Crew Resources Management
Crew resource management was originally developed to enhance the safety of air transport, and has been adopted by air carriers world wide. The track record of aviation safety, especially since the rigorous introduction of crew resource management, speaks for itself with regards to the success of this methodology. Purely as a point of demonstration and comparison, imagine if the deaths due to medical errors were translated into aviation scenarios. The reported number of deaths due to medical errors in this country alone is 98,000 per year. In aviation terms, this rate would be equal to the fatal crashes of 2 fully loaded Boeing 737 airliners every day of the year. Certainly that kind of safety record would trigger action on part of the traveling community, the aviation community and legislature.
Medical errors are driven by issues similar to the ones that used to plague aviation, however medical errors have not been addressed with the same degree of effectiveness. Crew resource management, properly adapted to healthcare, provides one excellent strategy with a direct impact on patient safety.
Medical care, much like aviation, depends upon a process being carried out by individuals with highly specialized expertise, each with distinct decision-making responsibility. Many accidents in these environments are not driven so much by errors made within any specific area of expertise, but rather breakdowns in communication, or hand-offs which lead to a series of events that result in extended hospital stays—or worse yet, fatalities. A streamlined crew resource management system can significantly reduce the potential of such errors taking place.
Crew resource management improves patient safety on three distinct levels: Error avoidance, error trapping and error mitigation. The training enables participants to identify potentially dangerous patterns, and then teaches behavior and communication patterns that address these situations in a non-confrontational way. For example participants are taught required communication patterns in the case of outranking, which jeopardizes patient safety. Historically outranking has been an issue in aviation and currently is a reality in many healthcare organizations.
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