crisis resource management (crm) concepts starting in aviation as crew resource management majority...
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Crisis Resource Management (CRM)
• Concepts starting in aviation as Crew Resource Management
• Majority of plane crashes caused by communication errors.
• Blend of technical and non-technical skills that improved cockpit performance and enhanced safety.
• Adapted by Dr. Gaba for use with anesthesiologists.
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CRM Principles
• Know the environment• Anticipate and plan• Call for help early• Exercise leadership and
followership• Distribute the workload• Mobilize and use all
resources• Communicate effectively
• Monitor, cross-check and use available data
• Prevent and manage fixation errors
• Re-evaluate and use cognitive aids
• Effective teamwork• Allocate attention wisely• Set priorities dynamically
Rall M, Gaba, D. Miller Anesthesia, 6th Ed.
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TeamSTEPPS tools
• Team Events– Briefs – planning– Huddles – problem
solving– Debriefs – process
improvement
• Situation monitoring– Shared mental model– D – describe situation– E – express concerns– S – suggest alternatives– C – consequences
– C- I am concerned– U –I am uncomfortable– S- This is a safety issue
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Team Performance Observation Tool
• Used to rate team performance on simulation scenarios
• Can guide debriefing discussion
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Using Simulation in
TeamSTEPPS® Training
http://www.ahrq.gov/teamsteppstools/simulation/index.html
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Observable Behaviors•Brief team on situation and goals •Encourage the sharing of information •Use commonly understood terminology •Direct communication to specific person(s) •Confirm communication (closed loop) •Ask for clarification •State directions and information clearly •Explain medical information using commonly understood language •Health professional confirms communication from patient •Update patient on changing conditions •Verbalize problems •Announce plans, seek confirmation or consultation •Introduce self/other HC workers, explain role
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IndividualRating Tools
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Team WorkRating Tools
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Evaluation of Teams• Characteristics of Effective Teams• Team Leadership• Backup Behavior• Mutual Performance Monitoring• Communication• Shared Mental Model• Mutual Trust
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by Guise et al
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Best Practices1. Grounded in theory2. Design to meet
specific learning outcomes
3. Capture relevant competencies
4. Measure multiple levels of performance
5. Link to the training event
6. Observable behaviors
7. Multi-source measurement
8. Capture performance processes
9. Create diagnostic power
10.Train observers11.Facilitate Debriefing
Rosen, M.A. et al, Sim Healthcare 3:33-41, 2008
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Hunt, EA
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