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Harry C. Sax, MD; Patrick Browne, BMil; Raymond J. Mayewski, MD; Robert J. Panzer, MD; Kathleen C. Hittner, MD; Rebecca L. Burke, RN, MS; Sandra Coletta, MBA

Arch Surg. 2009;144(12):1133-1137.

Objective  To quantify effects of aviation-based crew resource management training on patient safety–related behaviors and perceived personal empowerment.

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

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

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

Main Outcome Measures  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.

Author Affiliations: Department of Surgery, The Warren Alpert Medical School of Brown University (Drs Sax and Hittner), and The Miriam Hospital (Drs Sax and Hittner and Mss Burke and Coletta), Providence, Rhode Island; and Strong Memorial Hospital (Drs Mayewski and Panzer), University of Rochester Medical Center (Drs Mayewski and Panzer), Rochester, and Indelta Learning Systems, LLC, Pittsford (Mr Browne), New York.

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