In 1999, a Korean Airline aeroplane took off from Stansted, UK. The Captain's artificial horizon failed, which therefore gave inaccurate readings; the first officer had a correctly functioning horizon and the flight engineer had a clear view of both. Neither flight engineer nor first officer felt able to point out the captain's instruments failing, with the clear cultural training of ‘I must not question the captain’. The result was the aeroplane was flown into the ground by the commander and all the crew died. The outcome of this disaster was ultimately that worldwide pilots came to be taught enhanced mandatory safety standards.

Aviation has many similarities to medicine in that both involve professional teams responsible for complex decision making, using specialised technology, within a high-risk environment. Both have in place accepted practices to minimise potentially life threatening situations. Currently, there is approximately one passenger death per 10 million flights, whereas in hospitals there is one iatrogenic death per 100–300 admissions. Aviation recognises that three out of four accidents result from a less than optimal human performance;1 therefore, any improvement here has a significant impact. Human factors are seen as important for improving safety and efficiency. Human error recognises that no person, pilot, engineer or manager can perform perfectly at all times; however, it is the ability to respond to the unexpected that often reveals the safety issues.

Safety remains the first priority for pilots; if a pilot makes a mistake, his own life …