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"Crew Resource Management" Benefits Doctors, Nurses, and Patients Alike
Ugur Akinci, Ph.D.
A surgery is much like a commercial flight in many ways.
Both are delicate operations in which human lives are at stake.
Both rely on high-skilled services delivered by a highly-trained professional "crew."
And study after study has shown that both in operating rooms and aviation, a majority of accidents are directly attributable to human error.
Furthermore, in both aviation and medicine, the research has shown that the unquestioned authority of the pilot/surgeon, and the resultant lack of communication among the crew members for fear of getting rebuked by the "chief" in charge, turned out to be the main component of "human error."
It became clear about 20 years ago that in order to reduce human error in aviation there had to be better communication between a pilot and all his other crew members, including co-pilot, navigator, and flight attendants.
Thus the airline industry years ago started what it called a "Crew Resource Management" (CRM) program which turned out to be a resounding success in terms of reducing the human-error-related accidents and fatalities.
The same idea is borrowed these days by the medical industry in order to reduce surgery room fatalities traced back to human error.
A nationwide study conducted in 2006 by The Joint Commission estimated that 65 percent of the medical errors that caused injury to a patient could be attributed to a communication breakdown among members of the medical team.
For a number of years, due to the power disparity between the physicians and the other members of the operation room staff (including the nurses), communication surveys yielded a skewed data when only the physicians were interviewed.
For example in one study conducted by J.B. Sexton and colleagues in 1033 operating rooms in the USA, 73% of surgical residents and 64% of the surgeons reported "high levels of teamwork."
But when the same question was put to other members of the surgery team, the perception of teamwork evaporated. Only 39% of attending anesthesiologists, 28% of surgical nurses, 25% of anesthesia nurses, and 10% of anesthesia residents reported "high levels of teamwork."
The study underlined the need for a serious program like the one adopted by the aviation industry to eliminate that discrepancy and minimize human errors due to lack of communication.
All that is now changing thanks to various CRM programs rapidly adopted in many hospitals across the United States.
Nebraska is one state where CRM programs are in effect in a number of hospitals like Nebraska Medical Center . NMC hired a CRM consultant company to train hundreds of doctors and nurses for better communication skills and procedures.
Creighton University Medical Center is another facility that has adopted TeamStepps, a CRM program designed specifically for medical institutions.
Thanks to such training, the Nebraska Medical Center team members who did not hesitate to speak up their minds when they detected something wrong went up from 76% to 86% . Nurses who go through CRM training appear to be much less intimidated by the surgeon leading the operation compared to those who don’t get the training.
One crucial aspect of CRM is the formal protocol it introduces to make sure the communication is acknowledged and followed up. For example, if a nurse detects something wrong during an operation, she or he is supposed to express that concern in exact terms rather than with a general observation that "something does not feel right."
For example, one reference article (link provided below) describes the process this way:
"Team members are trained to say, for example: "Dr. Jones, I’m uncomfortable because the blood looks too dark." If the surgeon does not respond, the team member repeats the observation. If the surgeon continues to ignore the observation, the team member may call for help outside the operating room."
Another innovation ushered in by CRM is the concept of a Checklist, just like the kind that pilots go through before a take-off. The checklist is constantly revised and improved through post-operation debriefings, again similar to the post-flight debriefings that flight crews go through regularly.
LifeWings, a company specializing in CRM training has trained 70 hospitals last year and already has contracts to train 15 more. Other companies are expected to fill the gap in this newly emerging training market. The training is not cheap and can run as much as $125,000 per hospital. But since the end result is reducing fatal mistakes and saving lives, most observers (and especially the patient families) think that’s a fair price to pay.
Here are some additional sources you can use to learn more about CRM programs in medicine:
