The effects of crew resource management on teamwork and safety climate at Veterans Health Administration facilities

Abstract

Communication failure is a significant source of adverse events in health care and a leading root cause of sentinel events reported to the Joint Commission. The Veterans Health Administration National Center for Patient Safety established Clinical Team Training (CTT) as a comprehensive program to enhance patient safety and to improve communication and teamwork among health care professionals. CTT is based on techniques used in aviation's Crew Resource Management (CRM) training. The aviation industry has reached a significant safety record in large part related to the culture change generated by CRM and sustained by its recurrent implementation. This article focuses on the improvement of communication, teamwork, and patient safety by utilizing a standardized, CRM-based, interprofessional, immersive training in diverse clinical areas. The Teamwork and Safety Climate Questionnaire was used to evaluate safety climate before and after CTT. The scores for all of the 27 questions on the questionnaire showed an increase from baseline to 12 months, and 11 of those increases were statistically significant. A recurrent training is recommended to maintain the positive outcomes. CTT enhances patient safety and reduces risk of patient harm by improving teamwork and facilitating clear, concise, specific and timely communication among health care professionals.

Acting between Checklists and Reality. Managers’ Balancing between Standardization and Adaptive Behaviour in Patient Safety Work- an Interview Study

“…Another study from the Veteran Administration hospitals report similar findings; they suggest that the improvement in participants' perception or belief that their specific facilities were doing more for patient safety than they had was linked to that the staff that participated in the team training interventions knew, observed, and /or understood that their leadership supported efforts to enhance patient safety in their clinical units [15].…”

“…The VA hospitals highlight briefing as a mechanism of communication before the start of shifts or procedures in clinical areas became part of the team's standardized communication [15]. Being present at daily meetings and in daily work is highlighted also by the managers in this study [15].…”

Failure to rescue and 30‐day in‐hospital mortality in hospitals with and without crew‐resource‐management safety training

“…For example, an on-line module could be developed as required annual training for staff (Hughes et al, 2014). In studies of organizations after implementation of CRM, several researchers have found that without reinforcement and refresher training, staff experienced backsliding into previous behaviors (Kuy & Romero, 2017;Schwartz et al, 2018).…”

“…While one additional study demonstrated a link between nursing units’ whose organization underwent safety training and decreased mortality rates (Thomas & Lomas, ), another study did not find an association between safety training and mortality after acute myocardial infarction (Shahian, Liu, Rossi, Mort & Normand, ). Schwartz and colleges implemented CRM immersive training at veteran's administration facilities and found that participating in the training improved communication, teamwork, and situational awareness for patient safety among workers (Schwartz et al, ). To the authors’ knowledge, no studies have investigated the link between comprehensive CRM training and the patient outcomes of FTR and inpatient mortality.…”

“…Schwartz and colleges implemented CRM immersive training at veteran's administration facilities and found that participating in the training improved communication, teamwork, and situational awareness for patient safety among workers (Schwartz et al, 2018). To the authors' knowledge, no studies have investigated the link between comprehensive CRM training and the patient outcomes of FTR and inpatient mortality.…”