Crew Resource Management Plan Improved Efficiency, Patient Safety

The implementation of a methodology called crew resource management in a radiation oncology environment led to a new level of rigor and standardization, improved communication and an improved safety record, according to the results of a study published recently in Practical Radiation Oncology.

“Crew resource management was originally formulated in the airline industry,” said study author John A. Brown, RTT, BA, of the department of radiation oncology at Memorial Cancer Institute, Hollywood, Fla. “This sort of protocol or guideline was developed for pilots, co-pilots and staff to provide a cohesive type of framework for individuals who may not always work together.”

Teams of healthcare providers operate in a similar manner, where physicians, technicians, nurses and others come together to treat a patient. In 2009, the department of radiation oncology at Memorial Cancer Institute began the implementation of a crew resource management program for its 34 full-time equivalent staff at its two hospital campuses.

The four main areas of the new program included:

• Patient identification methods,
• “Pause for the cause,”
• Enabling all staff to halt treatment and question decisions,
• Daily morning meetings.

Many of the new aspects of the crew resource management program were designed to require a dialog between two staff members where items related to the patient and the patient’s treatment are checked and cross checked. Before a patient is called in for treatment, the two staff members must go through a guide and checklist to verify information such as the prescription and planning parameters. Once a patient is in for treatment, patient name and birthday, as well as additional information, are verified by each of the two technicians. After treatment a final set of checks are completed. Taking this extra time to ensure patient safety is called “pause for the cause.”

With this new formalized program focusing on patient safety, all staff has been empowered to stop or question treatment at any time in order to ensure patient safety. According to Brown, this type of environment encourages anyone on staff who sees something that might compromise patient safety to speak up. This program required buy in and support from leadership to ensure staff that someone who speaks up or challenges a superior on a question of safety will not lose their job.

Finally, each morning the staff has a morning huddle or debrief where they discuss things that happened the prior day. During these huddles team members can brings up any relevant issue, whether it’s a resource issue or a treatment plan issue. According to Brown, these daily huddles force management and staff to examine and address these issues promptly, rather than in a system where adjustments might only happen on a periodic basis.

“We have experienced benefits that go beyond patient safety, to include streamlining our processes and standardizing our practices across our clinics,” the researchers wrote. “This has allowed us to increase our capacity without increasing staff resources.”

Prior to implementation of the program, the two radiation oncology departments experienced about 11 “near misses” a month. A near miss is defined as a plan deviation that existed but was caught prior to the patient being treated. With the help of the treatment guides, the near-miss rate is currently an average of 1.2 per month.

Additionally, prior to the crew resource management program, the department experienced one treatment deviation - such as incorrect dose, incorrect field size, incorrect gantry angle - per year, with none at the level of “misadministration.” After the implementation of the new program, there have been no treatment deviations.

Finally, these departments have increased efficiency as measured by an 11.3 percent increase in units of service between 2009 and 2012 while maintaining the same staff levels. Although the implementation of these strategies initially slowed work flow, the researchers eventually found that the increased communication and teamwork involved in the program ultimately increased efficiency.

“While instituting such a wide-ranging organizational culture change is by no means an easy process,” the researchers wrote, “the advantages that our department has seen from implementing a crew resource management program for patient safety have been significant.”