CRM Model Application And Relevance In Medical Practice - Coursework Example

Introduction Crew Resource Management (CRM) is an effective team management strategy that was developed by aviation industry experts in 1979, after aNASA workshop studied the role of human error in aeronautical mishaps. Their aim was to enhance safety training focused on efficient team management. With time software data that enables one to keep accurate records of team work for assessment and attainment indices has been developed applicable to any given industry involved in cutting edge competition and management. Results from the aviation industry have showed that higher levels of safety have been attained since the introduction of CRM. Consequently, the medical industry has not been left behind in implementing CRM especially in Intensive Care Unit (ICU) and High Dependency Unit (HDU) operations, Shortell SM. et al (1994). It analyses the human factors in high-stress and high risk environments. All available resources, information and people are used to achieve safety and competence. It involves team training and simulation of emergency situations. Though there are wide variations in the specific designs and implementation of CRM programs in different organizations, the aim remains the same. CRM And The Healthcare Industry There are several similarities between the aviation industry and the healthcare industry. One obvious one is that both have highly specialized experts operating with high-tech equipment. Secondly, both have large numbers of people working in different areas in pursuit of differentiated objectives that lead to a common goal attainment; running efficient flights and delivering effective healthcare respectively. Another similarity is the inevitable interdependency of the different departments involved so as to attain the set goal. However, when it comes to risk factors, healthcare has a much higher occurrence of real emergency situations compared to aviation. Patients with complicated, life threatening ailments are rushed in several times a day and have to be attended to immediately. The possibility of human error in these high speed operations is a definite possibility. When such errors occur, they are attributable to poor teamwork in terms of communication, coordination and split second decision making. In a nutshell therefore, healthcare needs CRM even more than aviation. Modern healthcare organizations have no choice but to apply CRM models. This is because they have to do whatever is possible to ensure that they operate with the highest level of efficiency at all times. Application Of CRM In Health Facilities One of the numerous available CRM models focuses on primary elements of effectual management which are morale, safety and efficiency. The factors used to measure efficiency are materials used, organizational ability, individual and group performance. Expected outcomes are safety, efficiency and client satisfaction. Helmerich and his Colleagues came up with the “Error Troika” model which is designed to display countermeasures in three hierarchical error stages. The three are: training on avoiding errors; arresting potential errors that are about to occur before they do; and, mitigation of error circumstances in case they do occur, Helmreich RL (2000). Like all CRM programs, this model educates crews on the limitations of human performance by imparting understanding of cognitive errors. It identifies stress factors that lead to errors such as fatigue, emergency, work-overload, attention lapses, poor health and lack of physical fitness. It requires participants to asses their personal and peer behaviour, through inquiry, advocacy, observation, communication, conflict resolution, reporting and decision making. This model is a particularly useful one in a medi-care set up. It can be tailored to fit in well in the hospital environment especially in areas prone to high rates of human error. One such are is anesthesiology in which a recorded 65-75% of safety errors have been attributed partly human error, Howard SK et al (2004). Through didactic instruction, video tape re-enactment of a crisis situation with an anesthetic error, simulation and debriefing, hospital staff can be made to understand the gravity of the prevailing situation and the urgency of the need to correct it, if it does exist in the health facility. A similar experiment was carried out in the Palo Alto Health Care System, in Virginia USA called the Anesthetic Crisis Resource Management (ACRM), by the Stanford University, and recorded positive results. Currently, courses that list 83 critical events such as seizures and hemorrhage, as well as approaches to manage them are still going on. ACRM is in wide use in several hospitals world-wide as there is no time to waste when it comes to the urgency of saving human lives. In the operating room, the Helmerich and Schaefer model of CRM is also quite useful. It describes critical inputs by the operating team. Such inputs include environment, culture and personal attributes. Team formation, communication and decisions also form an integral part of performance indices. The Med-Teams behaviour system is another useful CRM variation applicable to the medical health environment. Developed by Dynamics Research Corporation with the support of Army Research Laboratories, it is useful in training medical teams in general in the health facility. It was adopted from team training of helicopter crews in the army. It is implemented through courses and continuous assessment. Known as the Emergency Team Coordination Course (ETCC) it is similar to the Helmerich and Schaefer model in its goals, but is more inclined towards team objectives such as: team building, team structure and climate, communication and coordination, team goals and roles and responsibilities. In the health sector, its application emphasizes responsibility for patients, clinical fallibility, peer monitoring and group awareness of patient conditions. For all this systems to succeed, it is important to have an in-built continuous peer monitoring tool. CRM relies as much on what people do individually just as much as what they do in the team. Peer monitoring tools include questionnaires, information exchange and constant observation. Over time this monitoring becomes habitual will thus help the health facility to run better. Useful Steps In The Implementation Of CRM The very first step to be taken into consideration when implementing CRM in any organization, including medical health facilities, is preparation. It is all very well to talk about coming up with a new safety and teamwork panacea, but no success will be forthcoming without prior preparation, , Agency for Healthcare Research and Quality,(2008) To begin with, it is important to put in place the necessary equipment and resources for carrying out CRM. Such resources would include computers and sufficient software for data collection, training personnel, training equipment, venues and communication paraphernalia. The personnel to carry out the program would then have to be trained first if only to define project goals and activities so that everything is carried out in an efficient and coordinated manner. One such useful piece of equipment is the Knowledge Discovery in Databases (KDD) software. This is quite useful in analyzing datasets as shall be collected during the course of CRM implementation. Since the data to be collected is both varied and voluminous, such software is crucial in its quick analysis and the deriving of conclusions. The most useful resource in any undertaking involving people is the people themselves. One would need to organize meetings, conferences, workshops or symposia to, first and foremost, inform the personnel to be involved that they are about to be involved, and what they are about to be involved in. This alone helps to overcome problems arising from confusion when the actual program begins. While organizing such meetings, it is paramount to remember that medical personnel are constantly at work such that they should attend such programs in shifts rather than all at the same time. Work in the medical facility cannot come to a stop just because there is this grand new idea. During the meetings the general idea, the objectives, the roles they are supposed to play and the expected outcomes should be communicated to them. After this the training program would start off in earnest. Immediately after training, each team trained would be expected to immediately begin implementation of the CRM. At this level the collection and recording of data from the medical personnel becomes an on going and continuous process. It also important to bear in mind that an in built feedback system must be available at all times for the personnel to communicate to the implementers of the project so that all the necessary adjustments can be made. One wrong assumption is that the project, once it takes off, always runs according to plan. The fact of the matter is that there are many unforeseen problems that come up such as misinterpretation of instructions, roles or communication. Ironically, it is the same team problems CRM tries to solve that may impede its implementation. Conversely, sorting out of such operational problems may lead to sorting out of similar problems in the health facility itself. For instance, if a process is mis-communicated by the CRM implementers to personnel, the same mode of communication may be avoided all together in the normal operations of the health facility itself. Weaknesses Of CRM Whereas CRM training builds teamwork, it does nothing to improve the performance of personnel in their specialized area of training. A surgical team for example may be fore efficient in working together, but this does not make them more conversant with heart the different types of heart ailments they are working to cure. The effect of CRM training that is too intensive therefore is that medical practitioners may end up concentrating more on getting the team work right than the particular chore at hand. As such CRM may end up interfering with rather than improving medical services. This can breed resentment among the medical practitioners thus leading to the failure of the CRM project. Just with any other thing, too much enthusiasm about CRM may end up being destructive rather that constructive in medical practice. So in its application, care must be taken to maintain moderation in order to avoid unpleasant eventualities, Agency for Healthcare Research and Quality,(2008) Secondly, the implementation of CRM is time consuming. Precious time that could have otherwise been used for crucial medical conferences, reading and research experiments is used up by management and team training. Even though the program is very useful in itself extreme caution that takes into cognizance crucial hospital programs should be employed in its implementation. Thirdly, medical health facilities have several departments with highly differentiated functions. This causes a wide variation in the way that they function such that what is useful as teamwork in one situation is not applicable in another. In the emergency unit for instance, speed is of the essence. In the surgical unit accuracy matters more than mere speed. In the autopsy unit and psychiatric units neither speed nor accuracy matter as much as keenness and observation. So what may apply as CRM in one unit, may be of absolutely no relevance in another. This may force the management to come up with tailor made CRM for each department which can be very cumbersome in implementation. Nevertheless, there are medical practitioners who operate in the same way in different situations such as emergency teams in the hospital, the ambulance or the battle field. These can benefit from similar training. Another point is that unlike in the aviation industry and the military, the great improvement of performance due to CRM in the medical sector is not very well documented. This could be because of the relatively few institutions carrying it out. Another reason is the defensive position most hospitals characteristically take when it comes to the question of human error. It is nearly impossible to collect accurate data on this phenomenon given that it is information voluntarily given in CRM. Perhaps if more and more institutions change their attitudes, then we may have more encouraging data. Conclusion Studies in team performance in general have developed numerous strategies that can be used in complex scenarios. In the medical community, these strategies adopted from the CRM models have been designed to suit the medical practice environment. Team based strategies that ensure the cardinal responsibility of patient safety have also been explored. With this development of practice specific and friendly taxonomies, CRM will add enormous value to medical practice. References 1. Health Journal,Agency for Healthcare Research and Quality, (2009)Gaither Road Rockville, 2. Helmreich RL. On error management: lessons from aviation. /BMJ/ 2000;320:781-5. 3. Howard SK, Gaba DM, Fish KJ, Yang G, Sarnquist FH. Anesthesia crisis resource management training: teaching anesthesiologists to handle, (2004) Havard 4. Shortell SM, Zimmerman JE, Rousseau DM, Gillies RR, Wagner DP, Draper EA, et al. The performance of intensive care units: does good management make a difference? /Med Care/ 1994;32:508-25. Read More