Crew resource management training in healthcare: a systematic review of intervention design, training conditions and evaluation

Abstract

ObjectivesCrew resource management (CRM) training formats have become a popular method to increase patient safety by consideration of the role that human factors play in healthcare delivery. The purposes of this review were to identify what is subsumed under the label of CRM in a healthcare context and to determine how such training is delivered and evaluated.DesignSystematic review of published literature.Data sourcesPubMed, PsycINFO and ERIC were searched through 8 October 2018.Eligibility criteria for selecting studiesIndividually constructed interventions for healthcare staff that were labelled as CRM training, or described as based on CRM principles or on aviation-derived human factors training. Only studies reporting both an intervention and results were included.Data extraction and synthesisThe studies were examined and coded for relevant passages. Characteristics regarding intervention design, training conditions and evaluation methods were analysed and summarised both qualitatively and quantitatively.ResultsSixty-one interventions were included. 48% did not explain any keyword of their CRM intervention to a reproducible detail. Operating room teams and surgery, emergency medicine, intensive care unit staff and anaesthesiology came in contact most with a majority of the CRM interventions delivered in a 1-day or half-day format. Trainer qualification is reported seldomly. Evaluation methods and levels display strong variation.ConclusionsCritical topics were identified for the CRM training community and include the following: the need to agree on common terms and definitions for CRM in healthcare, standards of good practice for reporting CRM interventions and their effects, as well as the need for more research to establish non-educational criteria for success in the implementation of CRM in healthcare organisations.

Reporting Complex Multidisciplinary Healthcare Team Training Interventions: Development and Validation of a Checklist

“…Additionally, we do not include distinct levels for training outcome assessment (Kirkpatrick, 1994). Although only a few of the publications in our review used this approach for assessing the effectiveness of their interventions, we contend that such a comprehensive method for training evaluation should be regarded as a standard procedure (Gross et al, 2019).…”

“…Despite some attempts, this field is presumably too young for such distinctions (Husebo & Akerjordet, 2016). However, the need for improved classifications of teamwork development interventions was increased by recent reports discussing the wide variety of interpretations and jargon, which further impedes optimal reporting in publications (Gross et al, 2019). Therefore, we concur with West and Lyubovnikova (2013) that the 'team' concept must be viewed with some caution, since teams in healthcare can vary widely in, for example, skills, culture, task-focus, and temporal stability or 'fluidity'.…”

“…Since the publication of 'To Err is Human,' teamwork in healthcare has increasingly gained attention as a serious potential threat to patient safety (Kohn et al, 2000). Over the last 20 years, valuable knowledge and experience has increased in this area, most of which has been derived from aviation and other high-risk industries (Aron & Headrick, 2002;Helmreich et al, 1999;Gross et al, 2019;Rosenbaum, 2019). During this same period, TT has gradually become a standard in quality and safety schemes in healthcare (WHO, 2011; Weaver et al, 2014).…”

“…Additionally, we realized that the checklist's E3 ('Faculty') component overlapped somewhat with the D2 elements ('Facilitation'). While comprehensive multidisciplinary team training curricula, such as TS, are on the rise, healthcare organizations are increasingly applying customized 'self-made' approaches, using a variety of trainers, coaches, and other faculty members (Gross et al, 2019). We suggest that, due to the essential role of these individuals in teaching, coaching, and assisting others, the reports should describe their roles in detail, using both elements.…”

A Complex Teamwork Intervention in a Surgical Ward in Norway

“…Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) [15] was chosen as the team training program in this study. This generic program is one of a few standardized training and researchbased programs that address the impact of human factors on healthcare teams [16]. The program aims to optimize patient safety and the quality of care by enhancing team structure and four teamwork competencies; communication, leadership, situation monitoring, mutual support [17][18][19].…”