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High Reliability Healthcare: Applying CRM to High-Performing Teams, Part 6

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In this series, Steve Kreiser describes a model for applying aviation’s crew resource management to healthcare. This model incorporates different elements inherent in most CRM programs but has an additional benefit of including simple error prevention tools and techniques that help reduce human error. These seven tools, essentially a “people bundle” to make humans more reliable, can help individuals experience fewer errors while encouraging teams to catch and trap those errors that do still occur in complex systems. The series will continue on Tues. and Thurs. through Jan. 19.

Element #5 – Adaptability

Adaptability is all about working well with others and being flexible enough to adjust to changes in the situation or plan of care. Remaining flexible when new information becomes available is critical to making a team function well, especially during unplanned situations and emergencies. Covering these situations in a brief with good contingency planning is the best way to keep them from becoming a crisis later on. The ability to work well with others includes those times where there is an unexpected change in personnel, where then are strained interpersonal relationships, or even when there is a feeling that the performance of someone on the team is not meeting expectations. The proper time to address such issues – unless they pose an immediate safety concern – is afterwards in a debrief or one-on-one conversation.  Debriefs are just as important as the brief, and should be open and honest – providing positive feedback and constructive criticism when needed.  Above all else, the key to adaptability and flexibility in team settings is to treat each other with mutual respect.

Perhaps the best example of adaptability at its finest comes from the “Miracle on the Hudson” landing of US Airways flight 1549 in January 2009.  Despite a highly stressful situation after the loss of two engines due to a bird strike, Captain Chesley Sullenberger and first officer Jeff Skiles calmly swapped flying responsibilities, went through their emergency checklists, and expertly landed their crippled aircraft on the Hudson River.  The entire team responded in a cool, professional manner, and despite the fact that the air traffic controller was trying to provide helpful, yet distracting, information about a possible alternate landing site at the nearby Teterboro airport, Captain Sullenberger continued to respond in a respectful manner all the way until touchdown. 

Watch for the next post in this series, Element #6 – Situational Awareness, on Tues., Jan. 17.

High Reliability Tip #5 – The key to adaptability is mutual respect by all team members. Remain flexible by covering contingencies during the brief, then monitor for changing conditions during execution. Debrief all aspects of performance – the good and not-so-good – after the fact.

Steve Kreiser is a consultant with Healthcare Performance Improvement (HPI). previously, Kreiser was an FA-18 pilot with more than 21 years of experience in the U.S. Navy, and a first officer for a major airline, where he worked extensively in the area of crew resource management. Mr. Kreiser can be contacted at This email address is being protected from spambots. You need JavaScript enabled to view it. .

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ABQAURP American Society for Quality American Society for Quality Healthcare Division Consumers Advancing Patient Safety
EMPSF Institute for Safe Medical Practices
Medically Induced Trauma Support Services (MITSS) Medication Safety Officers Society NPSF Partnership for Patient Safety Society to Improve Diagnosis in Medicine