Identifying Contributing Factors

Each team may have sources of stress that are unique to their program related to geography, patient population, referral and receiving staff, team composition, customer service, cultural diversity, or other expectations.

Strategies shown to improve communication, conflict resolution, and team work, such as Air Medical Resource Management (AMRM), Crew Resource Management (CRM), Medical Team Training, and Team Steps, contribute to reducing stress and increasing job satisfaction. One criti­cal feature of these programs is “flattening of the hierarchy,” allowing any member of the team to freely voice concerns. A familiar example of this is a surgical technician “stopping the line,” requiring everyone in the operating room (physicians, nurses, everyone present), to stop and address a situation before proceeding with the case. Another education program/strategy, “Just Culture” focuses on system design and behavioral choices, not specific errors and adverse outcomes. Just Culture focuses on acknowledgement of risk and risk management within the specific definitions of human error, at-risk behavior, and risky behavior on the basis of shared organizational and pro­fessional values. Just Culture provides a detailed algorithm with learning strategies and well-defined actions to be taken with the system and individ­ual in the response to identified risk.