Toma De Decisiones Y Crm

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i85

The human factor: the critical importance of effective teamwork and communication in providing safe care
M Leonard, S Graham, D Bonacum
............................................................................................................................... Qual Saf Health Care 2004;13(Suppl1):i85–i90. doi: 10.1136/qshc.2004.010033

Effective communication and teamwork is essential for the delivery of high quality, safe patient care. Communication failures are an extremely common cause of inadvertent patient harm. The complexity of medical care, coupled with the inherent limitations of human performance, make it critically important that clinicians have standardised communication tools,create an environment in which individuals can speak up and express concerns, and share common ‘‘critical language’’ to alert team members to unsafe situations. All too frequently, effective communication is situation or personality dependent. Other high reliability domains, such as commercial aviation, have shown that the adoption of standardised tools and behaviours is a very effective strategy inenhancing teamwork and reducing risk. We describe our ongoing patient safety implementation using this approach within Kaiser Permanente, a non-profit American healthcare system providing care for 8.3 million patients. We describe specific clinical experience in the application of surgical briefings, properties of high reliability perinatal care, the value of critical event training andsimulation, and benefits of a standardised communication process in the care of patients transferred from hospitals to skilled nursing facilities. Additionally, lessons learned as to effective techniques in achieving cultural change, evidence of improving the quality of the work environment, practice transfer strategies, critical success factors, and the evolving methods of demonstrating the benefit ofsuch work are described.
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See end of article for authors’ affiliations ....................... Correspondence to: Dr M Leonard, Physician Leader for Patient Safety, Patient Safety, One Kaiser Plaza, 22nd Floor, Oakland, CA 94612, USA; mmleonard@att.net .......................

ommunication failures are the leading causesof inadvertent patient harm. Although medical care is delivered by multiple team members, medical quality and safety has historically been structured on the performance of expert, individual practitioners. Effective communication and teamwork have been assumed, and formal training and assessment in these areas has been largely absent. Appreciation that the clinical care environment has becomeprogressively more complex, combined with the inherent limitations of human performance, has spurred interest in applying the lessons of other high reliability industries to medicine.

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The development and implementation of crew resource management (CRM) in aviation over the last 25 years offers valuable lessons for medical care. Realising that 70% of commercial flight accidents stemmed fromcommunication failures among crew members, CRM sought to standardise communication and teamwork. Currently, CRM is required globally in aviation training, and direct observational studies by Robert Helmreich’s group have correlated actual flight crew performance with attitudes toward teamwork and safety. In 2000, we undertook the adoption of relevant behaviours and skills into high risk medicalenvironments. Twelve clinical teams underwent a three day training programme in human factors; learning about the human factors experience in aviation, and the application of standard tools and behaviours to improve safety and ensure effective communication. The teams each worked on a clinical project in which these techniques could be applied to improve the quality and safety of patient care. The...