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Healthcare Reform and Commercial Fishing?

By Tony Avellino, Nick Mavar Jr. and Dan Mattsen

Cost, quality, and patient safety have been important issues facing U.S. health care for the past decade, especially now with the rollout of Obamacare.

In 1999, the Institute of Medicine reported in its “To Err is Human” publication that as many as 98,000 people die in any given year from “preventable medical errors.”

In both the health care and commercial fishing industries, there is no room for error — giving the wrong medication or going overboard in rough seas can both lead to death.

What then can the health care industry learn from the commercial fishing industry that would make health care safer and decrease health care costs? We believe that effective communication and teamwork are the answers.

According to the Centers for Disease Control and U.S. Bureau of Labor Statistics, commercial fishermen have the most dangerous job in the U.S. with 121 deaths per 100,000 workers. That’s 35 times higher than the rate for the average U.S. workers (3.5 deaths/100,000 workers).

The popular TV show “Deadliest Catch” on the Discovery Channel has raised awareness of the crab fishing industry in the Bering Sea. These crab fishermen must catch their crab quota in a safe and timely fashion while working in challenging weather or lose their anticipated yearly income.

Similarly, a health care worker must make quick decisions while working in a stressful environment.

Though seemingly dissimilar, whether a person is dealing with Mother Nature while navigating the frigid Bering Sea or with human nature inside the confines of a modern health care facility, commercial fishing and health care workers both have to be extremely cognizant of their surroundings as the slightest error or lapse in judgment may lead to devastating consequences and death.

Although both industries require attention to detail and workers face challenging work conditions and long hours, the most important difference between health care and commercial fishing workers is that health care workers put “other” people’s lives, limbs and organs at risk, while commercial fishing workers put their “own” lives, limbs or organs at risk.

Recently, the World Health Organization spearheaded the “surgical safety checklist” to reduce deaths and injury through effective teamwork in the operating room. However, this has been challenging to implement and far from universal, as it is a significant culture change, whereby the surgical team must think as “we” and not “I.”

As a neurosurgeon, I (Tony Avellino) was fortunate to have the opportunity to work with Nick Mavar Jr., a seasoned commercial fisherman of 38 years, to learn what they do (namely “effectively communicate and work in teams”) so that I may have further insight into how to improve health care.

Working on the Miss Colleen, the Mavar family’s 32-foot gillnetter, in Bristol Bay, Alaska, I was constantly reminded that all of the crew were at risk at all times. Even though there were no work-hour restrictions and we were fatigued, we were all extremely cognizant of our surroundings in that we were working as a high-level “team.”

We each had specific roles and were in constant communication, so that we kept each other safe, leading to catching more fish, and in turn, reaping larger financial rewards.

Importantly, all potential safety concerns on deck were immediately “called out” and corrected right away without any “crew” member feeling ashamed. For example, when the hatch to the fishhold was not secured, crew members would yell “open hole on deck” to warn all other crew members of a potential hazard.

There was no ego – the captain and crew were all on the same TEAM (Together Everyone Achieves More). Similarly, in the operating room, all team members must communicate with each other to ensure we are doing the right operation while giving the right medications on the right patient.

Failure in teamwork and communication has been associated with increased surgical errors, adverse outcomes, and staff turnover as well as war, divorce, and death.

How can we change the health care culture by having health care workers always act in ways that “their life or livelihood is at risk,” like the commercial fishermen do?

Effective communication and teamwork are key, which will lead to better coordination of quality care and decreased costs.

About the authors: Tony Avellino is a professor of neurological surgery and director of the UW Medicine Neurosciences Institute at the University of Washington.

Nick Mavar Jr. has been a commercial fisherman in Alaska for 38 years. He operates the Miss Colleen gill-net vessel in the summer and is a deckhand on the F/V Northwestern.

Dan Mattsen has been a commercial fisherman in Alaska for 34 years. He owns three crabbers/tenders and operates the F/V Scandies Rose.

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