The Psychological Training Program - Essay Example

Crew Resource Management in Medicine Investigation findings in the 70’s showed that more than 70 percent of airplane crashes were caused by human error. According to the National Aeronautics and Space Administration (NASA), most of the errors of personnel in the airline industry were leadership failure, team coordination and decision-making. Bad weather condition or equipment breakdown were not the major culprit. This prompted the aviation industry to seek the help of psychologists like John K. Luber and Robert Helmreich (American Psychological Association 2006). Luber and Helmreich were tasked to create new training programs for airline staff which focus on group dynamics, leadership, interpersonal communications and decision-making. The psychological training program which was developed was called the Crew Resource Management (CRM). CRM was developed for the purpose of insuring safe and efficient flight operations using all available resources including people, information and equipment. It is the active process participated in by airline crews which require them to be always alert on identifying existing and potential threats. Service men were also involved in the development, communication and implementation of action plans to prevent and minimize human errors. CRM also uplift the morale of crew members and improve efficiency of operations (American Psychological Association 2006). There are a lot of factors necessary to attain safety in aviation. Information gathering of airline crews which is done with strict confidentiality greatly contributes to a higher organizational commitment to safety, good teamwork and strong leadership. The courage of subordinates to speak up to their superiors when necessary, and the humility of the senior officers to consult, solicit and accept comments and suggestions from the junior officer is a good determinant of a harmonious workplace that contributes to the safety of the environment. Orientation about his job and the other skills and talents he possess constitute pilot’s professional culture. Surveys showed that pilots enjoy their work and take pride in their profession. But the denial of their own limitations works negatively on their professional culture. Majority of the 30,000 pilots claimed that their ability to make a good decision during normal times remain the same during emergencies. They also assert that personal problems are not brought to the workplace and they insist that fatigue does not hinder them to render an effective performance. Wrong self evaluation usually results to overconfidence in a particularly difficult situation (bmj.com 2000). Psychologists at the University of Texas Human Factors Research Project developed the Line Operations Safety Audit (LOSA) which will validate behavioral impact of CRM program. LOSA will also be used in the assessment of both CRM practices and management of the danger and error brought about by human frailties which can occur while on flight. Part of the observational process is the presence of expert observers in the cockpit during normal flight. Possible disruption in the operation and their control including also the nature and management of human error are being observed. These are done beyond everybody’s knowledge and a number of violations are recorded. Apparently, crewmen welcome the idea of being secretly monitored (American Psychological Association 2006). Flight crew error can be intentional non-compliance error, procedural error, communication error, proficiency error and operational decision error. They are crews’ action or inaction that results into violation of previously set company goals and objectives (Helmreich, Klinect, Wilhelm 1999). Crew Resource Management’s message that person to person interaction is basic to any team performance was well received by the air transport industry. Successful training on this aspect translates into savings of precious dollars. Lost of lives and properties caused by accidents involving aircrafts can be prevented too. While results of CRM program cannot be quantified in terms of the number of lives which may have been saved or airplane crashes which may have been prevented, data gathered by LOSA proved the significance of the training. LOSA data shows that for almost 100% of all flights, the airline faces an average of four threats per flight. In more than 80% of all flights, almost 3 errors per flight were observed. Because of CRM training, these threats and errors were identified and managed. CRM training was endorsed and is now being required by the International Civil Aviation Organization (ICAO) for airlines in 185 countries (American Psychological Association 2006). According to Helmreich, “The following are the sources of threat and types of error observed during line operations safety audit: Threats Terrain, including mountains and buildings - 58% of flights Inclement weather condition - 28% of flights Aircraft defects - 15% of flights Unfamiliar air traffic commands - 11% of flights External errors which consist of air traffic - 8% of flights Control, maintenance, cabin, dispatch, And crewmembers on the ground Pressures that accompany operations - 8% of flights Types of error Violation - consciously failing to follow procedures or regulations Example is performing a checklist relying only from memory Procedural - obey orders but made wrong execution Example is a double entry into flight management computer Communications wrong exchange of information; misinterpretation Example is not being able to give correct altitude clearance Proficiency - error due to insufficient knowledge or skill Example is the lack of ability to program automation correctly Decision - making wrong decision that increases risk Example is unnecessary navigation through bad weather condition To correct error in proficiency it is suggested that the crew undergo technical training, while communications and decision errors requires the whole team to conduct teambuilding. Bonding may build trust and may promote harmony within the team. Procedural errors could stem from vulnerability to fatigue or fear, or from outdated procedures which require updating. A violation is the result of the early formation of the habit of not conforming to instructions, overconfidence or not recognizing self limitation or poor procedures (Helmreich 2000) As threat and error are always present everywhere, effective management determine safety of flight. Crew resource management considers human frailties such as fatigue and stress and error. Measures to counter errors that are usually beyond human control include leadership, briefing, close monitoring and accurate cross checking, wise decision making and constant review and modification of plans. CRM is a requirement for flight crews everywhere and previous successful experience that it can change attitudes and behavior so that safety can be insured (Helmreich 2000). A vital part in the CRM is simulation. Highly sophisticated simulators permit crews to be familiar with situations prone to error. This can be done without putting the crew in a dangerous situation. This also enables them to gain feedback on their performance as a team and as individual as well. The evaluations of crew resource management lead to a conclusion that training needs to be ongoing. Without the continuous and repeated training and reinforcement, there will be backsliding and soon learned lessons are forgotten. It should also be designed so as to fit everybody in the organization (Helmreich 2000). Knowing how to properly manage threat and error is necessary to achieve safety. For this purpose, a model was developed to ease the understanding of the cause of accident and the efficacy of preventing and minimizing activities. A model should be comprehensive enough to cover the treatment context to include error classification and categorize the way to manage errors and threats. Use of the model is not intended for a single purpose but a combination of all contributing factors. The bottom line of assessment with the use of model is the discovery of potential threats that will result into the committing of error (Helmreich 2000). While error in aviation is observed while in flight, the venue for medical error is usually the emergency operating theatre. According to Helmreich, an operating table is more complex that an airplane cockpit. Characters are in different field of medical specialization combining their skills to treat a patient who may or may not respond to treatment. Threat and error in the aviation industry seem to be more manageable (Helmreich 2000). Although there are reasons that will not permit medical error to be revealed, methods used in the air transport industry can gain access to important data in order to develop similar intervention. Empirical methods were used by the project teams with doctors and nurses. While observing the performance of surgical operation, teamwork and communications have similarity with those observed in the cockpit. Flaws seen in the operation send negative impact on the patient. This process will be evaluated and recommendation will be given to hospital authorities that these people involved in the operation undergo crew resource management training. According to Helmreich the following are some of the behaviors that can be observed in the operating theatre. They tend to increase risk to patients: Communication: failure to inform team members of the medical history of patient, surgeon forgot to inform anesthetist of use of drug before blood pressure shoots up, failure to discuss other procedures that can be taken Leadership: Members of the team are not familiar with each other. The leader failed to have a get-to-know session before the operation started Interpersonal relations, conflict: Patient suffers health deterioration while surgeon and anaesthetist are in apparent conflict with one another over whether to end surgical operation after pneumothorax Preparation, planning, vigilance: No plan was prepared for contingencies Failure to monitor every minute situation and other team's activities are not well coordinated, distracted anaesthetist fails to note drop in blood pressure There are things common to pilots and doctors. According to surveys they are interpersonal problem and professional culture. Better communication is what most doctors and nurses said when asked what is needed to improve safety and efficiency in the operating theatre. Majority of doctors do not believe in the effects of stress stating that their ability to come to a decision is the same in emergencies and in ordinary situation. In a US teaching hospital, data gathered showed that 30% of doctors and nurses assigned in the intensive care unit claimed they did not commit any error (Helmreich 2000) The success of the aviation experience has made its way to the medical environment. A model of threat and error management fits well a high risk environment. Profession and organizational cultures are vital components of that model (Helmreich 2000). Hospitals and medical practitioners are embracing the concept of crew resource management. Psychological training similar to this is being initiated. The Agency for Healthcare Research and Quality is very supportive of the research being conducted at The University of Texas and believes that if CRM was successful in air transport industry, it can also serve well in medicine particularly in the emergency surgery theaters and intensive care unit (American Psychological Association 2006) Medical error in the United States ranks eight in the leading cause of death. Tens of thousand Americans die each year because of error in the practice of health care. Researchers in the high risk industry suggest that the present delivery care system needs to be understood so that proper solution can be prescribed (British Medical Journal 2000). British Medical Journal also presents the following observations and suggestions to cope up with the problem in the medical industry: “Acknowledgment of the limitations of technological solutions paved the way for the creation of a system for improvement. Professional and organizational cultural factors which lead one to deny vulnerability to stress, and interpersonal aspects of performance which is characterized by lack of teamwork need further study to gain better understanding of the subject and prevent human error. One has to be reminded of the findings made by researchers in stress to the effect that when an individual is stressed or excited, his ability to think and concentrate decreases. When the problems of poor teamwork and communication were identified, a system approach was implemented. It leads to the development of simulators that improved teamwork for surgical and trauma resuscitation including care for patient in the intensive care unit.” For the past two decades, the University of Texas human factors research project has been closely observing operations at highly risk industries like airline industry, space, maritime and medicine. Their data bank shows a comparison on attitude concerning error, stress and teamwork of those in the medical field and people in the aviation industry. Record also shows misleading perception of health care workers and experiences of people in the aviation industry serve as valuable reference of those in the other highly risk business environment (British Medical Journal 2000). The air transportation industry was successful in implementing an intervention called crew resource management. It was able to address specific problems concerning attitudes, change related behavior and improve performance of the crew members. Similar system approach can be used to address the problems in the medical field (British Medical Journal 2000). Cockpit crews and surgeons work in a high risk environment where the whole team comes into contact with technology. Risk in both fields can be high or low depending on the threats that come from different factors in the environment. Although safety is the primary concern of both professions, cost involved can have an effect on the allocation of budget for insuring safety. Accident in the air seldom happens, and if they do happen, news is heard worldwide because it could mean the death of all the passengers including crew members. Usually an exhaustive investigation follows an aircraft accident (bmj.com 2000). While the US Institute of Medicine claims that between 44,000 and 98,000 people die each year because of error in the delivery of heart care, news about them are never sensationalized. In medicine, there is an absence of standardized investigation, documentation and dissemination. Cases filed in courts and new regulations brought about by legislation are threats to both health and airline industries (bmj.com 2000) Human limitations such as fatigue, fear, poor interpersonal communications, poor understanding and inability to make a correct decision can result into error. This makes teamwork very important in both aviation and medicine. Error is used by industries to work to their advantage. From error safety can be improved. Management of error to be effective requires the full understanding of the nature and extent of error, altering the factors that caused the error, identifying ways to avoid or minimize error and requiring concerned people to undergo training. Although, emergency surgical theatres are not pilot cockpits, undergoing CRM will increase chance of patients to be in safe condition (bmj.com 2000). It is clear, based on the available information, that the experience in the aviation industry regarding improvement of communication and enhancing teamwork can be applied to medicine. The success of CRM in the air transport industry can be used as a pattern in order to develop plan of actions that will show the uniqueness of each organization. (Helmreich 2000). This can be trimmed down to a six step approach. Like the approach in the treatment of sickness, action should begin with history, examination; and findings. The history must discuss in detail knowledge of the organisation, its culture, and its staff. Diagnosis must show information which includes data from strictly confidential reporting systems and surveys, strategic observations of the team showing, and details of bad experiences and disappointments. More steps can be taken: Interacting with latent factors that are suspected that have some relevance to the subject., altering the organisational and professional cultures, providing benchmark, and adopting a kind approach to error (except for deviation to safety procedures) (Helmreich 2000) The whole component of the CRM such as conducting formal training program in teamwork, the human error, and boundaries of human capacity; Providing comments and strengthening on both interpersonal and technical performance; and ensuring error management a continuous organisational commitment through recurrent training and ongoing collection of data necessary for completion of information (Helmreich 2000). Others might think that such training will be an additional red tape in the bureaucracy and impose additional tax to an already overtaxed system. But in air transport industry, a diehard proponent and an avid practitioner of these measures are airlines that frown anything bureaucratic, learns from everyday mistakes, and enjoys an enviable safety record (Helmreich). Financial institution that will fund research into medical error, systems of reporting, and continuous search for the development of training is vital to the implementation of such endeavor. The conduct of research in the medical profession is historically dedicated the treatment of diseases, but error can greatly affect all what we have established (Helmreich). It is believed that if institutions and establishments and professional cultures accept that everybody can be prone to error and the necessary accumulation of reliable data on error and its management, systematic efforts to improve safety will reduce the frequency and sting of an unfavorable event (Helmreich 2000). CRM training is also being applied in most industrial settings, including offshore oil exploration and nuclear power plants. The program helps employees in control rooms and command centers avoid creating operational errors that may result to accidents (American Psychological Association 2006). . Reference: American Psychological Association, “Making Air Travel Safer Through Crew Resource Management (CRM)”, Psychology Matters; http://www.psychologymatters.org/crm.html Robert L. Helmreich, James R. Klinect, & John A. Wilhelm, “Models of Threat, Error and CRM in Flight Operations”, University of Texas Team Research Project, The University of Texas at Austin, Department of Psychology, Austin, Texas British Medical Journal, “Error, Stress, and Teamwork in Medicine and Aviation: Cross Sectional Surveys”; http://www.pubmedcentral.nh.gov/articleender/fcgi?artid Robert L Helmreich, “On Error Management: Lessons From Aviation” http://www.facmed.unam.mx/eventos/seam2k1/ligas/bmj_2000_320_781_785.ht ml . Read More