Crew Resource Management: Improving Patient Safety

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By Dave Robinson, February 12, 2012

In 1970 the aviation industry was experiencing an extremely high accident rate resulting in nearly 2,500 fatalities for every one million flights.  Over 80% of those accidents were a result of pilot error.  Advancements in technology reduced airline accident rates to 750 fatalities per one million flights by 1980, and then hit a plateau until 1995.  In an effort to further reduce the unacceptably high accident rate that was largely attributable to communication failures in the cockpit, the aviation industry implemented “Crew Resource Management” (CRM).  Today aviation is the safest high-risk industry in the world with less than one fatality per one million flights, placing it above the coveted “Six Sigma” performance threshold that today’s global business competitors aspire to achieve.

Crew Resource Management is a system of effective teamwork, open communication, and optimized decision making designed to reduce errors and maximize performance in high-risk environments.  CRM is a catalyst for culture change that is built on six pillars:

  • Leadership
  • Communication
  • Decision Making
  • Situational Awareness
  • Resource Management
  • Task Management

CRM is currently spreading to the healthcare industry because of the system’s proven results in aviation, and due to the inherent similarities between the two industries.  Healthcare and aviation organizations both employ highly-specialized professionals who routinely perform complex procedures that can have catastrophic consequences resulting from errors.  One major difference between the two industries, however, is that healthcare is currently missing out on the benefits of CRM that could significantly reduce preventable errors.

Alarmingly, according to the Institute of Medicine, medical error is currently the eighth leading cause of death in the United States, ahead of automobile accidents, breast cancer, and AIDS.  Over 22,000 preventable fatalities per one million patients are caused by medical error, and resulting malpractice losses exceed $20B per year.  The current patient fatality rate due to medical error equates to a “Sigma” performance level of 3.5, which is only slightly better than current airline baggage handling error rates.  Even more alarming is the fact that more than 80% of hospital errors go unreported by hospital employees according to a report released in December, 2011 by the inspector general of the U.S. Department of Health and Human Services.

In order to reverse this trend, the healthcare industry must take proactive steps to improve its culture of safety and standardization.  This will become even more critical in the months ahead as hospitals are required by law to post safety and quality performance indicators online.  Not only will these statistics drive patients’ decisions regarding which hospital they will choose for care, but these indicators will also be a determining factor in CMS reimbursements.

Hospitals that have received CRM training have reported the following results:

  • 50% reduction in surgical count errors
  • Clinical error rate reduction from 30% to 4.4%
  • 53% reduction in adverse outcomes
  • 55% reduction in observed errors
  • Quicker expertise with new technologies
  • Increased staff retention
  • Greater productivity
  • Reduction in malpractice losses

Evidence continues to show that the overwhelming majority of medical errors involve communication failure.  Similar to the aviation industry, CRM can help hospitals solve this problem by fostering a safety culture built on a foundation of sound leadership, open communication, and collaborative decision-making that has the potential to transform healthcare into one of the safest high-risk industries in the world.


“Crew Resource Management:  The Flight Plan for Lasting Change in Patient Safety,” F. Andrew Gaffney, MD; Captain Stephen W. Harden; and Rhea Seddon, MD.  HCPro, Inc. (2005).

Comparison of System Error Rates,” Robert Galvin, MD., Accessed October 16, 2011.

Transforming Surgical Care through Team-based Communication.” Palmetto Health System Presentation. August 12, 2010., Accessed October 16, 2011.

Hospital Errors Often Unreported,” ABC News.  Accessed January 6, 2012.

“Using Aviation Safety Measures to Enhance Patient Outcomes,” AORN Journal 2003; 77: 158.

“Error Reduction and Performance Improvement in the Emergency Department through Formal Teamwork Training: Evaluation Results of the MedTeams Project,” Health Service Results 2002;37:1553.

“Can Aviation Safety Methods Cur Obstetric Errors?” OB/GYN Malpractice Prevention 11, No. 8 (August 2004): 57-64.

”Beyond Blame: Ob-Gyns Investigating Model Reforms on Patient Safety,” ACOG News Release.

“Organizational Difference in Rates of Learning: Evidence from the Adoption of Minimally Invasive Cardiac Surgery,” Management Science 47, No. 6 (June 2001): 752.

About the author:  Dave Robinson is a retired United States Marine Corps Colonel with over 3,800 accident-free flight hours in 17 different types of aircraft.  He has been a CRM instructor since 1998.  Dave has held numerous Director and CEO-level leadership positions throughout his 25-year career, including Commanding Officer (CEO) of an aviation training enterprise that received the Chief of Naval Operations Safety Award for safety and operational excellence.  Prior to joining the PACE team, Dave served as the Commanding Officer (CEO) of a Marine Corps aviation organization including a medical staff that supported over 5,000 military and family members, and achieved the highest level of medical readiness among all Marine Corps organizations in North and South Carolina.

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