Crew Resource Management in the Medical Field Research Paper

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Introduction

The genesis of Crew Resource Management can be traced back to a conference that was held in 1979. The conference dubbed Resource Management on the Flightdeck was held at the National Aeronautics and Space Administration. This particular conference conducted by NASA was aimed at looking at the increased rate of accidents in the aviation industry. During the meeting, human error was found to have contributed to most accidents in the industry. Some of the identified human errors were things like lack of good communication, inability to make decisions and lack of good leadership. The meeting adopted the idea of training crews in order to reduce human error by encouraging good communication in the cockpit. It was then that the label of Crew Resource Management was coined. The idea of CRM has evolved over the years from the initial meeting held in 1979. (Royal Aeronautical Society, 1999)

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Reason for the Creation of Crew Resource Management

The first-ever CRM program in the United States was carried out by United Airlines following the crash of United Airline Flight 173 in 1978. This training was developed with the help of experts who had helped to develop similar programs for companies that were trying to adopt managerial efficiency. The training was aimed at looking at how different people apply managerial skills in different settings. The program covered the different ways used by crewmembers in dealing with different scenarios. This was meant to avert a situation where juniors disrespect their seniors and another where seniors disregard their juniors. According to the National Transportation Safety Board (NTSB), the captain in the United Airline flight failed to acknowledge the advice of subordinate crewmembers. Alternatively, the flight engineer failed to assert his authority when he realized that the fuel level was low. (Solutions for safer skies, n.d.). Effective people should therefore learn that CRM involves everyone playing their role effectively. It is also important to learn that interpersonal behavior plays a key role in CRM applications. (Kern, 1998)

Even though the concept of Crew Resource Management can be traced back to the NASA meeting in 1979, it was the United Airline Flight 173 crash on December 28, 1978, that triggered this meeting. The flight that was en route from Denver to Portland crashed killing ten people and seriously injuring twenty-four others out of the more than 180 who were on the plane. According to reports, a loud bang was heard when the landing gear was disengaged. This caused the pilot to abort the landing and instead circled the vicinity in a bid to ascertain the problem. Though the bid to abort the landing has been lauded by experts, the preceding events became the catalyst that led to the adoption of Crew Resource Management. The captain and the crew of United Airline Flight 173 in a bid to ascertain the cause of the problem forgot about the fuel state of the plane leading to its crash. (Avweb, 1999) Lack of proper communication between the crewmembers was, therefore, the basis of the accident and therefore the need to establish Crew Resource Management. (Krause, 2003)

Development of Crew Resource Management

As mentioned at the outset, the initial CRM course conducted by United Airline was psychologically centered. Largely, the course tested people’s psychology and looked at people’s general characteristics such as effectiveness in leadership. These courses provided crewmembers with good interpersonal conduct but failed to show how such conduct could be used in the cockpit. It is important to mention once again that most of those conducting the research did not have knowledge about cockpit management having been drawn from other managerial fields. Initially, CRM was an event that took place once in the life of a pilot. However, this was changed with the passage of time to a yearly event. This was geared toward orienting pilots to the application of CRM. However, many pilots resisted these training sessions by viewing them as an attempt to manipulate their individuality. (Sanders, 1999)

From the 1979 meeting, NASA held another seminar for the aviation industry in the mid-1980s. By that time, many airlines had adopted CRM programs amongst themselves. The 1986 meeting was therefore used as a forum for these airlines to report on the success of their programs. Instead of carrying out CRM training as a different entity, this meeting resolved to carry out these programs together with the normal flight operations. By this time, the training had been expanded to incorporate specific flight operations instead of just dealing with interpersonal skills among crewmembers. Whereas the initial program emphasized maintaining respect among crewmembers, the new training focused more on the aspect of team building among crews. During seminars, the issues addressed included effective methods to manage stress, being aware of one’s situation, briefing strategies among other things. Pilots were also taught how to make on the spur decisions that would prevent errors that would possibly cause accidents. Just as their predecessors, these meetings relied on training from experts who did not have knowledge of aviation to demonstrate how pilots ought to behave. (Wickens, & Mavor, 1997)

The early 90s specifically saw CRM training changed to reflect how crewmembers were required to act in order to resolve aviation safety. Alternatively, many airlines began to incorporate manuals meant to promote flight safety in the design of planes. Unlike the earlier training those only involved crewmembers, the third-generation courses expanded to include airline attendants among other personnel on the outside. At this time, most airlines were as well conducting joint CRM training between cockpit and cabin crews. There was also special CRM training for pilots to reflect the enormous responsibility that came with this position. However, the third-generation training saw less emphasis put on the idea of human error reduction, which was the original idea for the adoption of Crew Resource Management. (Risukhin, 2001)

Toward the turn of the 20th century, the Federal Aviation Administration (FAA) introduced new rules that were meant to govern flight crews. In this new initiative, airlines were required to adopt training that only fit their specific needs. This has seen every airline adopting CRM training in their initial flight crew induction. Again, FAA came up with a law that stipulated that the people charged with certifying flight crews be provided with special training. This law has seen airlines adopt specific guidelines geared toward ensuring that crewmembers adopt behavior that guides them to make critical decisions in situations that are not within their normal range of operations. (Risukhin, 2001)

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Though the concept of CRM has aided in reducing aviation catastrophes, there are times when some people have taken it too far. An example of this can be the case where a captain decides to disregard the other crewmembers’ opinions just because of his position. On the other hand, the juniors might disregard the captain on some important decisions. A clear example of how some people can take CRM training far is by examining an accident that occurred to Airbus A300 Flight 2033 on August 10, 1994. The plane that was coming from Seoul to Jeju crashed just as it was approaching the runaway. This accident saw the plane become a write-off but luckily, no one was hurt. According to voice prompts from the ill-fated plane, the pilot and his co-pilot began to argue just as the plane was about to touch down. (Smith, 2001)

The co-pilot was of the opinion that there was not enough runaway for the plane to land while the pilot insisted that there was enough runaway. The co-pilot advised the captain to fly around and attempt a second landing but the captain was not for the idea. It was then that the first officer grabbed the throttle making the plane touch down some several thousand feet beyond the runaway. The plane burst into flames but miraculously no one was killed in the accident. This accident is a very good example of how some people can take the idea of CRM too far. (Smith, 2001)

According to the first phase of CRM, the pilot was the overall leader of all the crewmembers. This gave him absolute authority to lead the rest of the crew in decision-making. Alternatively, the rest of the crewmembers were supposed to respect the decisions made by the captain. However, by looking at Airbus A300 flight 2033, one is led to deduce that the pilot and the first officer took things too far. By looking at the accident, it is clear that the pilot was indeed approaching the runaway too fast. He should then have heeded his first officer’s advice to overfly the runaway. He would then have gotten a good opportunity to approach the run away at a moderate speed that would have enabled him to land safely. On the other hand, the co-pilot should have respected the authority of the pilot as the commanding officer. (Smith, 2001)

The Korean Airline A300 Flight 2033 can be traced to the lack of team-building between the crews. The pilot should have listened to the first officer’s advice since he had a point. By failing to listen to the co-pilot’s advice, it showed that there was no team building between the crews. Captains should be taught how to listen to the opinion of their juniors without necessary relinquishing their authority. The Korean Flight captain had an inferior complex mentality when it came to being addressed by his junior and that is probably why he did not want to cede ground. This issue should be addressed in Resource Crew Management courses. It is important to teach pilots that by heeding the advice of their juniors they will not be losing their authority. (Jensen, 1995, p. 120)

Crew Resource Management in Other Fields

Crew Resource Management is not just a concept that is used in the aviation industry only. Research has shown that Crew Resource Management can also be effectively used in the health industry. Some of the areas in aviation that can be compared to healthcare are issues like teamwork. Practicing medicine involves some complex incidences that require cooperation from every participant. Let us take an example of the operating table. This procedure takes the combined efforts of surgeons, nurses, anesthesiologists among other medical personnel. If for any reason these specialists do not work in tandem, they might create a big human error that might lead to loss of life or to more complications to a patient. (Kohn, Corrigan, & Donaldson, 2000)

Research that has been carried out on the subject has shown that there is minimal cooperation between medical personnel in the operation process. This often causes numerous problems during the process. Just like in the aviation industry, some senior surgeons disregard the advice given by those people whom they feel are their juniors. This is exactly the same scenario where captains feel that the advice of first and second officers does not count. This aspect of teamwork draws a great similarity between the two fields and hence the need for adopting Crew Resource Management courses in the health industry. This will in return reduce human error during some complex medical operations something that will in return save many lives. (Nemeth, 2008)

Another reason why the medical industry should learn from the aviation industry is the aspect of stress management. Just like in the aviation industry, there are times when surgeons are called to work under stress. These are moments like when an operation encounters some hurdles and has to run for long or in the case of complex operations like those of the brain. Since many people in this field do not know how to deal with stress in their life, it is important for this industry to come up with Crew Resource Management courses that would in return teach them how to deal with stress. (Kohn, Corrigan, & Donaldson, 2000)

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It is important for the medical field to have Crew Resource Management programmes in areas where human error can lead to accidents. Again, these areas include operations, labor wards and emergency rooms. One way that can be used to implement Crew Resource Management studies in the medical field is by using training programmes for personnel in this field. One way to carry out these programmes would be to have courses where medical personnel can be taught about CRM. In order to draw the relevance between aviation and the healthcare industries, it would be helpful to use plane mishaps to demonstrate how the two fields are linked. This can be achieved by the use of plane mishaps videos for a clear understanding. The best way that these training courses can be carried out is by inducting them together with the normal class medical studies. This would give CRM more influence and avoid a situation where surgeons especially those in senior positions feel that the courses play with their psychology. This would greatly help since medical personnel would perceive the CRM tutorials to be a part of their work ethics. This would greatly help since it would help overcome hurdles that were experienced during the initial stages of CRM courses in the aviation industry. (Kohn, Corrigan, & Donaldson, 2000)

In trying to come up with CRM courses for the health industry, many hurdles have to be considered and overcome. First, there are no clear guidelines to prove that CRM programmes really help to reduce human error in the health industry. This may make stakeholders lax in implementing the program within their organizations. Again, an adaptation of the CRM programmes requires a lot of money that many healthcare providers may not be prepared to give. This is because the CRM setting in healthcare requires every specific care setting to have tools that have been customized for exactly the same setting. Given the high cost of medical supplies, many health providers may not see the need to adopt Crew Resource Management courses. Again, these costs do not include the cost of hiring tutors among other overheads. This is compounded by the fact that usually no instant safety benefits following these precautions are observed. (Edmondson, Bohmer, & Pisan, 2001)

It is also important to consider the cultural shifts that are predominant in the health industry before setting up a CRM program. The idea of CRM is relatively new in healthcare. For a long time now, the medical field has only been focusing on developing technical efficiency instead of enabling human interaction. Despite the fact that effective communication and decision-making are pertinent issues in healthcare, there is very little that is said on the subject. This hurdle has to be overcome before effective CRM courses can be inducted into the medical field. It is important to ensure that the phenomenon where senior medical personnel feels that they are above their juniors is overcome before effective CRM courses can be carried out in the medical field. (Dekker, 2005)

It is more interesting to learn that mishaps caused by lack of CRM do not just happen in the aviation industry. History is explicit with accidents whose origin can be traced to poor or lack of Crew Resource Management. A good example of such an event is the sinking of the Titanic. On the morning of April 15, 1912, the world awoke to the shocking news that the Titanic had sunk the previous night. The Titanic was a ship that had been made close to perfection. In fact, analysts say that the Titanic was a symbol of man’s advancement in the 20th century. According to experts, the titanic had been so well built such that it could resist any kind of damage to its body. (Titanic Facts, 2005)

However, it is ironic that on the night of April 14, 1912, this claim was proved false. The real cause of the sinking is claimed to have been a collision with an iceberg. It is sad to learn that the accident of the Titanic could have been avoided had there been effective Crew Resource Management among its crew. Reports indicate that the officers had been warned of the possibility of the iceberg but they disregarded the reports. When the ship hit the iceberg, the crewmembers tried everything that was within their power but it was too late and the Titanic sank claiming 1500 lives. The most surprising thing is that most of the passengers in the ship did not know that the ship was sinking until the last moment. (Titanic Facts, 2005)

The sinking of the Titanic can be likened to an incident that happened at the Fairchild Air Base in Washington State. In the particular incident that happened on June 24, 1994, the pilot in command banked the plane dangerously in a bid to show off. This caused the death of all those on board. This incident can be likened to the incident that happened to the Titanic. Though it might not have been on exactly the same terms, it is important to note that indiscipline was the biggest cause of the accident. Reports indicate that the crew aboard the Titanic had been forewarned of the possibility of encountering an iceberg. However, due to the mentality that the ship was “unsinkable”, they went on with the journey, which culminated in a disaster that has been the worst so far in sea transport. It is therefore important to note that indiscipline is the main contributor to accidents both in aviation and in other transport sectors.. (Titanic Facts, 2005)

The accident that happened to the Titanic could have been averted if the crew had obeyed the warning signs and failed to take the journey. Again, if they could have navigated the waters slowly, this accident could not have happened. By choosing to plow n to the water at full speed, the Titanic did not have any alternative other than to sink once it hit the iceberg. The captain as the overall leader of the ship should have used his authority and failed to make the journey until the sea became clear. It is also interesting to learn that the crew did not alert the passengers that the Titanic was sinking. This deprived them of the precious opportunity to enter the lifeboats. It is a pity to learn that out of the 1500 lifeboats that were present at the Titanic, only 700 were used. This was exactly the number of those who survived. It then follows that if the crew had notified the passengers of the impending catastrophe, then many lives could have been saved. The accident that happened to the Titanic can be likened to United Airline Flight 173 where the lack of communication led to the death of many people. Again, this brings out the importance of communication in both flight and sea transport. (Titanic Facts, 2005)

Conclusion

The issue of Crew Resource Management has grown over the years. Since its inception, the program has undergone numerous changes towards its perfection. When the program was initially set up, it experienced a lot of resistance from captains who felt that the program was trying to change their psychology. Having seen these problems, most airlines changed these training programs and instead inducted them with the normal flight training programs. Though this scenario saw the program become more acceptable to most people, it altered the initial meaning, which was to avert human error in causing accidents.

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The idea of CRM incorporates team building, effective communication, the contribution of human factors, good leadership, maintaining discipline among other aspects. If properly used, these factors can go a long way in reducing accidents in the aviation industry. As the years go by, the idea of CRM is slowly being adopted into other fields such as the medical field. This is playing a big role in bettering the medical industry by avoiding mishaps that are caused by human error, lack of effective communication among other things caused by poor Crew Resource Management. It is also important to learn that history contains many accidents that were caused by poor CRM among its members. A good example of this is the accident that befell the Titanic where indiscipline and lack of proper communication among its crew caused an accident that has been the worst so far in sea transport. If the facts are considered, then we will all find that CRM goes a long way in minimizing or eliminating accidents caused by human error in the aviation industry among other spheres of life.

References List

Avweb. (1999).Close-up: United Airlines flight 173. Web.

Dekker, S. (2005). “Ten Questions about Human Error” Human Factors in Transportation. Routledge.

Edmondson, A, Bohmer, R, & Pisan G. (2001). Speeding up team learning. Harvard Business Review.

Jensen, R.S. (1995). ‘Crew resource management’ Pilot Judgment and Crew Resource Management. Aldershot, UK, Ashgate, pp 115–149.

Kern, T. (1998). “Flight Discipline”. McGraw Hill Professional.

Kohn, L.T, Corrigan, J.M, & Donaldson, M.S (Eds). (2000). To Err Is Human: Building a Safer Health System. Washington, DC, National Academy Press.

Krause, S. S. (2003). Aircraft safety: Accident investigations, analyses, and Applications. NewYork: McGraw-Hill Professional.

Nemeth, C.P. (2008). Improving healthcare team communication: building on Lessons from aviation and aerospace. New York: Ashgate Publishing, Ltd.

Risukhin, V. (2001). “Controlling Pilot Error” Automation. McGraw-Hill Professional.

Royal Aeronautical Society. (1999)Crew Resource Management. London, Web.

Sanders, J. (1999) , Study Of Cockpit Crews Finds Co-Pilots Use “Hints” To Correct Captains. Georgia Institute of Technology, Atlanta, Georgia, Web.

Smith, D. R. (2001). Controlling pilot error: Controlled flight into terrain (CFIT).New York: McGraw-Hill Professional. Solutions for safer skies. (n.d.).Investigation: united Airlines Flight 173. Web.

Titanic Facts. (2005). Web.

Wickens, C. D. & Mavor, A. S. (1997). Flight to the future: Human factors in air traffic control. Washington, DC: National Academies Press.

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