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The NHS can learn from aviation—but not from Ryanair

Roger Kline, 2 July 2013

Two weeks ago the Ryanair Pilot Group wrote to aviation regulators expressing concern that the airline’s employment practices could undermine airline safety. They warned that the “confusing, uncertain and unpredictable employment situation” at Ryanair was becoming “an increasing distraction in daily flight operations” and that this was causing “stress and worry” for pilots, with implications for safety.

Ryanair, with its customary attitude to labour and customer relations, responded by writing to the pilots warning that any "who participates in this so-called safety petition will be guilty of gross misconduct and will be liable for dismissal".

The pilots responded: “Voicing concerns about safety and petitioning any government agency about those concerns is legal, necessary and in line with every pilot’s legal obligations to report those kinds of concerns when they arise.”

David Learmount, operations and safety editor of Flight International magazine, commented: “Ryanair are pushing their luck on human factors when they employ pilots like a warlord employs mercenaries. There is the worry that if they are self-employed that might place additional pressures on them to work even if, for any number of reasons, they might not feel entirely fit to do so.”

The “human factors” Learmount refers to has a special meaning in aviation safety, and increasingly in healthcare too, as an excellent 'how to guide', Implementing Human Factors in healthcare, has explained.

Its approach is informed by the Clinical Human Factors Group, founded in 2007 by Martin Bromiley after his wife Elaine tragically died after routine surgery. It starts from the fact that as human beings healthcare staff make mistakes, which can be fatal. So there need to be 'levels of defence' to prevent 'latent conditions' from leading to catastrophic consequences -- the so-called Swiss Cheese model.

Martin Bromiley and colleagues argue for an “open, just and informed culture” in which staff feel comfortable discussing safety incidents and issues, confident that the focus is on learning and prevention.

He points out that teams in healthcare are generally well trained in the technical aspects of their job but generally get no “human factors” training, which helps explain why the research literature and incident reports are full of examples of failures of leadership, situational awareness, communication, coordination and teamwork.

Martin has written passionately, from his own experience as a pilot, about how “a regular feature in accident reports across all safety-critical industries is an inability of people to speak up, or an inability to be heard", and he added: "From my own experience of observing interactions in a number of industries, I can assure you that this inability isn’t something that develops instantly, it has to be developed over time. I’d like to suggest that the problem isn’t so much the lone bully with a ‘personal issue’, but more likely the passionate, driven individual or team.”

Noting the weaknesses as well as strengths of leaders with passion and conviction, he says the bullying approach that “if you see anything unusual, shut up and do it my way” is not acceptable “on the flight deck, or in a nuclear plant, or during a Formula 1 pit stop". So, "why should it be accepted in healthcare where you’re all at the cutting edge of safety?”

If you’re thinking of flying Ryanair, bear in mind that this latest incident is not an isolated one, and that bullying can be dangerous. If you’re working in the NHS, please do the same.

  • Roger Kline is a former national negotiator for the British Air Line Pilots Association, as well as a being a former senior trade union official in the health and education sectors. He is now a director of Patients First and an associate consultant with Public World.


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