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Communication failures are the leading causes of inadvertent patient harm. Although medical care is delivered by multiple team members, medical quality and safety has historically been structured on the performance of expert, individual practitioners. Effective communication and teamwork have been assumed, and formal training and assessment in these areas has been largely absent. Appreciation that the clinical care environment has become progressively more complex, combined with the inherent limitations of human performance, has spurred interest in applying the lessons of other high reliability industries to medicine.
The development and implementation of crew resource management (CRM) in aviation over the last 25 years offers valuable lessons for medical care. Realising that 70% of commercial flight accidents stemmed from communication failures among crew members, CRM sought to standardise communication and teamwork. Currently, CRM is required globally in aviation training, and direct observational studies by Robert Helmreich's group have correlated actual flight crew performance with attitudes toward teamwork and safety. In 2000, we undertook the adoption of relevant behaviours and skills into high risk medical environments. Twelve clinical teams underwent a three day training programme in human factors; learning about the human factors experience in aviation, and the application of standard tools and behaviours to improve safety and ensure effective communication. The teams each worked on a clinical project in which these techniques could be applied to improve the quality and safety of patient care. The clinical domains represented varied widely from the operating room, the intensive care unit, and continuing care (the transfer of patients from hospitals to skilled nursing facilities), to obstetrics and a cardiac treadmill unit.
After the initial training, the clinical teams were supported with site visits and educational sessions for leadership and clinicians within the facilities. Cultural surveys with regard to safety were carried out using the Safety Attitude Questionnaire (SAQ). 1 Valuable insights into the climate in these care areas with regard to teamwork, communication, and attitudes toward safety were obtained. Gathering intimate knowledge of the specific culture allowed interventions that focused on the strengths of the team and targeted opportunities for improvement. Monthly conference calls helped create a collaborative community dedicated to improving safety, and to sharing successes and approaches to the inevitable barriers.
Our experience has reinforced the belief...