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2008 Annual Meeting Abstracts

Can Aviation Based Team Training Contribute to Sustainable Personal Empowerment?
Harry C. Sax, MD1, Patrick Browne2, Rebecca Burke, MSN3, Nancy Coelho3, Sandra Coletta, MBA3, Kathleen Hittner, MD1.
1Warren Alpert Medical School / Miriam Hospital, Providence, RI, USA, 2InDelta Learning, Rochester, NY, USA, 3Miriam Hospital, Providence, RI, USA.

Objective: Increased interest has focused on aviation-based crew resource management (CRM) training to improve the safety environment of hospitals by breaking down communication barriers across hierarchies and confronting unsafe conditions proactively. It is unclear if training leads to long term changes in personal empowerment, promoting a culture of safety.
Design/Setting: A free, dynamic, six hour multidisciplinary CRM course was offered on multiple occasions at a teaching hospital. Topics included CRM rationale, error chains, communications, hierarchies, briefings and debriefings, and checklists. Participants received CEUs, paid time, and malpractice premium reductions. Prospective surveys measured personal attitudes (“How comfortable are you..?”; 1-4 scale) immediately before the course, at its conclusion, and two months later.
Main Outcome Measures: Results are mean (SD), analyzed by ANOVA with Tukey HSD procedure, maintaining alpha =0.05. N = 276 pre, 242 post, 140 2 months post. *<0.05 vs Pre, ^<0.05 vs Post. Initial attitudes were lowest in areas of communication barriers and confronting mistakes/ incompetence. Training had an immediate, significant increase in personal empowerment in all 10 realms. This was sustained at 2 months, however downward trends were seen in communication environment and addressing performance issues in a medical hierarchy.
QuestionPrePost2 mos
knowing institution committed to safety3.4(0.1)3.6(0.6)*3.7(0.6)*
knowing institution committed to breaking down communication barriers2.8(1.1)3.5(0.6)*3.4(0.)*
identifying and eliminating barriers to communication3.1(0.8)3.5(0.6)*3.4(0.7)*
communicating that, in your opinion, an error is about to occur3.0(0.8)3.4(0.6)*3.6(0.6)*
effectively confronting mistakes/ incompetence in a technician2.8(1.0)3.7(0.8)*3.4(0.7)*
effectively confronting mistakes/incompetence in a nurse2.8(0.9)3.3(0.7)*3.4(0.7)*
effectively confronting mistakes/incompetence in a physician2.8(0.9)3.2(0.7)*3.1(0.8)*
taking on a leadership role in a team setting3.0(0.8)3.4(0.7)*3.6(0.7)*^
developing a checklist for a critical process3.0(0.8)3.4(0.7)*3.5(0.6)*
knowing the concepts learned today will be applied long term3.3(0.8)3.5(0.7)*3.5(0.6)*

Conclusions: CRM programs are effective at increasing awareness and personal empowerment, the first steps in creating a “culture of safety.” Lower long term confidence in confronting incompetence in physicians suggests the need for continued interventions on an institutional level in this realm.


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