Teamwork Training as a Safety Tool

It is becoming well understood that errors are minimized and safety is sup­ported when the members of highly skilled teams function as a cohesive unit. The concepts were developed in the military and later were embraced by the aviation industry as “cockpit resource management” and the evolution to “crew resource management.” More recently, they have been adapted for use in health care settings.

A complete discussion of these concepts is beyond the scope of this chapter (the reader is referred to the Selected Readings); however, the basic tenets will be summarized briefly. First, team structure is created and strengthened, and team members are assigned specific roles. Although one team member serves as the leader during each patient encounter, this role need not remain fixed across encounters; one member may serve as the leader for one transport with another member serving as the leader for a subsequent transport. Second, all team members are accountable to one another for performing their assigned duties and for asking for assistance when needed. Third (and a very important concept for teams that include a physician), team members must not be bound by traditional roles and are free to object to or question an order or a plan at least twice. This so-called 2-challenge rule is intended to force the leader to reconsider the action or order in question. Fourth, team members are encouraged to communicate in a specific manner. Orders are acknowledged and repeated by the recipient to ensure understanding. Unclear orders and plans are immediately ques­tioned and clarified. Fifth, when errors or untoward events occur, as they surely will, they are discussed openly and in a spirit of system correction rather than individual blame.