Crew resource management training—clinicians' reactions and attitudes

AORN Journal,  August, 2005  by Daniel J. France,  Renee Stiles,  F. Andrew Gaffney,  Margaret R. Seddon,  Eric L. Grogan,  William R. Nixon, Jr.,  Theodore Speroff

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The article "Crew resource management training--Clinicians' reactions and attitudes" is the basis for this AORN Journal independent study. The behavioral objectives and examination for this program were prepared with consultation from Susan Bakewell, RN, MS, BC, education program professional, Center for Perioperative Education.

Participants receive feedback on incorrect answers. Each applicant who successfully completes this study will receive a certificate of completion. The deadline for submitting this study is Aug 31, 2008.

Complete the examination answer sheet and learner evaluation found on pages 227-228 and mail with appropriate fee to

AORN Customer Service

c/o Home Study Program

2170 S Parker Rd, Suite 300

Denver, CO 80231-5711

or fax the information with a credit card number to (303) 750-3212,

You also may access this Home Study via AORN Online at http://www.aorn.org/journol/homestudy/default.htm.

BEHAVIORAL OBJECTIVES

After reading and studying the article on clinicians' reactions to and attitudes about crew resource management (CRM) training, nurses will be able to

1. define CRM,

2. discuss the six key components of CRM training,

3. discuss outcomes of reaction and attitude surveys from one group of clinicians who underwent CRM training, and

4. describe the need for additional research about the effects of CRM training on the health care industry.

In partnership with a commercial vendor of crew resource management (CRM) aviation-based safety training, Vanderbilt University Medical Center (VUMC), a level one trauma center in Nashville, is adapting CRM to the health care domain. The medical center has committed substantial human and financial resources to system-wide implementation of CRM in both its adult and children's hospitals, and the organizational impact and value of this endeavor will be assessed via a focused evaluation.

The Federal Aviation Administration defines CRM as

   the utilization of all available human,
   informational, and equipment resources
   toward the effective performance
   of a safe and efficient flight. CRM
   is an active process by crewmembers
   to identify significant threats to an
   operation, communicate them to a person
   in charge, and to develop, communicate,
   and carry out a plan to avoid or
   mitigate each threat. (1(p2))

Adapting CRM to the health care domain is an appealing idea because doing so fulfills the Institute of Medicine's (IOM's) charge to apply knowledge and safety practices from other industries to reduce patient care errors. (2) The aviation industry also could benefit from rigorous evaluation of how CRM training affects organizational outcomes in other industries because CRM's cost-effectiveness still is questioned in aviation. (3) This article provides an overview of the CRM training course, presents survey data on clinicians' and hospital administrators' reactions to and attitudes about a first exposure to CRM, and discusses the next steps for evaluating the use of CRM in health care.

A HIGH PRIORITY RESEARCH AREA

The CRM concept was developed in 1979 in response to a National Aeronautics and Space Administration (NASA) workshop that examined the contribution of human error and failed team processes to aviation mishaps and disasters. (4,5) Federal reports published subsequent to the NASA workshop estimated that between 50% and 80% of all aviation incidents and accidents can be attributed directly to human error involving poor group decision-making, inefficient communication, inadequate leadership, and poor task or resource management. (6,7)

Crew resource management has been used in aviation for more than two decades. The CRM concept has undergone five major phases of evolution since its inception, from a model that targeted individual styles and correcting deficiencies in human behavior to the current error management model. (8) The basis of the error management model is that human error is inevitable, but errors can provide a great deal of information for safety improvement. Under this model, CRM is envisioned as a set of error countermeasures with three lines of defenses:

* error avoidance,

* early detection of error, and

* minimization of consequences resulting from errors. (8)

One of the specific recommendations put forth by the 1999 IOM report, To Err Is Human: Building a Safer Health System, was that patient safety could be enhanced if concepts from the aviation industry, such as team training and CRM, were incorporated in health care practices. (2) The IOM re-emphasized this recommendation in its 2001 follow-up report, Crossing the Quality Chasm. (9) The Agency for Healthcare Research and Quality (AHRQ) provided additional support for this recommendation in its evidence report and technology assessment, Making Health Care Safer: A Critical Analysis of Patient Safety Practices; (5) however, AHRQ ranked the quality of evidence regarding CRM's effectiveness at improving patient safety outcomes as low, primarily because of CRM's limited application in medicine and the near absence of outcomes studies in aviation. (5)