Precision Approach
Pilots often fly a type of approach called a “precision approach”. The precision approach provides guidance which allows them to land safely – that is to say the aircraft remains clear of obstacles on the final approach path, lands in the center of the runway, and touches down within the first 3000 feet of concrete. The precision approach results in a constant uninterrupted descent. It is efficient and stabilized, and when set up correctly, requires only small corrections to remain on course. The precision approach works very well; it is consistent and the result of the effective utilization of equipment, human resources and standard operating procedures. Because the approach is stable, it usually results in a landing that is both safe and smooth.
Nursing – a New Approach Needed
It is my view that nursing needs a new approach – a “precision approach” – which will create practice environments that are stabilized, efficient, and “on course”, facilitating a touchdown that results in safe care for our patients. Crew Resource Management (CRM) is just that approach.
We know that years ago, airline disasters were more often the result of poor communication, poor leadership, and lack of teamwork than mechanical failures. In 1978, a United Airlines jet ran out of fuel and crashed after junior crew members failed to communicate to the captain that the aircraft was dangerously low on fuel. These crewmembers spoke up, but without the directness and assertiveness required to convey the gravity of the situation. The culture at the time was hierarchical, stressing captain’s authority rather than teamwork. United then became the first airline to implement this NASA based CRM training. Shortly after that other airlines followed. Today, flying on a commercial jet is without question the safest way to travel. The airline industry has transformed itself into a true culture of safety; it is a high risk industry that enjoys extraordinarily low error rates.
Nursing is a profession comprised of professionals who care deeply about their patients – yet there are problems. Consider that 13% of patients who develop complications in the hospital will die (failure to rescue) because subtle changes are detected either too late, or not at all. An outcome like this is not the result of individual failings – it is the result of environmental and cultural realities that are all too evident for nurses at the front line: fatigue, task saturation, poor teamwork, fragmented communication, intimidation by physicians, and inadequate training. The answer to these problems lies in the exportation of CRM to nursing practice. The tools, concepts and behaviors that have been taught to flight crews for three decades can change the profession and make the outcomes we desire a reality. This change will require transformational nurse leaders willing to think differently and directly challenge long standing obstacles. We’ll touch on leadership issues later, for now, let’s get started discussing in more detail this new “precision approach” – CRM in nursing practice.
