Page 134 - HA Convention 2015

Symposiums

S2.3 Crew Resources Management 10:45 Convention Hall A

Tuesday, 19 May Are We Growing What We Need? The Crew Resource Management Seeds
Cheng BCP
Department of Anaesthesia and Intensive Care, Tuen Mun Hospital, Hong Kong

Crew Resource Management (CRM) was first introduced within aviation to tackle problems related to teamwork and the
resulting safety issues. And it is known for its effectiveness over the past two decades.

The CRM concept has undergone five major phases of evolution before it became the error management model nowadays.
With the gaining adoption of CRM as a worthwhile team-training approach in high risk industries, the healthcare community
was not spared. In 1999, the Institute of Medicine (IOM) report, To Err Is Human: Building a Safer Health System,
recommended CRM as a concept that should be incorporated in healthcare practice to enhance patient safety. This
recommendation was further emphasised by IOM in its follow-up report in 2001, Crossing the Quality Chasm and vast
resources were poured in for CRM development in healthcare industry.

In Hong Kong, CRM concept has been introduced as discrete principles since 2001, like “Situation, Background, Assessment
and Recommendation” (SBAR) and Speak-up Culture, which was further developed into systematic classroom-based
training programme in Pamela Youde Nethersole Eastern Hospital in 2009. In 2013, CRM training was incorporated with
simulation and rolled out in Queen Elizabeth Hospital and Tuen Mun Hospital. To put forth CRM training, support from senior
management was inevitable. To make it sustainable, a passionate CRM team was the lead to success. Following these was
the on-going assessment for improvement and cross-checking with the organisational goals.

Over the years, various evaluation of CRM training revealed that CRM brought about improved attitudes towards teamwork
and safety, improved team behaviour, better communication and collaboration. All these were subjective outcomes with
reference to the reaction data commonly collected in evaluations.

However, training evaluation is, in fact, multi-dimentional.

According to Kirkpatrick’s (1976) typology, there were four levels of training evaluation, namely reactions, learning, behaviour
and results. For behaviour, we pinpointed the extent of performance change. As for results, we assessed the degree of
impact on organisational effectiveness or mission success. Therefore, safety attitude or culture is not our destiny. CRM
seeds were planted within the workplace.

We are looking for behavioural change and healthcare safety.

In aviation, a drastic drop in accidents and fatalities was measured as an objective outcome. And, what do we measure for
our healthcare industry?

It took two decades for CRM to be proven successful in the skies. By the same principle, should we expect the same in
healthcare in 20-year time?

In five-year time, we are supposed to know the answer. What will we harvest with this CRM seeds in 2020?

HOSPITAL AUTHORITY CONVENTION 2015

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