CREW RESOURCE CREW RESOURCE MANAGEMENT IN MEDICINEMANAGEMENT IN MEDICINE

John Pawlowski, MD, PhDJohn Pawlowski, MD, PhDBeth Israel Deaconess Medical CenterBeth Israel Deaconess Medical Center

Boston, MABoston, MA

CON: OutlineCON: Outline

It’s not a fad.It’s not a fad.It improves communication.It improves communication.It prevents accidents.It prevents accidents.It saves lives.It saves lives.

Definition: FadDefinition: Fad

A temporary fashion, notion, A temporary fashion, notion, manner of conduct.manner of conduct.

Definition*: Definition*: FadFad

A temporary fashion, notion, manner A temporary fashion, notion, manner of conduct.of conduct.From obsolete From obsolete faddlefaddle to play with, to play with, fondlefondle

* The Random House Dictionary, 2* The Random House Dictionary, 2ndnd Edition, Edition, UnabridgedUnabridged

Definition: Crew Resource Definition: Crew Resource ManagementManagement

= Team Training= Team Training= Crisis Resource Management= Crisis Resource Management= Safety Culture Training= Safety Culture Training= Root Cause Analysis= Root Cause Analysis= Error Management= Error Management= Human Factor Analysis= Human Factor Analysis

What is the number 1 reason for What is the number 1 reason for disasters?disasters?

Pilot ErrorPilot Error

Nuclear Power IndustryNuclear Power Industry

Why bother?Why bother?

Why Bother in Medicine?Why Bother in Medicine?

Not always Marcus Not always Marcus WelbyWelby, MD, MD

Data 1Data 1

Data 2Data 2

Data 3Data 3

Data 4Data 4

Data 5Data 5

Data 6Data 6

Swiss Cheese ModelSwiss Cheese Model

Errors are multipleErrors are multiple

FADFAD--10 by ELECOM Corp.10 by ELECOM Corp.

I GIVE UPI GIVE UP

Problems due to Problems due to communicationcommunicationMedical people Medical people communicatecommunicateThere are no There are no problemsproblems

RebuttalRebuttal

We don’t practiceWe don’t practiceWe don’t keep scoreWe don’t keep scoreWe rely on fadsWe rely on fads

See one, do one.See one, do one.

Hours of practice (total)Hours of practice (total)

NBA playerNBA player-- 10,000 hours10,000 hoursNHL playerNHL player-- 10,000 hours10,000 hoursSymphony musicianSymphony musician-- 10,000 hours10,000 hoursAstronautAstronaut-- 5,0005,000--10,000 hours10,000 hours

Hours of practice (total)Hours of practice (total)

ACLSACLS-- 6 hours6 hoursCentral line placementCentral line placement-- 1 hour1 hourAdvanced airway managementAdvanced airway management-- 1 1 hourhourEpidural placementEpidural placement-- 1 hour1 hour

Ace= 5 killsAce= 5 kills

Fads in MedicineFads in Medicine

VagotomyVagotomyFenFen--phenphenPTCAPTCACOXCOX--22

Not just a fadNot just a fad

ConclusionConclusion

–– And Crisis Resource Management CenterAnd Crisis Resource Management Center