Patient safety is of utmost importance in anaesthesiology and has to be considered as a number one priority, also from a managerial point of view.1 Research, practice advisories and guidelines have tremendously improved perioperative patient safety over the last several decades. Anaesthesiologists have played a key role in these developments.2
High-reliability organisations, such as airlines, very quickly saw that qualitative factors (human factors) were just as important as quantitative factors, and were essential in the provision of the highest quality service. In 2007, a working group on Safety and Quality in Anaesthesiological Practice in the Section and Board of Anaesthesiology of the European Union of Medical Specialists (EUMS/UEMS) presented guidelines that also embraced legal aspects, audits and ethics.2 ‘Adaptive coordination’ has been shown to be a key characteristic of high-performing teams.3 The WHO surgical safety checklist, designed to improve teamwork, significantly reduced perioperative death rates.4 Chassin defined the elimination of ‘barriers to a strong and vibrant culture of safety’ as today's highest priority for healthcare leadership.5 Human resource practices and policies that support group orientation have been shown to directly affect the safety climate of organisations.6
Very recently, however, the tragedy in the French Alps caused by a psychologically disturbed pilot showed how dangerous a single team member can be if their behaviour is unstable and if their instability goes unrecognised by other team members and leadership. Comparable incidences in the healthcare setting, especially in acute care medicine, have happened and the number of unreported or undiscovered cases may presumably be high. Psychologically unstable staff members have induced patient damage or death multiple times.
This airline catastrophe teaches us that the selection of team members is probably the critical task of leadership clearly going beyond that of ensuring safety provided by any guidelines and checklists. How to early identify those at risk in an interview situation as applicants or even at entry level as trainees? In addition, as psychotic or psychologically aberrant behaviour may occur throughout one's career, proven tools are needed to identify individuals and subsequently thereby prevent catastrophic incidents. How to then remove such members from duty will be a challenge going forward for both the airline industry and those in the operating suite.
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