Crew Resource Management - Essay Example

? Review and Critically Evaluate the Issues Related to crew Resource Management Postgraduate Certificate In Pre-Hospital Care Word Count 869Crew resource management (CRM) is a framework designed to ensure control over human errors and reduction in mishaps caused by such errors in an operation or an activity especially with regards to crisis and emergency situation management. This is achieved through human resource training and development, process improvement and use of application, systems, standardized tools and techniques. The concept of CRM has become very phenomenal and effective in areas where margin of error or tolerance for negligence is minimal or zero. This is relevant for sectors such as aviation, healthcare and other similar areas. The concept of CRM was first evolved and applied in aviation sector where it is most prevalent today. It has evolved to such an extent that its application is mandatory and regulated by the authorities (Musson & Helmreich, 2004). CRM in aviation has contributed much value to commercial airline safety as it played a pivotal role in reduction of human-error caused mishaps of devastating effects resulting it being the safest and efficient mode of moving people and goods from one channel to another. Its success in aviation has won much supporters and proponents of its application in other critical areas. Based on its success story in aviation and major concerns about human element in medical mishaps raised in the research report “To err is human” (Kohn et al., 2000), significant amount of funding has been allocated for its development and application in health sector. Many hospitals and organizations in health sector has embedded CRM programs into their daily operations and intimately combined them with regular training programs.However, it is still in the development phase with extensive research and study being conducted around the world (Musson & Helmreich, 2004). This main objective of this research report is to identify and review major issues being faced in implementation and application of CRM in general and other constraints and issues which are only specific to health care sector especially pre-hospital care. Further, in this report I will also analyze the possibility and feasibility of its application in Pre-health care which shall be backed by recommendation and conclusion. Success factors and issues in CRM aviation The ides of CRM was the first major shift from the general perception of engineering being the only way of dealing with technology. With the advent of technological development human involvement was generally perceived to be related to technical and engineering aspect. However, the human psychological aspect was first formally introduced during the NASA sponsored research workshop Resource Management Flightdeck in 1979 (Cooper, White & Lauber, 1980). It was acknowledgment of the fact that Human factors evolved from an initial combination of engineering and psychology and methods and principles of behavioral social sciences, engineering and physiology plays crucial role in optimization of human performance and to reduce human error. The outcome of the research workshop was the recognition of this human performance problem which stimulated an integrated and formalized approach to manage such errors. Thus, the foundations of CRM were initiated. CRM was focused on enhancement of cognitive and interpersonal skills required for gaining and maintaining situational awareness, for solving problems and for making decisions and a range of behavioral activities associated with teamwork needed to manage the flight within an organized aviation system rather than with the technical operational skills. (Musson, David & Helmriech, 2004). Musson and Helmriech in their paper Team Training and Resource Management (2004) elaborate CRM: “Crew Resource Management includes basic education about human factors and human limitations, appropriate techniques of leadership and followership along with the formal guidelines for addressing safety concerns in the face of command hierarchies and interpersonal disagreements, as this system aims to foster a climate where a respectful critic is appreciated. Basically it is a shift away from autocratic and individualist styles of command to one that is more team based with mutual interdependence and shared responsibility” (p. 5). Currently CRM has evolved and developed with standardized guidelines and the implementation of which is regulated by the authorities. Hence, the training and resource management as per the guidelines of CRM has become the integral part of aviation operations. Further, despite the absence of single and sovereign criterion of its measure of success, it is widely accepted and acknowledged that CRM in aviation is a success story. The success can be attributed from indirect indicators such as reduction in incidents turning into accidents and data from audits of crew during non-jeopardy conditions has revealed that CRM training has produced desired changes in behavirour of the staff and attitude endorsing change in the cognitive aspect through CRM training. (Helmriech, Merritt & Willhelm, 1999). However, despite all the success and claims, there are still major issues and constraints which need to be reviewed and addressed in order to further refine the framework. First and foremost is the lack of acceptance and resistance to change in process and aviation culture entailed with the implementation CRM. This can be attributed to the resistance to perform additional tasks or procedures or lack of understanding of applying what is learned in the didactic settings to actual line. As in their journal “The evolution of Crew Resource Management training in commercial aviation”, Helmriech, & Willhelm(1999) states: “While CRM is endorsed by the majority of pilots, not all its percepts have moved from the classroom to the line. For example, number of airlines has introduced CRM modules to address the use of cockpit automation. This training advocates acknowledgment and verification of programming changes and switching to manual flight rather than reprogramming Flight Management Computers in high workload situations or congested airspace. However, a significant percentage of pilots observed in line operations failed to follow these percepts.” Beside non acceptance, another hurdle could also be decay in acceptance of basic CRM procedure. Lack of support from management and absence of control to reinforce practice may result in decay in acceptance of CRM modules and related procedures. (Helmriech & Willhelm, 1999). In addition, another issue that is causing major hurdle is the “One size fits all” or excessive standardization approach. CRM model is standardized and is implemented in all different cultural and social settings while in some cases completely ignoring the local geographical and organization environment. It has been observed that CRM Training program developed in accordance with the organization culture and operational issues of the carrier are more effective and successful. However, majority of the organization are buying the training modules from other organization and replicating it exactly in a similar fashion which may result in its failure. . (Helmriech & Willhelm, 1999). Issues being faced in health care and pre – hospital care In continuation aforementioned issues regarding CRM implementation the problems and limitations being faced and could be faced in the health sector needs serious rectification. The major problem arises here where we see a certain lack of community in medical human factors training and a definite lack of sharing of information. Particularly the Physicians who are trained to behave largely in a self sufficient manner and individually they are held responsible for the care they deliver; It is a challenge to make them behave differently and learn the ways of information sharing. Hence, there is a strong need of changing the attitudes held by professional health-care providers. Moreover, there is also a need of active organizational-shells who could organize professional health-care trainings in a manner to determine the work-cultural parameters, resolve professional conflicts and distribute the workload within and between teams so that the purpose remains intact. (Musson & Helmreich, 2004) Second most important issue faced by this industry is that the leading role in developing CRM type programs in health-care is currently being taken up by private corporations. As practitioners fulfill their primary role in patient care and daily treatments, development of new technologies is often left to private industries which are driven by the incentive of patent protection and profit making in the long-run. However, it is a mere fact that lessons learned and explicatory resources best appear from inside one’s own industry, which has already been proven by the aviation industry them self.( Musson and Helmreich: 2004). One more very common issue being faced by the practitioners and professional physicians is that they only receive technical training for their routine work. The experience they gain and the research they conduct is all related to the technical areas of medicine and health-care, whereas they lack a very major skill of handling every patient according to their nature. The professionals are not trained with these non- technical skills and hence face issues understanding the different body language of the patients. Recommendations for CRM implementation in Pre-Hospital care: Drawing from the success and drawback of CRM application in other sectors, the effectiveness of CRM for pre health sector can easily be acknowledged and broader guidelines and macro level structure can be imported in Pre hospital care. However, it needs to be comprehensively analyzed, designed and simulated as per the specific requirement of the pre-hospital care sector. First and foremost, it is highly recommended to self produce the Resource management programs by the pre hospital care units and rely less on the professional service providers in order to share firsthand experience with the trainees and give them the tested knowledge. Moreover, simulation exercises should be organized periodically in order to create a mistake free zone where medical staff can be prepared and trained accordingly. This will enhance their performance to the fullest resulting in reduction of human error. (Musson and Helmreich, 2004). Simulation-based medical education (SBME) offers a safe and “mistake-forgiving” environment to teach and train medical professionals. The diverse range of medical simulation modalities enables trainees to acquire and practice an array of tasks and skills. SBME offers the field of trauma training multiple opportunities to enhance the effectiveness of the education provided in this challenging domain The practitioners should also be given non-technical trainings in order to bring them more close sensationally with their patients and they may learn how to bond covalently with them. This can again be regularized by the simulation exercises. Conclusion A human is designed to make mistakes, for they carry growth but there are certain times when mistakes cannot be affordable at any cost. Health-care is one such sector and especially the pre-hospital care, where there is no cushion for mistakes as it would result in the loss of a precious life and nothing could be more precious in the whole world than the gift of God in the form of life. Originated in 1979, The Crew Resource Management is a training system in order to completely reduce the chances of human error and save the life. The aviation industry designed the training which is meant for a group of individuals, in order to teach them to work in teams and promote a communal effort. After the success of CRM in aviation, other specific organizations from different sectors have also adopted the procedure of training their staff. As the pre-hospital medicine phase is very serious for a sufferer, it is vital to make a very smart timely decision; free from any human error. Knowing the problem and handling it proficiently can save half the life of the patient already before he reaches the hospital. References: Cooper, G. E. White, M. D. & Lauber, J. K. (Eds). (1980). Resource Management on the Flightdeck: Proceedings of a NASA/Industry Workshop. (NASA CP-2120). Moffett Field. CA: NASA-Ames Research Centre. KOHN, L. T., CORRIGAN, J., & DONALDSON, M. S. (2000). To err is human building a safer health system. Washington, D.C., National Academy Press. http://books.nap.edu/catalog.php?record_id=9728.  Musson, D. Helmreich, R. L., (2004), Team Training and Resource Management in Health Care: Current Issues and Future Directions, , Vol. 5, No. 1. San Diego, CA: Academic Press, Inc. Available from: http://homepage.psy.utexas.edu/homepage/group/helmreichlab/publications/pubfiles/musson_helmreich_HHPR_2004.pdf , : [Accessed: Oct 3, 2011]. Salas, E. (1999). Team training in the skies: Does crew resource management (CRM) training work? Human Factors 41, no. 1:641-674. WIENER, E. L., KANKI, B. G., & HELMREICH, R. L. (1993). Cockpit resource management. San Diego, Academic Press. Read More