A few months ago, I was listening to NPR on the way to work, and they had a very interesting segment on the man who invented the airplane black box.

I googled that to find an article from BBC on "This little-known inventor has probably saved your life".

Reading it got me thinking about every airplane crash anywhere in the world that I have heard of since childhood, and the near fixation with finding the "black box". Not that it brings back the unfortunate lives lost, but there is trust and some closure in knowing that the information in that black box will help prevent future catastrophes.

The words "probably saved your life" got me thinking about the many striking parallels with critical care (e.g. ICU, Operating Rooms, etc.) Just like the primary goal of the flight crew and the ground staff is to land the airplane safely at its destination, the goal of the clinical staff (flight crew) is to get the patient (airplane) safely back to normal (land at destination).

There is one big difference though, the "airplane" in this case is malfunctioning because, by definition, the patient is there for critical care; and we are sending our "flight crew" out on a flight with the simplest cockpit and no black box... equivalent to the airline industry of the 1930s. Is that the best we can do?

Some would argue that we already have our black box in the Electronic Medical Record. However, based on how clinicians mostly use it today, it is equivalent to the logbooks pilots used back in the day... documenting after the fact.

The next step up in this space are the Clinical Information systems, which integrate and document information about the patient and the actions by the clinicians, but still do not provide that real time cockpit that is needed to fly an airplane that is in some way malfunctioning.

What we still need in the critical care space in Healthcare is that live cockpit and more importantly, the black box. One that both provides and captures live information about what's happening during the whole critical care episode.

The technology to do so is relatively easy. What is much more difficult is the inherent trust that needs to be built up, to ensure that it’s not perceived as yet another additional burden or a punitive measure by the clinical staff.

The story of that airplane black box has a lot to teach us on what it would take to make this happen:

Its existence should not be felt. Nothing added for the clinical care team to do.
Trust should be established with the clinical staff that the information will be used only to learn when there are significant errors. Just like the black boxes retain only last 2 hours of voice and 12-20 hours of flight data...pretty much just for that one flight.
Administrative leadership – and the regulators – should set up parameters to ensure this does not become punitive. Remember the basic fact that this "flight crew" is flying and trying to safely land an "airplane" that by its very definition already has a malfunction.

Just like the introduction of the black box contributed towards making commercial flight so much safer than it used to be that we cannot imagine flying on planes without a black box, we need to do the same for critical care – because we or someone close to us are going to need it sooner or later – and lives matter!

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Would You fly in a Plane without a Black Box? ...and What Does That Have to do with Healthcare?

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