Crew Resource Management Training Program Research Articles

Generic Crew Resource Management Training to Improve Non-technical Skills in Acute Care—Phase 1: An Interdisciplinary Needs Assessment Survey

BackgroundAs the first phase of a larger multicentric study, a needs assessment was conducted to develop generic crew resource management training for all critical care wards in hospitals. MethodThe online survey study included 103 Belgian physicians, nurses, and midwives working in obstetric units, emergency rooms, operating rooms, and intensive care units. ResultsAcute care professionals across specialty areas and professions had a positive attitude toward non-technical skills and multidisciplinary simulation-based team training. The majority preferred simulation-based training as an educational format to train non-technical skills. Preferred training content and the gap between attitude and skill were similar across specialty areas and professions. However, perceived barriers during emergency situations did differ somewhat between specialty areas. ConclusionsA generic crew resource management training program for all acute care professionals is feasible provided that barriers, needs, and concerns are taken into account.

Development of a Virtual Crew Resource Management Training Program to Improve Communication.

Crew Resource Management (CRM), a method focused on the management of human error and risk reduction, has shown promise in reducing communication failure in health care. The purpose of this project was to develop a virtual training program in CRM principles of effective leadership and followership, and evaluate the applicability to nurses working in the hospital setting. The intervention included the development of a virtual CRM training program consisting of a self-learning module and virtual simulation. Beta testing of the module was conducted by six nurses, followed by an evaluation of the training program by nurses (n = 5) in a general medicine department. Nurses reported the overall program to be worthwhile (X̄= 5; SD = 0.5), with great applicability to nursing care (X̄= 4.5, SD = 0.5). Nurses completing the simulation activity reported strong agreement to CRM applicability and training effectiveness. The CRM training module proved to be applicable to nursing care and is ready for widespread use to improve patient care and communication. J Contin Educ Nurs. 2017;48(11):525-532.

ISQUA16-1195EVALUATION OF TEAM TRAINING IMPACT ON SURGICAL OUTCOMES: A CLUSTER RANDOMIZED TRIAL

The application of safety principles from the aviation industry to the operating room has offered hope in reducing surgical complications. We aimed to assess the impact on major surgical complications of adding an aviation-based crew resource management training program after checklist implementation. We prospectively conducted a parallel group cluster trial between September 2011 and March 2013. Operating-room staff (surgeons, anaesthetists, nurses …

Sustainability of Improvements in Perinatal Teamwork and Safety Climate

The purposes of this study were to describe changes in perinatal nurse (n = 70) and physician (n = 88) perceptions of teamwork and safety climate after implementing a 6-month Crew Resource Management training program and compare responses between nurses and physicians. The Teamwork and Safety Climate Survey was administered prior to and 1 year after the intervention. There were significant improvements in nurse and physician perceptions of teamwork and safety climate; however, physicians perceived teamwork more positive than nurses.

The effects of Crew Resource Management (CRM) training on flight attendants' safety attitudes

IntroductionA number of well-known incidents and accidents had led the aviation industry to introduce Crew Resource Management (CRM) training designed specifically for flight attendants, and joint (pilot and flight attendant) CRM training as a way to improve teamwork and communication. The development of these new CRM training programs during the 1990s highlighted the growing need for programs to be evaluated using research tools that had been validated for the flight attendant population. MethodThe FSAQ (Flight Safety Attitudes Questionnaire—Flight Attendants) was designed specifically to obtain safety attitude data from flight attendants working for an Asia–Pacific airline. Flight attendants volunteered to participate in a study before receiving CRM training (N=563) and again (N=526) after CRM training. ResultsAlmost half (13) of the items from the 36-item FSAQ showed highly significant changes following CRM training. Years of experience, crew position, seniority, leadership roles, flight attendant crew size, and length of route flown were all predictive of safety attitudes. Practical applicationsCRM training for flight attendants is a valuable tool for increasing positive teamwork behaviors between the flight attendant and pilot sub-groups. Joint training sessions, where flight attendants and pilots work together to find solutions to in-flight emergency scenarios, provide a particularly useful strategy in breaking down communication barriers between the two sub-groups.

Improving Patient Safety and Optimizing Nursing Teamwork Using Crew Resource Management Techniques

This project describes the application of the "sterile cockpit rule," a crew resource management (CRM) technique, targeted to improve efficacy and safety for nursing assistants in the performance of patient care duties. Crew resource management techniques have been successfully implemented in the aviation industry to improve flight safety. Application of these techniques can improve patient safety in medical settings. The Veterans Affairs (VA) National Center for Patient Safety conducted a CRM training program in select VA nursing units. One unit developed a novel application of the sterile cockpit rule to create protected time for certified nursing assistants (CNAs) while they collected vital signs and blood glucose data at the beginning of each shift. The typical nursing authority structure was reversed, with senior nurses protecting CNAs from distractions. This process led to improvements in efficiency and communication among nurses, with the added benefit of increased staff morale. Crew resource management techniques can be used to improve efficiency, morale, and patient safety in the healthcare setting.

Évènements indésirables et problèmes de communication en périopératoire

In recent decades, anaesthesia and surgery have undergone major scientific and technical developments. However, these improvements have not solved a recurring problem, communication deficiencies within teams in charge of surgical patients. Current figures show that 21% to 65% of accidents and errors in patient management during the perioperative period are related to communication problems. These problems occur when gaps arise in the continuity and coordination of care within teams. Some of the contributing factors to these gaps are emergency status of patients, staff shifts and handovers following patient transfers. To minimize the impact of these phenomena, it is important to improve standardization of information flow within operating theatres and to improve teamwork between anaesthetists and surgeons. This can be done through crew resource management training programs or simulation. This should ultimately contribute to minimise medical error and improve the overall quality of care provided to patients in operating theatres and during all the perioperative period.

Using In Situ Simulation to Identify and Resolve Latent Environmental Threats to Patient Safety

Since the publication of "To Err Is Human" in 1999, health care professionals have looked to high-reliability industries such as aviation for guidance on improving system safety. One of the most widely adopted aviation-derived approaches is simulation-based team training, also known as crew resource management training. In the health care domain, crew resource management training often takes place in custom-built simulation laboratories that are designed to replicate operating rooms or labor and delivery rooms. Unlike these traditional crew resource management training programs, "in situ simulation" occurs on actual patient care units, involves actual health care team members, and uses actual organization processes to train and assess team performance. During the past 24 months, our research team has conducted nearly 40 in situ simulations. In this article, we present the results from 1 such simulation: a patient who experienced a difficult labor that resulted in an emergency caesarian section and hysterectomy. During the simulation, a number of latent environmental threats to safety were identified. This article presents the latent threats and the steps that the hospital has taken to remedy them.

Using In Situ Simulation to Identify and Resolve Latent Environmental Threats to Patient Safety

Since the publication of To Err is Human, health care professionals have looked to high-reliability industries such as commercial aviation for guidance on improving system safety. One of the most widely adopted aviation-derived approaches is simulation-based team training, also known as crew resource management (CRM) training. In the health care domain, CRM training often takes place in custom-built simulation laboratories that are designed to replicate operating rooms or labor and delivery rooms. Unlike these traditional CRM training programs, in situ simulation occurs on actual patient care units, involves actual health care team members, and uses actual organization processes to train and assess team performance. During the past 24 months, our research team has conducted nearly 40 in situ simulations. In this paper, we present the results from one such simulation: a patient who experienced a difficult labor and delivery resulting in an emergency caesarean section and a hysterectomy. During the simulation, a number of latent environmental threats to safety were identified. The following article presents not only the latent threats but also the steps that the hospital has taken to remedy them. Results from clinical simulations in operational health care settings can help identify and resolve latent environmental threats to patient safety.

국내 원자력발전소 인적오류 저감을 위한 Crew Resource Management 교육훈련체계 개발

The nuclear power industry in the world has recognized the importance of integrating non-technical and team skills training with the technical training given to its control room operators to reduce human errors since the Three Mile Island and Chernobyl accidents. The Nuclear power plant (NPP) industry in Korea has been also making efforts to reduce the human errors which largely have contributed to 120 nuclear reactor trips from the year 2001 to 2006. The Crew Resource Management (CRM) training was one of the efforts to reduce the human errors in the nuclear power industry. The CRM was developed as a response to new insights into the causes of aircraft accidents which followed from the introduction of flight recorders and cockpit voice recorders into modern jet aircraft. The CRM first became widely used in the commercial airline industry, but military aviation, shipboard crews, medical and surgical teams, offshore oil crews, and other highconsequence, high-risk, time-critical industry teams soon followed. This study aims to develop a CRM training program that helps to improve plant performance by reducing the number of reactor trips caused by the operators' errors in Korean NPP. The program is; firstly, based on the work we conducted to develop a human factors training from the applications to the Nuclear Power Plant; secondly, based on a number of guidelines from the current practicable literature; thirdly, focused on team skills, such as leadership, situational awareness, teamwork, and communication, which have been widely known to be critical for improving the operational performance and reducing human errors in Korean NPPs; lastly, similar to the event-based training approach that many researchers have applied in other domains: aircraft, medical operations, railroads, and offshore oilrigs. We conducted an experiment to test effectiveness of the CRM training program in a condition of simulated control room also. We found that the program made the operators' attitudes and behaviors be improved positively from the experimental results. The more implications of the finding were discussed further in detail.

Crew Resource Management in Healthcare

The crew resource management training program was developed by the aviation industry in response to critical and fatal errors by the flight team. This article examines the evolution and application of crew resource management to the healthcare industry. The goal of this evolution was to increase patient safety through better communication and teamwork. To accomplish this goal, teamwork training programs, such as MedTeams, are being introduced to healthcare professionals. Clinical studies have yet to show conclusive results of these training programs. Further studies are ongoing and necessary.

Development and Pilot Testing of Crew Resource Management Training Program for Railroad Industry

Between 2001 and 2005, a research team at the Texas Transportation Institute worked with FRA and the BNSF Railway (formerly the Burlington Northern Santa Fe Railway) to develop a training course in improved crew resource management (CRM) for use in the U.S. rail industry. Initial tasks included site visits to a cross section of railroad types in various U.S. locations, identification of railroad team makeup and tasks, and classification of railroad teams. Subsequent tasks included the design and pilot implementation of a CRM training course at various locations on the BNSF Railway. The course was designed to be used for training a variety of railroad crafts in technical proficiency, situational awareness, communications, teamwork, and assertiveness. There were 186 railroad workers trained during the pilot testing program, with positive employee response to the course materials and content.

Crew Resource Management Training and Young Driver Safety

Compared to other age groups, young novice drivers have a higher risk of being involved in road crashes. Recent research has indicated that, depending on certain passenger and driver characteristics, passengers can have either a positive or negative influence on driver behaviour and also that the principles of Crew Resource Management (CRM) training might be beneficial in addressing some of the problems associated with young driver behaviour when in the presence of passengers. This paper describes a program of research that was undertaken in order to investigate the potential application of CRM training principles within young driver training programs in the Australian Capital Territory (ACT), a jurisdiction located in South-East Australia. The findings indicate that the application of CRM principles within young driver training is a viable concept to pursue, and that such interventions have the potential to significantly enhance the positive, and reduce the negative effects of passengers on young driver behaviour. In conclusion to this research, a set of recommendations for the development of an ACT-based trial young driver CRM training program are proposed, and recommendations for further research regarding CRM and driver training are discussed.

U.S. Navy/Marine Corps CRM Training: Separating Theory from Reality

The breakdown or failure of crew resource management (CRM) has been cited as a causal factor in a large number of civilian and military aviation accidents. However, a recent review of the literature has revealed that many of the CRM concepts currently being trained are unrelated and/or unclear, making it difficult to determine the effectiveness of existing CRM training programs. The U.S. Navy/Marine Corps are no different. In an effort to determine the critical skills that should be taught, we examined U.S. Navy/Marine Corps Class A aviation accident data between 1990 and 2000 for CRM failures. In this study, 275 U.S. Naval aviation CRM failures were examined to identify those critical to safety in U.S. Naval aviation. Of the six CRM failures identified, the failure to conduct an adequate brief and the lack of communication accounted for over 50% of the failures examined, suggesting the importance of these areas when training CRM.

Team training in the skies: does crew resource management (CRM) training work?

The aviation community has invested great amounts of money and effort into crew resource management (CRM) training. Using D. L. Kirkpatrick's (1976) framework for evaluating training, we reviewed 58 published accounts of CRM training to determine its effectiveness within aviation. Results indicated that CRM training generally produced positive reactions, enhanced learning, and promoted desired behavioral changes. However, we cannot ascertain whether CRM has an effect on an organization's bottom line (i.e., safety). We discuss the state of the literature with regard to evaluation of CRM training programs and, as a result, call for the need to conduct systematic, multilevel evaluation efforts that will show the true effectiveness of CRM training. As many evaluations do not collect data across levels (as suggested by D. L. Kirkpatrick, 1976, and by G. M. Alliger, S. I. Tannenbaum, W. Bennett, Jr., & H. Traver, 1997), the impact of CRM cannot be truly determined; thus more and better evaluations are needed and should be demanded.

Can Applied Research Help Naval Aviation?: Lessons Learned Implementing Crew Resource Management Training in the Navy

One challenge for applied training research is to effectively balance the need to deliver a product to meet operational requirements with the need for scientific rigor. In this article we document an applied research effort and offer lessons learned from balancing science and operational necessity while meeting naval aviation's crew resource management (CRM) training requirements. Specifically, in 1990, 60%-80% of all accidents in naval aviation were due to human error. In an effort to reduce accidents attributable to poor aircrew coordination, a program of training research was conducted. Research involving empirical and field investigations was performed and the result was strategies, methods, and tools that supported CRM training. The success of this applied training research resulted in a methodology for the design, development, and evaluation of CRM training programs for naval aviation. The methodology was used as the basis for required annual CRM training throughout naval aviation. This article disc...

The Design and Delivery of Crew Resource Management Training: Exploiting Available Resources

Despite widespread acceptance throughout commercial and military settings, crew resource management (CRM) training programs have not escaped doubts about their effectiveness. The current state of CRM training is an example of how an entire body of pertinent research and development has not had the impact on practice that it could. In this paper we outline additional resources (i.e., principles, information, findings, and guidelines) from the team training and training effectiveness research literatures that can be used to improve the design and delivery of CRM training. Some of the resources discussed include knowledge about training effectiveness, training teamwork-related skills, scenario design, and performance measurement. We conclude with a discussion of emerging resources as well as those that need to be developed. The purpose of this paper is to provide the CRM training developer with better access to resources that can be applied to the design and delivery of CRM training programs.

Enhancing transfer of training: using role-play to foster teamwork in the cockpit.

Role-plays serve a unique purpose in providing practice and feedback for aircrew team development training in the classroom. When compared with other training strategies, role-play provides targeted practice and feedback of specific behaviors at low cost, with the trade-off being the amount of fidelity it provides. This article presents guidelines for designing role-plays to elicit crew resource management (CRM) behaviors and providing feedback to trainees on their performance. Through careful design procedures, a role-play exercise can provide both targeted practice and feedback and serve a useful purpose in the overall training design of a CRM training program.

Evaluating a Maintenance Crew Resource Management Training Program; Effects on Attitudes, Behaviors, and Performance

A Crew Resource Management program for maintenance personnel has been developed by an airline company which involves several team related concepts. Technical operations managers' pre and post-training attitudes and their follow-up attitudes (2, 6 and 12 months afterwards) concerning a variety of management and organizational factors were compared with one another as well as with maintenance performance measures. Comparisons of participants' attitudes before and after their training showed a significant improvement in attitudes indicators and these attitudes remained stable overtime. Positive trends for two of the maintenance performance indicators are demonstrated in comparing pre and post training performance measures. Increased safety and improved on-time performance was found related to improved attitudes about participation and assertive communication. Open ended responses as well as anecdotal evidence confirms the positive changes in attitudes and behaviors.