Crew Resource Management Review of Literature Essay

Crew Resource Management in Graduate Medical Education
Chapter 1
Introduction
Nature of Problem
Initially instituted by the aviation industry, crew resource management (CRM) is a safety training program, which utilizes tools, such as checklists, brief/debrief sessions, read and initial file management, anonymous feedback, and feedback mechanisms, to facilitate safe outcomes (Ricci, 2012). These tools require behavioral activities and communication amongst team members to enlist resources to aid in safe practices. According to Teigland (2013), “Medical errors are a significant cause of mortality. For example, in the United States, medical errors are thought to be responsible for more than 900,000 deaths annually” (p.16). Providing graduate medical students with patient safety education has resulted in positive behaviors, specifically increasing quality performance improvement projects, which ultimately may decrease medical errors (Kirkman, 2015).
Purpose of the Practicum
It is the goal of the practicum to explore various patient safety approaches and strategies in the pursuit of high quality medical care delivery for graduate medical students. A PowerPoint presentation will be designed that will introduce the concepts of crew resource management and its successful influence on patient safety. Provided annually, this presentation will be deployed didactically to the graduate medical students rotating in their clinical surgical rotation.
Research Question
There is one research question to be answered by this practicum. What are the necessary topics to be included in creating the curriculum to be delivered as a PowerPoint presentation, focusing on crew resource management and patient safety for graduate medical students at Grand Strand Medical Center in Myrtle Beach, South Carolina?
Significance to Graduate Medical Students
The provision of cutting-edge information to graduate medical students facilitates the optimal goal of improving patient safety and health care delivery systems at the consumer level. The significance of crew resource management training to the graduate medical student is to promote the development of quality performance improvement geared to increasing patient safety and the reduction of medical errors. This training will provide the graduate medical students with conceptual and practical tools, which can be applied in their everyday practice, ultimately enhancing patient safety and the reduction of medical errors.
Definition of Terms
1. Crew resource management. A safety training program, which utilizes specific tools to facilitate safe outcomes (Ricci, 2012).
2. Graduate medical education. A formal, usually hospital-based, education training that follows graduation from a medical school, which includes internships, residencies, and fellowships (“Graduate Medical Education," n.d.).
3. Medical errors. A direct failure of an individual’s knowledge or performance, but it can also have been caused by a lack of oversight. Continuous monitoring of performance should be maintained to assure the experienced professional is maintaining competency and quality control (Teitelbaum & Wilensky (2013).
Current Employment
This writer is currently employed as the South Atlantic Division Director of Trauma Services for Hospital Corporation of America (HCA). This position has direct oversight of seven various trauma centers spanning across the territories of North Florida, South Carolina, and Georgia. The Division Director of Trauma Services Provides facilitation and direction to South Atlantic Division hospitals for a multidisciplinary trauma service with primary focus on developing/implementing and monitoring systems to enhance care of the trauma patient. In addition, the position serves as a resource for inter-intra disciplinary team members, assumes accountability and responsibility for care provided by nursing and ancillary staff, collaborates with trauma medical directors to promote the goals of the Trauma Program, qualifies all care issues and system issues regarding the program development, optimizes patient care across the age and injury spectrum, and successfully develops trauma programs at the division level, hospital level and within state/national systems.
Chapter 2
Review of Literature
Overview
Crew resource management originated in the aviation industry in the year 1979 (Marshall, 2009). Crew resource management is a safety and quality initiative to enhance patient safety and reduce medical errors in health care (Marshall, 2009). Quality should improve as the experienced professional continues to provide care over time. However, regardless of the experience of the professional, there must be an efficient system in place to maintain quality. Providing graduate medical students with patient safety education has resulted in positive behaviors, specifically increasing quality performance improvement projects, which ultimately may decrease medical errors (Kirkman, 2015).
Evolution of Crew Resource Management
History of crew resource management: In 1977, two Boeing 747s were on a collision course on a foggy runway in the Canary Islands, which would ultimately cause the largest aviation tragedy, resulting in 582 deaths (Marshall, 2009). This preventable human error was caused by a well-respected and seasoned pilot (Marshall, 2009). Over the next 2 years, 60% to 80% of all aviation incidents were caused by preventable human errors. The results started a change process, which resulted in a 1979 National Aeronautics and Space Administration (NASA)-sponsored workshop, held for the purpose of error reduction entitled crew resource management (Marshall, 2009).
Safety outcomes in industry
Etiology and prevalence of medical errors: It is estimated that 440,000 Americans die each year as a result of hospital-related medical errors (Teitelbaum & Wilensky, 2013). Medical errors can be a direct failure of an individual’s knowledge or performance, but it can also have been caused by a lack of oversight (Teitelbaum & Wilensky, 2013). Continuous monitoring of performance should be maintained to assure the experienced professional is maintaining competency and quality control. Medical errors can occur as a result of technology and or lack of current technology to reduce the chance of errors (Teitelbaum & Wilensky, 2013). Transparency and an environment that fosters self-reporting without punitive damages tends to reduce the reoccurrence of medical errors (Teitelbaum & Wilensky, 2013).
Safety outcomes in health care
Crew Resource Management Skills
The purpose of the creation of CRM was to increase the safety of individuals on board an aircraft (Marshall, 2009). CRM refers to the combination of all techniques and knowledge aimed at mitigating human error, which is the leading cause of accidents and mishaps (Malecet al., 2007). It also involves the formation of teams and their training as well as the development of leadership within the aviation industry. It also includes the employment of safety tools and appropriate measurements or approaches, which all work together to stimulate communication among individuals.CRM also stimulates progression in teamwork, effective decision-making, and encouragement of feedback to stimulate improvement. Additional imperative activities include cross-checking tools to prevent possible mishaps and management of fatigue (Marshall, 2009). The healthcare industry today has begun to incorporate the CRM concepts to progress and advance patient safety in the hospitals, and it has been a success for many years. It has inspired health care leadership, teamwork performance, and increased passion for great care (Marshall, 2009).
Standardized communication: The prevention of human error within healthcare facilities is largely based on the quality of communication, which if ineffective, will lead to detrimental effects (McConaughey, 2008). In most cases, attaining effective communication may become challenging due to various reasons. First, all care providers have different views concerning their priorities on the requirements of the patients (McConaughey, 2008). Consequently, they act independently without consulting other care providers. The healthcare industry is a complex environment, comprised of different people with specialties in diverse fields. Health care workers take care of various needs of the patients and they rarely communicate with one another. The Situation, Background, Assessment, and Recommendation (SBAR) standardized communication tool is an intervention of the CRM comprised of four factors, including situation, background, assessment, and recommendation. In the first step, the caregiver must question the condition of the patient to determine the current health status. Afterwards, he or she evaluates the clinical background of the patient and assesses or evaluates the origin of the problem. Finally, the caregiver recommends the most appropriate treatment for the patient. The SBAR ensures the organization of information concerning the change in the status of the patient (McConaughey, 2008).
Team briefings and debriefings: The team briefing skill in CRM refers to huddling teammates in the same room to discuss issues related to patients, the healthcare facility, and working conditions. Prior to a decision being made, the team briefings are a vital aspect of communication in crew resource management. Team briefing and debriefing are essential in creating a team learning cycle in the health facility, which all members learn to stay focused on their responsibilities. In CRM, the mentioned skills are excellent ways to expose possible errors and feasible solutions to mitigate disasters. During the briefing, the entire team unites to set goals and objectives for particular situations, such as cardiac operations, patient records, reduction of medical errors, and patient risk factors among others. Next, the team implements the debriefing and evaluates its performance. In the end, the debriefing segment allows the team to come back together to discuss and evaluate that performance, consequently finalizing the learning cycle (Malecet al., 2007). At this stage, they develop solutions and provide sufficient feedback. Attentiveness is a crucial communication skill that promotes the success of team briefings and debriefings. Other relating factors include active listening, committed attendance, punctuality, concise information, and limited time constraints (Malecet al., 2007).
Situational awareness: The term situational awareness refers to the capability of an individual to be aware of the events surrounding him or her (Gaba, 2004). The person has to comprehend the situation fully, rather than just perceive. It is an excellent tool in diminishing medical errors, and the basics of situational awareness are inclusive in medical training sessions today (Gaba, 2004). Situational awareness is imperative because it provides the caregivers with a wider spectrum of the events surrounding the patient; hence, they can act appropriately when things go according to the plan or fail. It is most common in complex situations, such as in the operating room, where duties and tasks are dynamic and sweat breaking. However, SA is also applicable to other areas of the healthcare industry, such as nursing and administration. Any caregiver in a health facility must be aware of various red flags or warning signs that show that there is a loss of situational awareness (Gaba, 2004). They include fatigue, confusion and ignorance of hazards, continued employment of inappropriate procedures, and the violation of set regulations. The insufficiency of situational awareness can lead to bad decision-making, which reduces patient safety (Gaba, 2004).
Decision making and leadership: Decision-making is vital in the healthcare industry, being that the lives of individuals are always at risk (Malec et al., 2007). Through the adoption of crew resource management concepts and practices, caregivers can make the right decisions regarding the life and health of the patient, such as the need for urgent surgery and the appropriate treatment after a diagnosis. The CRM training teaches caregivers in healthcare facilities how best to make decisions at their professional level (Malec et al., 2007). In this way, there are minimal medical errors that can take place. The decision-making skill requires that the individual becomes aware that there is a problem and that he or she can define it appropriately. Next, the individual weighs all possible solutions to the issue and chooses the best one. The final step of deciding includes acting upon the selected solution. The entire process demands that the caregiver is of sound mind and body and not under the influence of any drug (Malec et al., 2007).
Conflict resolution: Conflict is natural, neutral, and inevitable within all sectors of the society and most importantly in the healthcare industry (McConaughey, 2008).Caregivers and physicians trained in CRM are capable of handling adverse situations within the workplace, either between colleagues or between the patient and physician. Regardless of the level of conflict, the leader incorporates excellent communication skills to resolve an argument or a fight. According to the CRM training, various principles apply to promote the conflict resolution. First, the leader or individual must acknowledge the presence of conflict and be prepared to have an open communication with the parties involved (McConaughey, 2008).
Effective teamwork: Teamwork is one of the most valuable skills within CRM and acts as the backbone of the entire management (Gaba, 2004).It requires the participation of all members for it to be a success. Team huddles involve mobilizing people together in one area where important issues and topics are discussed (Gaba, 2004). People have to work together and communicate between departments and especially, concerning the health of the patient. If one individual decided to act i...