This can't be overstated.

I'm not sure the risk profile in medicine is similar enough to expect the same magnitude of improvement that aviation got.

I am sure, however, that the systematic way of viewing errors as an opportunity for improvement and transparent evaluation, rather than an opportunity for blame throwing and obfuscation, was absolutely key to the success of ASRS and related.

The key takeaway isn't a checklist system, it it is the report and reviewing that arrived at what is on the checklist, and why.

Exactly. The checklist is actually a product of the solution - transparent reporting and rigorous analysis of those reports.

Unfortunately, the healthcare system is basically cargo-culting checklists without putting in place the underlying processes to get to the "right" checklist. Or perhaps a solution that is even better for healthcare than checklists.

There's significant argument in aviation community about how checklists should be designed as well.

I personally don't think an 8-page checklist (6 pages for normals) to fly a Piper Cherokee or Cessna 172 is the safest approach or most sensible operational tool. Many pilots seem to agree and make up their own checklists that they actually use with only the "killer items" and I think that probably increases safety; certainly it increases safety over the 8 page checklist that stays in the map pocket for the whole flight. Why doesn't the factory do that? Well, if they remove something from a checklist and a pilot comes to grief, they're thinking of how it will look in a courtroom. "No charge to add something to the list..."

You'd probably enjoy reading Checklist Manifesto by Dr Atul Gawande: http://amzn.to/1ZlTjoJ I read it years ago, but I seem to recall he did cover some of the processes and social aspects of checklist usage.

> When a pilot makes a mistake, they file an ASRS report and instead of being disciplined or hit with a huge legal liability they can be open and transparent while NASA and the FAA work to mitigate those accidents from happening in the future.

When a pilot "makes a mistake" that falls outside of the norms expected of the profession, and through that mistake causes injury or death to another person, they don't face the risk of losing their license and/or facing large legal liability?

That seems...improbable.

ASRS doesn't grant immunity to certificate actions or fines when an accident is involved. (Most deviations do not involve accidents, of course.)

GP was (presumably) comparing the situation of legal liability or discipline to the case of a medical practitioner self-reporting a mistake.

Yes, that is correct. I was a bit imprecise in my langauge but was referring to something like a case where a nurse is about to accidentally deliver a lethal misdose of medicine but then catches and rectifies the mistake before causing any harm. In healthcare, there is a strong incentive not to report that potential error whereas the ASRS system incentivizes reporting these kinds of "pre-accidents".