patient safetyHealth care professionals work in a complex environment. Care of patients in high-acuity areas, such as intensive care units, emergency rooms, operating rooms, and labor and delivery suites, require the constant input of expertise from individuals with varying backgrounds and training.  Anesthesiologists, nurses, surgeons, pediatricians, intensivists, respiratory therapists, attendants, and technicians need to work with each other to deliver care in the safest possible manner.  Yet, when these highly qualified individuals train in their formative years, hardly any attention is spent on role crossover and they often do not have a clear appreciation of each other’s priorities and responsibilities. Health care professionals have long been ingrained to function as responsible individual experts taking responsibility, credit, and blame for individual actions.

The CRM model focuses on the safety, efficiency, and morale of humans working together.  CRM training is an international requirement for nearly all aviation employees.  CRM has moved aviation training beyond the limited focus of technical flying to broader dimensions of human factors engineering, fatigue and stress management, effective communication, shared awareness, and teamwork.  Airline crew members consistently cite CRM training as relevant, useful, and effective in changing attitudes and behaviors to improve safety.

Cross-sectional surveys have demonstrated that safety-related behaviors applied and studied extensively in aviation may also be relevant in health care.  Researchers have proposed a translation of teamwork behaviors from aviation to health care by the application of “countermeasures”—briefings, debriefings, standardized communication language and process, workload distribution, fatigue management, inquiry, graded assertiveness, contingency planning, and conflict resolution—introduced in CRM training.

CRM applications in a simulated work environment have been applied in ORs, labor and delivery units for neonatal resuscitation, and hospital emergency departments (EDs).  CRM training has been undertaken for multiple medical disciplines in large health systems with great success.

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