From the staff development bookshelf: Crew resource management in healthcare leadership

Staff Development Weekly: Insight on Evidence-Based Practice in Education, June 8, 2012

Part of the early mantra of crew resource management (CRM) was “authority with participation.” This correctly implies that authority is not weakened by team involvement, but enhanced. This one statement, if truly accepted in healthcare, would go a long way toward preventing harm to our patients. However, we know that on many fronts in healthcare, and certainly within the nursing experience, ego, rigid authority, and inappropriate behavior serve to mitigate and drive away resources. This is a cultural constant and places patients in danger. Here are some examples:

  • A surgeon avoids actively conferring with an anesthesiologist and OR team when deciding whether  to continue a complicated case
  • A nurse refuses to seek advice from other staff nurses when unsure about how to respond to unexplained changes in a patient's assessment
  • An ER physician is slow to accept help after several failed attempts at intubation
  • An intensivist dismisses suggestions from an ICU nurse regarding a patient's medication regimen because the physician feels that "a nurse should not tell him how to practice medicine"
  • A staff nurse on a medical unit fails to accept input from a nurse's aide about a change in a patient's neurological assessment
  • A chief nursing officer decides to add bed capacity to a step-down unit but never seeks input from the manager of the unit

In each of these examples, individuals are focusing heavily on themselves, not on the resources around them. In healthcare we focus heavily on competence, as we should. However, when we focus so much on individual competence and performance that we expect perfection, harshly judging the skill set of practitioners needing help in clinical situations, we do so at the patient's peril.

Book excerpt adapted from Soaring to Success: Taking Crew Resource Management from the Cockpit to the Nursing Unit by Gary L. Sculli, RN, MSN, ATP, and David M. Sine, MA, ARM, CSP, CPHRM.

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