Table 3 Key similarities and differences in the challenges faced by intensive care unit and aviation teams

Environment/taskwork

Reliance on complex technology

ICU work is more varied in nature, with teams diagnosing diverse illnesses, applying treatments, and managing emergencies.

Constant innovation in technology and working practices

ICU teams tend to perform more 'hands-on' work than aviation teams.

Performance depends on cognitive performance of operators (for example, situation awareness, problem solving, and decision making)

Patients are experiencing a crisis on admittance to the ICU; diagnosis is critical and often teams must apply risky and uncertain treatments.

Ever-present need to manage uncertainty and risk, particularly during emergency scenarios

Emergency scenarios in the ICU are more common than in aviation.

Dependency on multidisciplinary expert teams

Resources in the ICU frequently are stretched to capacity (for example, patient numbers).

Use of handovers to transfer information

Patient outcomes in the ICU are variable; a significant proportion of patients die.

Need for collaboration with external agents/units

Duration of patient care can be undeterminable, and treatment continues after discharge.

Safety and error

Error threatens the safety and well-being of patients/passengers.

Errors in aviation can be identified more easily (for example, through computers and air traffic controllers).

Vigilance and monitoring behaviors are critical for avoiding error.

The magnitude of harm caused by errors in the ICU is less than in aviation, and consequences/causes of error may not be immediately noticeable.

Factors such as fatigue, stress, and burnout increase the likelihood that errors will occur.

Aircrews and passengers share the potential consequences of error.

Non-technical factors such as communication, situation awareness, and decision making frequently feature as causes of error.

Error reporting is more commonly discussed in aviation, and staff have more positive perceptions of safety culture.

Team performance

Generic skills, knowledge, and attitudes that underpin effective teamwork in aviation are likely to be similar in the ICU.

Team structures in the ICU differ substantially, and senior doctors manage large groups of multidisciplinary team members.

Team hierarchies and group norms can negatively influence the performance of junior team members (for example, speaking-up behaviors).

Teams in the ICU tend to be more hierarchical in nature.

ICU team leaders have greater autonomy over leadership style and operating procedures, and leaders rotate on a daily or weekly basis.

Communication behaviours for building shared mental models for teamwork and taskwork are important in both aviation and the ICU.

Expertise is widely distributed in the ICU, and trainee doctors learn 'on the job' and often without direct supervision (for example, at night).

Effective team leadership is a key determinant of team performance.

Team decision-making in the ICU can be influenced by a range of external parties, including patients, families, surgeons, and pharmacists.

Procedures used to maintain safety in aviation (for example, checklists) have been shown to have a favorable impact on outcomes in the ICU.

Protocols for communication tasks and handovers have greater standardization in aviation.

Simulators can be used for team training in both domains.

Standardization for many team-related functions may not be possible or desirable.