High-flyer Niall Downey using medical and aviation experience to push organisations to learn from mistakes

Within hours he was sprinting up Shipquay Street to the cheers of the home crowd as a competitor in a televised critérium as part of the Impact ‘92 celebrations.

“We did about 30 laps of Shipquay Street,” he recalls. “There were 15 professionals and 20 amateurs. I was one of the amateurs...three amateurs and nine professionals lapped the field and I was one of them. Then back down to Dublin the next day for another part of my surgery finals at Trinity.”

Niall remembers his late mother and father cheering him on each time he sped past the Richmond Centre on his way up the sharp incline. His pals and teammates from Derry’s Ilex cycling club were doing the stewarding.

"The barriers were about five deep...all my teammates and friends were the marshals that day so after a few laps you could see we were going to lap the field.

"They were saying, ‘The guy in the green jersey there, he's from Derry, his name is Niall, shout for him’. Then when I was coming up Shipquay Street you could hear everybody shouting, 'come on Niall!'”

The determination exhibited during that epic race typifies an attitude Niall has adopted in whatever field he has applied himself over the years.

As he tells the ‘Journal,’ “I tend to do it fully or not at all.”

Niall has been living in exile for the past 37 years but hails from a well-known local family.

Gentlemen of a certain age would have purchased suits of clothing from his late father Jackie.

“My father was from Waterloo Street. He had a shop there just opposite the Rocking Chair, ‘Downey's Menswear’, for about 35 years or so. I'm the youngest of five. Kevin and Dermot were solicitors in Clarendon Street and Paul and Brian were both in the civil service.

"We grew up in Belmont Drive. Daddy had a shop in Waterloo Street but by the time I came around we were living in Helen Street and we moved to Belmont Drive when I was about two. I was there until I left ‘the College’.”

Niall attended Rosemount Primary School and then St. Columb’s before heading to Trinity to study medicine.

"I was six years at Trinity and then I did my first medical year down at St. James's Hospital. I went back and taught at Trinity for a year and then I moved to Belfast.

"I did three years of cardiothoracic training there and got my fellowship of the Royal College of Surgeons, then back down to Dublin for a year and a bit.”

After spending 12 years training and working in the high pressure, high skilled field of heart and lung surgery, Niall found himself at an impasse.

"I was getting blocked from getting a consultant training post so I hit a dead end. The way the system was back then to work as a registrar you had to have a specific training post to become a consultant,” he says, explaining that he had no luck in getting a position in Ireland.

“I was shortlisted for Mass. General [Massachusetts General Hospital] in Boston and tried to get jobs in the ‘States, the UK and Australia. Again, you had no problem getting work but you couldn't get a training post that led to a consultant post so you were sort of treading water.”

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Having scaled the heights of the medical profession but finding himself denied access to the very summit, the high-flying Derry man took a leap of faith and decided the time was right for a completely different challenge.

"I had 12 years of training done and I was stuck. I had nowhere further to go. I was too senior to go back and start anything else. The following week Aer Lingus had a half page ad in the ‘Sunday Indo’.”

Four and half thousand applied for the state airline’s cadet programme and Niall was enrolled as number 11 out of 38.

"That was 1999. I was away training for a year. We bought a house in Navan and lived there for six years. Lucky enough we are in Newry now and have been there for the last 18 years.

"I'm still full-time with Aer Lingus. We have a base in Manchester. We have two 330s [Airbus A330-300] doing long haul out of there. We transfer some of the Dublin crew over there for a couple of years so I'm over there at the minute now.

"I was in Dublin for a good few years. Then I was in Belfast for three-and-a-half years, then back down in Dublin but Manchester at the minute.”

Over the past decade Niall has been trying to use the expertise he has learned through medicine and aviation to help other industries adopt transferable systems where these might prove useful.

In 2011 he set up Framework Safety Group Ltd – an error management training company – that advises companies and health service providers on how to respond to and manage adverse events that may occur through human error.

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In 2016 Niall was a speaker at TEDx Stormont, where his ideas got a wider airing. Things really started to take off, ironically, when the coronavirus pandemic grounded most of the world’s aircraft.

"Back at the beginning of COVID, I was still flying in Europe at that stage. We went from doing 60 flights a month to doing one return Belfast to Heathrow a month...I had a lot of spare time so I decided I'd write a book instead.”

The result was ‘Oops! Why Things Go Wrong: Understanding and Controlling Error’ which was published in June 2023.

In it Niall provides examples from business, politics, sport, technology, the civil service and other fields, and makes a powerful case that by following some clear guidelines any organisation can greatly reduce the incidence and impact of human error.

"When we go to work we assume we are going to make mistakes and the whole system is structured around that and in health care you weren't allowed to make mistakes. Everything has to be perfect every time. The real world doesn't work like that so they still have these huge problems,” he explains.

He points out that an inflection point for the airline industry was the Tenerife disaster of March 27, 1977, that led to 583 fatalities.

"In aviation if you look at the figures for the past 50 years the Tenerife disaster was our turning point. Our mortality rates improved by about 97 per cent and all the figures for health care show that they have made absolutely no progress in 50 years so I've spent the past 13 years trying to teach our aviation system back into health care because a lot of it is very transferrable.

"We don't try to eliminate errors in aviation because you are going to make them anyway. Our whole system is avoid, trap, mitigate. You try to avoid mistakes if you can but you assume you are going to miss a pile of them, so you try to trap them before they go too far.

"You assume you are going to miss a pile of them as well. Then there is mitigate where you try to intercept them before it kills the patient or crashes the plane.

"We assume you can never eliminate all the errors. You are going to make them. You probably make errors writing. You make spelling mistakes. You make grammar mistakes. You are going to make them. It's just a given. Our system is designed to absorb that whereas the health care system is not. It is very fragile.

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"Basically if you make a mistake there is no safety bet and you kill the patient. There needs to be more resilience built into the system.”

Since the publication of the book last year Niall says his ideas are beginning to gain more and more traction.

He believes acknowledging mistakes will happen should be a starting point for any organisation.

"The culture in health care is if people make mistakes heads must roll. If there is a death in a hospital the instinct is that doctor must be struck off.

"If you struck off everybody who makes a mistake in the health care system there would be nobody left in about five years. Our whole idea is that you have to accept that mistakes happen.”

He points to the revolution in safety in aviation over the past half century.

"Your biggest risk flying is driving to the airport. There are around 4 billion passenger movements per year now. For the last 15 or 20 years now the average death rate has been less than a thousand per year.

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"That's 1,000 deaths out of 4 billion passengers. If you look at health care - there have been no figures done for NI but there have been figures done for all over the world and there were two studies done in Dublin in the last ten years.

"If you work through the numbers it works out that if the same figures were applied to NI, there would be about 40 deaths a week in NI from human error. Just from mistakes within the health service.

"That's 1,000 every six months in NI alone, whereas in aviation we have 1,000 deaths a year worldwide,” he says, providing food for thought for high-risk service and industry managers everywhere.

‘Oops! Why Things Go Wrong: Understanding and Controlling Error’ by Niall Downey is available from all good bookshops and online retailers.

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