Can aviation-based team training elicit sustainable behavioral change?
OBJECTIVE
To quantify effects of aviation-based crew resource management training on patient safety-related behaviors and perceived personal empowerment.


METHODS
Prospective study of checklist use, error self-reporting, and a 10-point safety empowerment survey after participation in a crew resource management training intervention.


METHODS
Seven hundred twenty-two-bed university hospital; 247-bed affiliated community hospital.


METHODS
There were 857 participants, the majority of whom were nurses (50%), followed by ancillary personnel (28%) and physicians (22%).


METHODS
Preoperative checklist use over time; number and type of entries on a Web-based incident reporting system; and measurement of degree of empowerment (1-5 scale) on a 10-point survey of safety attitudes and actions given prior to, immediately after, and a minimum of 2 months after training.


RESULTS
Since 2003, 10 courses trained 857 participants in multiple disciplines. Preoperative checklist use rose (75% in 2003, 86% in 2004, 94% in 2005, 98% in 2006, and 100% in 2007). Self-initiated reports increased from 709 per quarter in 2002 to 1481 per quarter in 2008. The percentage of reports related to environment as opposed to actual events increased from 15.9% prior to training to 20.3% subsequently (P < .01). Perceived self-empowerment, creating a culture of safety, rose by an average of 0.5 point in all 10 realms immediately posttraining (mean [SD] rating, 3.0 [0.07] vs 3.5 [0.05]; P < .05). This was maintained after a minimum of 2 months. There was a trend toward a hierarchical effect with participants less comfortable confronting incompetence in a physician (mean [SD] rating, 3.1 [0.8]) than in nurses or technicians (mean [SD] rating, 3.4 [0.7] for both) (P>.05).


CONCLUSIONS
Crew resource management programs can influence personal behaviors and empowerment. Effects may take years to be ingrained into the culture.
Sax
Harry C
HC
Department of Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island 02906, USA. hsax@lifespan.org
Browne
Patrick
P
Mayewski
Raymond J
RJ
Panzer
Robert J
RJ
Hittner
Kathleen C
KC
Burke
Rebecca L
RL
Coletta
Sandra
S
D001291:Attitude of Health Personnel; D001359:Aviation / Q000193:education; D057189:Checklist; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control*; D010348:Patient Care Team / Q000458:organization & administration*; D011209:Power, Psychological; D015397:Program Evaluation; D011446:Prospective Studies; D040841:Resource Allocation / Q000193:education*; D012308:Risk Management / Q000458:organization & administration; D012649:Self Concept; D013192:Staff Development