Crisis resource management in relation to empowering people to speak up in emergency medical service clinical practice settings

Padarath Gangaram,Guillaume Alinier,Aldo Mendoza Menacho

doi:10.12968/jpar.2017.9.2.60

Abstract

Teamwork and effective communication have been identified as key principles in Crisis Resource Management (CRM) in the context of emergency care medicine. The aim of CRM is to ultimately improve patient safety and prevent at-risk situations or events. These principles optimise patient safety and benefits. Pre-hospital emergency care in Qatar is provided by the national Ambulance Service (HMCAS). Their operations are labour intensive, and depend on the professional readiness and communication of their culturally diverse practitioners. Structures within HMCAS are hierarchical, which may be a deterrent to effective communication in Qatar. Emergency medical care (EMC) practitioners may not be forthcoming with their concerns to the detriment of patient safety. These factors can create an environment which is not conducive to effective communication, and may inherently suppress free expression of speech in emergency situations and day-to-day working practices. Managers should therefore be encouraged to create an environment whereby practitioners can speak up, irrespective of culture, nationality, or the presence of more senior or experienced colleagues. CRM principles are well incorporated as part of the EMC's orientation programme and specialised professional development courses. Regular training involving all role players (including supervisors) in different settings, and appropriately simulated scenarios that call for application of CRM principles is required to further improve the quality of EMC service in Qatar.

Highlights

Introduction ofCrisis Resource Management (CRM) in the pre-hospital setting Crisis resource management (CRM) had its humble beginnings in the training of airline pilots in the 1960’s (Howard et al, 1992)
In order to overcome these barriers and encourage Emergency medical care (EMC) practitioners to “speak up” during clinical practice, the researchers recommend that the CRM principles are enforced regularly
Training on the CUS, two-challenge rule, and other TeamSTEPP principles must be entrenched in all EMC learning programmes

Summary

Motivation

The hierarchical prehospital EMC setting may be a deterrent to effective communication in Qatar. The individual’s ability to work safely is potentially affected by fatigue, sleep deprivation, anger, stress, ill health, inexperience, lack of knowledge, and fear of reprimand Team dynamics such as role confusion, authority, and ineffective communication skills labour the process of effective teamwork. This will ensure that participants overcome individual, team, and environment pressures in a controlled setting (Alinier and Newton, 2013). CRM must involve the training of individuals to function in teams whereby non-technical skills such as: collaboration, communication, task management, teamwork, and leadership are taught and are accompanied by practice and feedback encouraging reflection on the part of the practitioners. Repeated regular training will facilitate effective teamwork and help minimise risks in patient care (Jankouskas et al, 2007). Logarajah and Alinier (2014) proposed an acronym (ABCDE approach) to help recall the CRM principles and to increase patient safety, and promoted the use of simulation-based education in order to master the teamwork approach

Conclusion

Key Points