workshop crew resource management › london › wp-content › ... · 2017-05-11 · workshop...
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Workshop
Creating situational awareness
with Crew Resource
Management
Ada van den Bos, Cynthia van der Starre
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Aim workshop:
• Understanding CRM principles and teamwork training
• How to make teamwork training an ongoing process
• How to determine what is needed to improve teamwork
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Crew Resource Management
• From the world of aviation
• Insufficient communication and teamwork
among team members contributed to
causing incidents in 70% of cases
• Awareness/training of team members a
significant improvement
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“A Team of experts does not make an
expert team”
(Burke et al. 2004)
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Teamtraining works!
OR Teamwork Climate and Postoperative Sepsis Rates
(per 1000 discharges)
Group Mean
Low Teamwork
ClimateMid Teamwork
Climate
High Teamwork
Climate
0
2
4
6
8
10
12
14
16
18
AHRQ National Average
Teamwork Climate Based on Safety Attitudes Questionnaire
Low High
1
1.2
1.4
1.6
1.8
2
2.2
2.4
June July August Sept Oct Nov Dec Jan Feb March April May
Avg
. Len
gth
of
Sta
y (
days)
Time on the ICU after Team Training
Indemnity Experience
20
11
0
5
10
15
20
25
Malpractice Claims, Suits, and Observations
Pre-Teamwork Training Post-Teamwork Training
Adverse Outcomes
50%
Reduction
50%
Reduction
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Problems in healthcare:
Situations are:
• Sudden
• Unexpected
• Hazardous to the patient
Contributing factors:
• Time constraints
• Stress
• Insecurity
• Team processes
• Organizational flaws
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What is needed to improve teamwork?
• Training (CRM, simulation)
• Knowledge of systems approach of errors (why do things go wrong?)
• Inventory of (near-)incidents and risks that threaten teamwork
• Using this info to select goals and devise improvement plans
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Crew Resource Management
What is it?
• with a view on integrated ‘team situational awareness’ ,
• as a basis for solid decision-making and well-considered
coordination of efforts , and
• as part of the professional standard
• the ambition to reach optimal exchange of information
between team members
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Crew Resource Management
In practice:
The effective use of all available resources within the team
and in the working environment (team members, equipment
and ancillary facilities) that enables the team to work safely
and efficiently…
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Elements CRM- training :
Information-management
Communication
Stress
management
Group processes
Leadership
Decision-making
Risk management
Patient
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Information management: situational awareness
Situational awareness is an interpretation of the world around
us and is no more than a MODEL of reality: NOT reality itself!
Thus there is always a risk of errors or lacunas!
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Information management: situational awareness
Data storageFrame of
reference
Long term memory
Short term memory
Information DecisionMental
processing
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Information processing:
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Effective communication
• Effective communication is goal-oriented
• Within CRM: aimed at creating and maintaining (team)
situational awareness and performing activities
• The basis for making the right decision in an unexpected
situation
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Stress management
• Planning and preparation
• Compliance with protocols and checklists
• Team discussions
• Postpone unimportant things
• Be clear and honest
• If you have stress, please do tell!
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Group processes
• Becoming aware of the effects of being a group member on
one’s own behavior and that of others
• Recognizing group effects
• Recognizing/preventing group thinking
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Leadership
• Effective leadership
• Good followership
• Leadership models:
Situational leadership
Daily leadership
• Team leader tasks
• Personality and individual differences
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Effective leadership
Features of effective leadership
• Setting goals
• Steering of activities
• Supporting, motivating, stimulating
• Providing feedback
• Making decisions
• Considering task requirements, individual needs, and
group needs
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Decision-making
• How optimal decision-making is achieved
• How decision-making proceeds under time pressure/stress
• Recognizing risks for the decision-making process
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Risk management
• Tailored for each department / unit / hospital
• Monitoring risks through:
• Blame free reporting of (near-)incidents
• Assessing protocol violations
• Multidisciplinary meetings
• Monitoring adverse events
• Stimulating information updates in reports, newsletters, etc.
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Quality and Patient Safety Management
System & structure
Monitoring Cultuur
Improvement interventions
Teamwork
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Who’s in the team?
“What is the matter?”
“What matters to you?”
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Elements CRM- training :
Information-management
Communication
Stress
management
Group processes
Leadership
Decision-making
Risk management
Patient
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Turn training activities into an ongoing process
• CRM basic training (2 days)
• CRM advanced training (every 2 years / 1day)
• Team simulation training (yearly / 1 day)
Safety Climate indicator: Safety Attitudes Questionnaire
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Assignment
For each table:
Organise your team
Identify CRM elements in “Just an oridnary day” (movie)
Write down 3 “tops” related to CRM items: what went extremely well?
Write down 3 “tips”: what should be improved/changed?
Come up with 3 recommendations to prevent this “never event”
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Creating teams
1. Choose one of the colored cards on your table
2. Search the table with that color
3. Organise your team
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Assignment
For each table:
Organise your team
Identify CRM elements in “Just an oridnary day” (movie)
Write down 3 “tops” related to CRM items: what went extremely well?
Write down 3 “tips”: what should be improved/changed?
Come up with 3 recommendations to prevent this “never event”
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Plenary feedback
Top 3 recommendations:
Why?
How?
….
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recommendations
• standard operating procedures and guidelines (stressmanagement )
• ensuring valid and up-to-date training (teamtraining)
• effective communication (communication, decision making,
leadership)
• medication safety ( 6 R’s, TOP)
• patient engagement