High-reliability organisations are those, such as within the aviation industry, which operate in complex, hazardous environments and yet despite this are able to balance safety and effectiveness. Crew resource management (CRM) training is used to improve the non-technical skills of aviation crews and other high-reliability teams. To date, CRM within the health sector has been restricted to use with "crisis teams" and "crisis events". The purpose of this discussion paper is to examine the application of CRM to acute, ward-based multidisciplinary health care teams and more broadly to argue for the repositioning of health-based CRM to address effective everyday function, of which "crisis events" form just one part. It is argued that CRM methodology could be applied to evaluate ward-based health care teams and design nontechnical skills training to increase their efficacy, promote better patient outcomes, and facilitate a range of positive personal and organisational level ALTHOUGH CONSIDERABLE WORK has been undertaken within other industries, a sound theoretical basis for team work in the health care sector is still emerging. Group structures persist within the workplace because they improve the working environment of employees and because results obtained 5 and decisions made 7 within the group context are often superior to those of Evaluating multidisciplinary health care teams: taking the crisis out of CRM
Gigi SuttonWhat is known about the topic? Crew resource management (CRM) training programs emerged in the 1980s to improve the non-technical skills of aviation crews 1 and other high-reliability teams by addressing skills which do not relate directly to clinical or psychomotor skills, but to cognitive and interpersonal skills that impact on team processes. The earliest adaptation of crew to crisis resource management within the field of health focused on high-reliability teams working within "crisis" units of intensive care, operating rooms and emergency rooms. 2,3 To date, application of CRM has not extended to health care teams operating outside a "crisis" environment.
What does this paper add?This discussion paper identifies a gap in team evaluation and training methodology, and positions CRM as a meaningful framework to guide the development of assessment and training tools for use with multidisciplinary ward-based health care teams, hereafter referred to as ward teams. Secondly, the paper compares and contrasts ward teams and "crisis" teams and highlights the need to develop domain-specific evaluation tools for acute, non-crisis health care teams. Finally, I assert the need for all health care teams to focus on the acquisition of nontechnical skills required for effective everyday function beyond the time-limited crisis.
What are the implications for practitioners?To improve the effectiveness of ward teams, change agents need to develop a better understanding of the way in which team effectiveness can be operationalised within acute health care team settings by drawing on behavioural marker method...