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How has crew resource management used in the aviation industry been applied to healthcare and nursing?


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Elements of crew resource management (CRM) have been taught and applied in healthcare settings to improve teamwork and communication. For example:

  • Within the Veterans Administration, a Medical Team Training Program teaches the use of briefings among surgery teams. Statistically significant improvements were observed in team communication scores, timeliness of preoperative antibiotics, timeliness of deep vein thrombosis prophylaxis, and perioperative mortality.
  • A global study by the World Health Organization demonstrated statistically significant reductions in postoperative mortality and complications with the use of a surgical safety checklist.*
  • CRM training was implemented over one year in a multidisciplinary obstetrical setting. Participants demonstrated a significant positive change in their knowledge of teamwork and shared decision making. Positive changes were noted in the teamwork, safety climate, and stress recognition dimensions of a safety attitude assessment.
  • A CRM-based human factors training program was administered in surgery departments at five facilities across the United States. Core CRM concepts and tools were implemented. A patient safety culture survey was administered to staff pre- and post-training throughout the five hospitals (n=688). Collectively, participants had an average 7.4% increase in all 12 dimensions of the survey. The largest gains occurred in the dimensions measuring teamwork, handoffs, and event reporting.**
  • An aviation-based team training program was taught to patients at Dana Farber Cancer Institute, covering briefings, assertive communication, closed loop communication, and situational awareness. Thirty-nine percent of patients reported a change in their behavior regarding the level of involvement in their care. ***

CRM initiatives are producing positive changes worldwide in the knowledge, behavior, and attitudes of healthcare teams, along with measureable improvement in clinical outcomes. So, let’s build on this momentum! The 2004 Institute of Medicine report entitled Keeping Patients Safe: Transforming the Work Environment for Nurses emphasizes that nurses are the largest contingent of clinical providers, and they play a critical role in the surveillance and rescue of patients. Allocating resources to implement and sustain a comprehensive CRM training program tailored specifically for nursing units is a warranted and logical next step.

*Haynes, A., et al., A surgical safety checklist to reduce morbidity and mortality in a global population. New England Journal of Medicine, 2009. 360:p. 491-9.

**Marshall, D.A. and D.A. Manus, A team training program using human factors to enhance patient safety. AORN Journal, 2007. 86(6): p. 994-1011.

***Weingart, S. et al., The You CAN Campaign: Teamwork Training for Patients and Families in Ambulatory Oncology. Joint Commission Journal on Quality and Patient Safety, 2009. 35(2): p. 63-71.

Gary L. Sculli, RN, MSN, ATP

David M. Sine, MA, CSP, ARM, CPHRM

(April 2011)