“Communication is not like a conveyor belt where the meaning is transferred from one person to another arriving – and being interpreted – exactly the same way it was sent”

Redding and Sincoff (1984) 

Over the course of the simulation sessions we have observed, the biggest thing that has struck Alex & I has been the way explicit instructions involving patient safety, and specifically requests for medication, are given with no readback for confirmation. No-one has been able to say why this isn’t done: it just seems to be custom and practice.

The dangers of misunderstandings would seem clear. Aviation has been acutely aware of the consequences of verbal misunderstandings for a long time. Evidence ranges from the amusing – a young traveller inbound for Auckland in New Zealand was transiting in LAX and ended up on a flight to Oakland because he consistently misheard the destination due to the accent – through to the worst accident in aviation history when a 747 taking off in fog in Tenerife collided with another 747 crossing the runway after landing because the pilot misunderstood the Air Traffic Control question “ready for take-off?” and just heard the words “take-off”. 583 people died. Incidentally, that pilot was the airline’s most senior and respected captain.

The increased requirements for full PPE brought about by the Covid crisis has further introduced a potential failure point as verbal communication is more muffled beneath full masks. To medically untrained eyes, the system seems to rely on assumptions that the instruction is clear and obvious and has been fully understood once delivered.

Whilst time is usually a factor, the act of repeating back the instruction will take no more than 1-2 seconds and is easy to do. For sure it feels a bit weird to begin with, and the initial instinct is often “don’t you trust me?” when asked to readback an instruction. But given the fact that hearing is the first sense to go in a stressful situation, combined with PPE issues and potential lack of familiarity with team members due to redeployments in the crisis, not to mention fatigue, we are scratching our heads as to why you wouldn’t do it.

The lack of effective communication by aircrew continues to be the most causal factor in aviation accidents (Taneja 2002). Hence anything important that needs communicating gets read back every time. It’s natural to us. And it traps more errors than we care to admit.

Capt Dave Fielding
Project Wingman Co-Founder and Project Lead