogating what made aviation successful and how we can thoughtfully adapt those principles to improve healthcare.

The Value of Curiosity

Every safety-critical industry has something to contribute. Healthcare is doing innovative work in resilience, simulation, patient-centered care, and managing complexity that other industries can learn from. Maybe images of the cockpit don’t need to disappear from our presentations, but the cockpit shouldn't be the only image. I'd rather see it alongside healthcare, nuclear power, manufacturing, firefighting – they all have something to offer to the discussion. Human factors should be viewed as a multidisciplinary field, not one owned by aviation.

If someone currently working in human factors is looking to pivot into healthcare, I’d recommend they start with a conversation. Human factors professionals are incredibly generous and excited to talk about their work, and there’s a shared value of curiosity in the field. The more we can learn from one another about the principles, tools, and practices we use, the safer we can make our industries. 

That same curiosity has served me well in my role as a CPHFH Review Course faculty member, where I was exposed to tools I hadn’t used before, such as Human Reliability Analysis and usability testing. Both concepts gave me new language and resources I could pull from in my own practice. No single approach will be right for every situation, and the CPHFH Review Course helps practitioners build a toolbox they can draw from as the situation demands. Additionally, earning the Certified Professional in Human Factors in Healthcare (CPHFH)™ credential validated the human factors proficiency I’d been building for years, both in aviation and after my transition to healthcare.

Approach human factors in healthcare with curiosity rather than assuming your industry has the answers. Cross-industry collaboration works best when everyone recognizes that each field has valuable perspectives to contribute. Spend just as much time listening and observing how healthcare operates as you do sharing insights from your own field. That's, I think, where the real learning happens.

Jeff Durney is the Director of Quality and Safety for the Department of Pediatrics at Boston Children's Hospital. Prior to entering the healthcare space, he worked as an airline pilot for a decade. 

Photo by Aleksandr Grechanyuk on iStock

You may also be interested in:

• To Err is Human – But to Design for Safety is Essential: Why Human Factors Matters in Healthcare 
• Why Every Healthcare Organization Needs Human Factors Expertise, and How to Get There 
• Learn more about IHI's healthcare certifications for professional growth