© 2011 American Society for Healthcare Risk Management of the American Hospital Association

Published online in Wiley Online Library (wileyonlinelibrary.com) • DOI: 10.1002/jhrm.20080

JOURNAL OF HEALTHCARE RISK MANAGEMENT • VOLUME 31, NUMBER 150

Book Review

Use aviation principles to improve delivery of patient careSoaring to Success: Taking Crew Resource Management from the Cockpit to the Nursing Unit

Gary L. Sculli, RN, MSN, ATP, David M. Sine, MA, CSP, ARM, CPHRMPublisher: HCPro 2011, Danvers, MA 219 pages

Background

Communication failures in healthcare are at the core of most medical errors creating patient harm. Those failures are compounded by the inability of practitioners to work in functional teams to deliver quality patient care. As healthcare teams work to create an environment that pro-motes learning, and are trustworthy and transparent, it is imperative that mission-critical systems and processes are continuously reviewed for their ability to create and sup-port error. Understanding human factors as the nexus of the healthcare environment and workforce is imperative to ensure effective change when systems and processes fail.

Nursing is the largest workforce in most healthcare organizations, and the delivery of patient care by these dedicated professionals is a complex process. The ability to think critically in an environment replete with distrac-tions, fatigue, task saturation, limited staffing, and com-peting priorities becomes a difficult, if not impossible, task. The failure to think critically then becomes a con-tributor to medical error and is hard to manage.

About this book

Crew resource management (CRM), originally called cockpit crew management, as a practice and process, was first identified, developed, and implemented in the aviation industry to reduce and manage error in the late 1970s and early 1980s. The authors sharing the back-ground and impetus for the development of CRM in aviation effectively set the stage for how the same princi-ples can be utilized in nursing. The concept of CRM can be described in two main parts: the first is teamwork and

communication, and the second is human factors and situational awareness. Applying CRM in the professional practice of nursing as practiced by the aviation industry in reducing and managing near misses and adverse event is the focus of this book.

Soaring to Success: Taking Crew Resource Management from the Cockpit to the Nursing Unit is written by two health-care professionals with different backgrounds, specialties, and interests: Gary Sculli is a pilot returning to nursing in the aftermath of 9/11, and David Sine is a risk man-ager and safety professional. Their combined efforts have created an easy-to-read, realistic, well-organized book complemented by the use of real case scenarios from both nursing and aviation. The liberal use of examples and tools throughout makes the book an interesting and enjoyable read.

Book chapters

The book is organized into nine chapters moving the reader from one concept to another seamlessly. The chap-ters included are:

Chapter 1: Nursing and Aviation: A Culture of Comparison

Chapter 2: What Is Crew Resource Management?

Chapter 3: Behave Like a Leader: Value Your Team

Chapter 4: Get Connected and Set the Tone

Chapter 5: Improve Team Cohesiveness With Briefings

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Chapter 6: Followership: Putting an End to “Hint-and-Hope” Communication

Chapter 7: Situational Awareness: Making Clinical Decisions in the Nursing Environment

Chapter 8: The Sterile Cockpit Concept in Nursing Practice

Chapter 9: Developing Checklists on the Nursing Units

Other useful features

Downloadable materials (tables, figures, etc.) are available • from HCPro, the publisher. Most of the materials are offered in both a “pdf” version and as a Word document. To access the materials, a link is given in the front mate-rial of the book after the Preface.

Application for continuing educational credits are avail-• able for up to two years after the purchase of this book. For information on credits and to take the examina-tion, the reader is referred to the link for downloadable materials.

The generous use of callout boxes highlighting key • information.

Learning objectives noted for each chapter.•

Use and listing of valuable references for each chapter.•

Similarities with enterprise risk management

I quickly realized when reading this book that I was reminded of the principles of enterprise risk management

(ERM) and the similarities with CRM in several ways. The principles and concepts of CRM also require the explicit endorsement of the executive team, medical staff and board. This endorsement requires the support and empowerment of the nursing staff if the practice of CRM is to be successful. Just as in the movement of traditional risk management programs to those that are focused on enterprise risks and opportunities, many organizations (to implement CRM) may require a culture change. CRM and ERM are organization-wide initiatives requir-ing an environment that is open, learning, transparent, and empowering. Both start as top-down initiatives, but eventually the principles and concepts are utilized by all employees, in this case nursing and all its participants. The authors also stress the concept of error manage-ment. This same concept is at the heart of ERM as well. Preparing the organization to withstand errors that can and do occur instead of focusing on error avoidance is an important concept supported by both; the management of uncertainty, standardization, and variability reduction is a key concept of both ERM and CRM. The authors are quoted as saying “CRM is not a seminar or a class; it’s a way of life.” Further recognizing the synergy with ERM is shown by saying that “ERM is not a stop on the road: it is a journey (Carroll).” Both CRM and ERM, once started, continue; philosophically they change the way in which the organization reduces and manages error and are complementary processes. While the focus of this book is on nursing, it can be a useful tool for any healthcare prac-titioner, and I highly recommend it without reservation.

Reviewed by: Roberta Carroll, RN, ARM, MBA, CPCU, CPHQ, CPHRM, HEM, LHRM, DFASHRM, Senior Vice President, Aon Risk Solutions, National Health Care Practice.

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