Ground Clutter

April 3, 2006
The first CRM classes tended to be a bit touchy-feely, just short of singing Kumbayah.

Did you know that surgeons in operating rooms are now using safety techniques borrowed from aviation? It’s true. The cover article of the February 2006 Bulletin of the American College of Surgeons is titled, "Error Reduction Through Team Leadership: Applying aviation’s CRM model in the OR.”

The first sentence reads, “Over the past several years, efforts have been made to bring the crew resource management (CRM) model used in aviation into the operating room.” Sounds good to me. Airline and corporate aviation in particular have reached and maintained levels of safety nothing short of phenomenal. The techniques should be used by other industries. Why reinvent the wheel?

To recap a bit of history, back during the 1970s it became evident that old, macho captains from WWII were sometimes somewhat autocratic in their management of cockpit duties. Tales were legend of captains who told the first officer that “everything on this side of the cockpit is mine, and everything on your side of the cockpit is mine. You just sit there and keep your mouth shut.”

As cockpits and airspace grew more complex, this attitude had its problems. Cockpit resource management (later changed to crew resource management to include flight attendants), or CRM, was born to address this problem.

According to friends who were involved at the time, the first CRM classes tended to be a bit touchy-feely, falling just short of singing Kumbayah around campfires. That didn’t sit well with typical, square jawed, ex-bomber pilot types, so changes were made quickly. Today, CRM is an important and valuable part of crew training.

A few years back, the medical profession began to realize that the operating room (OR) greatly resembled a cockpit with the surgeon playing the role of the airline captain of old. Even the jokes were similar. (How many surgeons does it take to change a light bulb? One. He sticks the bulb in the socket and waits for the world to revolve around him.)

Evidently, the medical industry was smart enough to realize that this field had already been plowed. In 2000 an Institute of Medicine report, “To Err is Human,” specifically suggested that CRM, as practiced in aviation, might be successful in the OR. Its use has grown since. Surgeons pay for their own liability insurance; they have a personal interest in any procedure that helps protect them when lawyers get involved.

I just learned about CRM in the OR in late February. Several years before that, I developed a safety workshop based on the application of aviation safety techniques to other industries. That workshop has been well received by some top-drawer groups around the country. (I even got a kudo from Enron on that program, just before they imploded. My wife says they were doing fine until I got there.)