Safety Engineering Meets Patient Safety via Physician Who's Been to Space

A physician leaves behind a careeer at NASA to embark on a different kind of journey—engineering improved patient safety solutions.

James P. Bagian, MD, PE, dreamed of becoming an astronaut from the time he was a child.

As he grew, Bagian decided to pursue other fields: first engineering, then medicine. But his career was altered during medical school when, while waiting for an operating room to be cleaned, Bagian spotted a magazine article mentioning that NASA was accepting applications for astronauts.

He applied and, to his surprise, was selected for training, becoming an astronaut in July 1980.

After 15 years, two space shuttle missions, and 337 hours of logged space flight time, Bagian left his career at NASA and embarked on a different kind of journey—engineering improved patient safety solutions.

In 1999, Bagian became the first chief patient safety officer and founding director of the VA National Center for Patient Safety at the U.S. Department of Veterans Affairs; he is also the founding director of the Center for Healthcare Engineering and Patient Safety and a professor in the College of Engineering and the Medical School of the University of Michigan.

On bringing safety engineering to medicine:
Let's say a nurse is stuck with a needle; you don't just treat them for the needlestick. You ask, how are the sharps containers set up? Do the nurses have to reach up blindly to dispose of the needles and end up getting stuck? That's a bad design. The question is, how do we design this sharps disposal system to be safer?

On organizational safety culture:
While I never thought I'd end up in healthcare safety, I always thought about managing risk and defining organizational goals. I was always frustrated and unhappy with the way healthcare did them.

It's not that healthcare safety was never done well, but it certainly wasn't done in a uniform way, and it was hierarchical; whoever was in charge was often considered to be right based on their position, which is ridiculous.

Someone needs to be in charge, but assuming management always knows best about safety is foolish. You want to take advantage of the various expertise and talent people in your organization have, at every level.

On a culture of risk management:
Many of my attitudes on managing risk don't come from having worked for NASA, or being an engineer—a lot of it comes from how my parents raised me. My father was a highly decorated fighter pilot during World War II, and had experienced many demanding situations.

But at home, as a family, when we would talk about anything we were going to do, we would ask what the risks were and decide how we would manage those risks.

My parents were clear that bad things could happen, but always talked about what we could do to get the risk to an acceptable level so that whatever it was that we were thinking about doing could be accomplished.