The use of Crew Resource Management is well known in areas like airline cockpits. CRM, when properly implemented, maintains certain aspects of the hierarchy that is required in a command situation, but it also empowers all members of the crew to behave in a way that satisfies safety and quality concerns--even if the pilot is failing to do his or her job correctly. An article by Haerkens, Jenkins, and van der Hoeven in the Annals of Intensive Care provides support for the proposition that CRM might make a difference in clinical settings. No subscription is required (yay!), so please read it here.
I like some of the observations:
The majority of current interventions focus on implementing safety tools such as event-reporting systems, quality and safety dashboards, evidence-based guidelines and checklists. Even though the results of a comprehensive unit-based safety program (CUSP) are promising, introducing more stringent rules potentially increases the gap between procedure and practice. Therefore, the question remains if these tools can be truly effective in the traditional hospital climate, where highly trained professionals tend to focus more on individual performance than team effectiveness. Moreover, the typical culture in which junior members of the ICU staff should not question the decisions made by senior members adds to the challenge.
ICUs with a “team-oriented culture” have shorter lengths of stay, lower nursing turnover, higher quality of care and can better meet family members’ needs.
Human Factors account for the majority of adverse events in aviation as well as in clinical medicine. The current safety paradigm is still based on ways to limit human variability in otherwise safe systems, promoting stringent procedural guidelines. CRM focuses on improving interprofessional cooperation and team performance and thus patient safety. Even though evidence of CRM on medical errors and patient outcome is still scarce, the parallels between the critical processes in aviation and Intensive Care suggest that a well-adapted medical CRM training has potential for the ICU environment too.
I like some of the observations:
The majority of current interventions focus on implementing safety tools such as event-reporting systems, quality and safety dashboards, evidence-based guidelines and checklists. Even though the results of a comprehensive unit-based safety program (CUSP) are promising, introducing more stringent rules potentially increases the gap between procedure and practice. Therefore, the question remains if these tools can be truly effective in the traditional hospital climate, where highly trained professionals tend to focus more on individual performance than team effectiveness. Moreover, the typical culture in which junior members of the ICU staff should not question the decisions made by senior members adds to the challenge.
ICUs with a “team-oriented culture” have shorter lengths of stay, lower nursing turnover, higher quality of care and can better meet family members’ needs.
Human Factors account for the majority of adverse events in aviation as well as in clinical medicine. The current safety paradigm is still based on ways to limit human variability in otherwise safe systems, promoting stringent procedural guidelines. CRM focuses on improving interprofessional cooperation and team performance and thus patient safety. Even though evidence of CRM on medical errors and patient outcome is still scarce, the parallels between the critical processes in aviation and Intensive Care suggest that a well-adapted medical CRM training has potential for the ICU environment too.