CRM and CRM and ChecklistsChecklists

Robert S. BarrettRobert S. BarrettSureSurgery Inc.SureSurgery Inc.

GreenDot Global Inc.GreenDot Global Inc.

CRM RefresherCRM Refresher

Management philosophyManagement philosophy Focus Focus notnot on technical skills but on technical skills but

interpersonal, leadership, and teaminterpersonal, leadership, and team Use all available resources for the Use all available resources for the

best decision possiblebest decision possible Open communication and Open communication and

inclusiveness to improve situational inclusiveness to improve situational awarenessawareness

Reminder of human fallibility (fatigue)Reminder of human fallibility (fatigue)

Preliminary findings in Preliminary findings in observing neurosurgical OR observing neurosurgical OR Little or no formal ‘briefing/debriefing’Little or no formal ‘briefing/debriefing’ Little ‘overt’ redundancy checkingLittle ‘overt’ redundancy checking Several misunderstood/unacknowledged Several misunderstood/unacknowledged

communicationscommunications Extraneous conversation during ‘critical phases’Extraneous conversation during ‘critical phases’ Little preparedness for mechanical equipment failuresLittle preparedness for mechanical equipment failures ‘‘Broken Window Effect’ was present (once lax Broken Window Effect’ was present (once lax

procedures start they tend to form the new norm)procedures start they tend to form the new norm) Some tension regarding “power” within team unitSome tension regarding “power” within team unit Lack of ‘handover’ procedures for shift changesLack of ‘handover’ procedures for shift changes

(Louw, D; Barrett, R..; Brien, S.; Kopp, G.)(Louw, D; Barrett, R..; Brien, S.; Kopp, G.)

Briefings and ChecklistsBriefings and Checklists

BRIEFINGSBRIEFINGS Reduce potential Reduce potential

error and omissionerror and omission Set the toneSet the tone Communicate plan Communicate plan

for any abnormal or for any abnormal or emergency situationemergency situation

Pass routine Pass routine information when information when necessarynecessary

CHECKLISTSCHECKLISTS Reduce/trap potential Reduce/trap potential

error and omissionerror and omission Build redundancyBuild redundancy Overcome Overcome

interpersonal interpersonal differences with SOPdifferences with SOP

Establish procedural Establish procedural flow and normsflow and norms

CRM and CRM and Briefing/Checklist UseBriefing/Checklist Use

IMPORTANT CONSIDERATIONS:IMPORTANT CONSIDERATIONS: Checklist types (flow; challenge-and-Checklist types (flow; challenge-and-

response; read-and-do; “I will – you will”)response; read-and-do; “I will – you will”) Ease of use (functional fit into normal flows)Ease of use (functional fit into normal flows) Division of labour (who reads? who actions?)Division of labour (who reads? who actions?) Compliance and Standards (monitoring)Compliance and Standards (monitoring) Pushback (threat to authority; group culture)Pushback (threat to authority; group culture) Feedback loops (system learning; reports)Feedback loops (system learning; reports)

General “CRM” General “CRM” GuidelinesGuidelinesWhere are we right now? Where are we right now?

Where are we going? Where are we going? What do we do if things go wrong?What do we do if things go wrong?

*situational awareness**situational awareness**shared commitment**shared commitment*

INTERPERSONAL AND TEAM PERFORMANCEINTERPERSONAL AND TEAM PERFORMANCE Set the toneSet the tone Clarify receptiveness (input from team)Clarify receptiveness (input from team) Review roles and responsibilities for normal, abnormal, and Review roles and responsibilities for normal, abnormal, and

emergency situationsemergency situations

LOSALOSA