Crew resource management, defined as effective utilization of all available equipment and people to carry out safe, efficient flight operations,27 is a term introduced in the aviation industry during a NASA workshop in 1979. It was designed as a training program to improve air safety and reduce the increasing number of fatal accidents attributable to human error.28 When errors were analyzed, they were mainly attributed to failure of interpersonal communication, leadership, and decision-making. The same principle can be applied to the medical field where it is called crisis resource management (CRM). Health care industry has now recognized the importance of this training and is slowly and steadily incorporating it into different subspecialties. The traditional medical curriculum does not lay emphasis on nonclinical skills such as communication, leadership, and team building. Now, with human errors being linked to inadequate nonclinical skills, importance has been given for developing and maintaining these skills by simulation training.
How can one evaluate and measure CRM skills? Two validated scales in critical care are the Ottawa Global Rating Scale (GRS) and Mayo High Performance Teamwork Scale (MHPTS).29 In their study, Kim et al30 had first- and third-year residents participating in two simulator scenarios, recreating emergencies in acute care settings, and were evaluated using the Ottawa GRS by three different evaluators. With his results, Kim found acceptable inter-rater reliability and validated the Ottawa GRS to evaluate CRM performance during high-fidelity simulations.
Malec et al30 performed a study to develop and evaluate a scale for assessing teamwork skills in simulated settings. He developed the MHPTS and found that it provides a brief, reliable, and practical measure of CRM skills that can be used by participants in CRM training to reflect on and evaluate their performance as a team.
CRM involves leadership, problem solving, situational awareness, resource utilization, and communication skills. CRM is extremely important for patient safety but is not covered in the traditional learning curriculum. In order to master CRM skills, one has to practice them repeatedly in simulated sessions. Figure 75–6 illustrates how simulation helps improve different skill sets to achieve patient safety.
Combination of clinical and nonclinical skills for patient safety. (Data from Driskel JE, Adams RJ: Crew Resource Management: An Introductory Handbook, August 1992. U.S. Department of Transportation. Federal Aviation Administration.)