Better Teamwork Means Better Outcomes
An Overview of CRM, the Heart of the Award-Winning Initiative
CRM stands for Crew Resource Management. CRM originated in 1979 from a NASA workshop that focused on improving air safety. NASA research found that improving teamwork and interpersonal communication in high stress and high risk environments would significantly reduce the number of air crashes.
At the participating CHS hospitals, team training was provided to a core group of clinicians who then instructed every nurse, obstetrician, anesthesiologist and neonatologist on the service at each of the 3 hospitals. In total, 235 staff members were trained. Staff training focused on creating a culture where all staff members feel empowered to speak up if they believe a situation may jeopardize patient safety, while emphasizing safety procedures, efficiency, and teamwork.
Each unit adopted the core principles around communication, team structure, situation monitoring, mutual support and team behavior, including team rounding and huddles on each patient incident, debriefing and emergency drills. Nursing staff was encouraged to invoke the two-challenge rule, where they would be responsible for assertively but respectfully voicing concerns about a patient care situation at least two times to ensure they have been heard. If an issue remains unresolved, the nurse would then contact a supervisor in the chain of command.
The Results: Better Outcomes, Safer Babies
- Adverse events were reduced between 26 and 42%.
- Severity index of events dropped between 9 and 17%
- Malpractice claims were reduced by 66%
- Unexpected admission to NICU dropped by over 60%
- Staff perception of safety culture increased 50%
- Results have been sustained over 36 months
- After initial training expenses no additional costs have been incurred