Ever since observers first recognized the critical role of flight crew behavior in aviation accidents, crew communication has been in the spotlight (Helmreich and Foushee 1993; Lautman and Gallimore 1987). Several accidents occurred in the 1970s and 1980s that were caused at least in part by crew communication problems. Many of these involved what has come to be known as “monitoring and challenging” errors (NTSB 1994), a form of crew communication with special relevance to healthcare communication. In addition, vague hints at problems, ambiguous terminology, and unwillingness of more senior crew members to attend to concerns of junior crew members have all contributed to accidents. Consider a few examples:

In 1971 a Convair 340/440 crashed during approach to the New Haven Airport under adverse weather conditions and low visibility. The captain disregarded the first officer’s repeated advisories that minimum descent altitude had been reached. The airplane continued to descend without the crew being able to see the runway environment (NTSB 1972).

In 1978 a DC-8 crashed near Portland, OR, due to fuel exhaustion. It had circled the airport for nearly an hour while the crew tried to resolve a landing gear problem, despite repeated attempts by the flight engineer to call attention to the dwindling fuel situation. When the captain said he needed 15 minutes more, the second officer replied, “Not enough. Fifteen minutes is gonna’ really run us low on fuel here.” (Kayten 1993; NTSB 1979).

In a third case, while preparing to take off from Washington National Airport in a snowstorm, the first officer of a B-737 noticed that engine indicators were not quite right. “God, look at that thing, … That don’t seem right, does it? … Ah, that’s not right.” The captain replied, “Yes it is, there’s eighty,” but the first officer persisted, “Naw, I don’t think that’s right.” During the 35-second take-off roll the crew did not discuss the meaning of the abnormal engine behavior or check other indicators that would have told them that their power settings were below normal for take-off (NTSB 1982).