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The U.S. healthcare system is now spending many millions of dollars to improve "patient safety" and "inter-professional practice." Nevertheless, an estimated 100,000 patients still succumb to preventable medical errors or infections every year. How can health care providers reduce the terrible financial and human toll of medical errors and injuries that harm rather than heal?
Beyond the Checklist argues that lives could be saved and patient care enhanced by adapting the relevant lessons of aviation safety and teamwork. In response to a series of human-error caused crashes, the airline industry developed the system of job training and information sharing known as Crew Resource Management (CRM). Under the new industry-wide system of CRM, pilots, flight attendants, and ground crews now communicate and cooperate in ways that have greatly reduced the hazards of commercial air travel.
The coauthors of this book sought out the aviation professionals who made this transformation possible. Beyond the Checklist gives us an inside look at CRM training and shows how airline staff interaction that once suffered from the same dysfunction that too often undermines real teamwork in health care today has dramatically improved. Drawing on the experience of doctors, nurses, medical educators, and administrators, this book demonstrates how CRM can be adapted, more widely and effectively, to health care delivery.
The authors provide case studies of three institutions that have successfully incorporated CRM-like principles into the fabric of their clinical culture by embracing practices that promote common patient safety knowledge and skills.They infuse this study with their own diverse experience and collaborative spirit: Patrick Mendenhall is a commercial airline pilot who teaches CRM; Suzanne Gordon is a nationally known health care journalist, training consultant, and speaker on issues related to nursing; and Bonnie Blair O'Connor is an ethnographer and medical educator who has spent more than two decades observing medical training and teamwork from the inside.
- Sales Rank: #430245 in eBooks
- Published on: 2012-11-20
- Released on: 2012-11-20
- Format: Kindle eBook
Review
"An excellent account of the history of crew resource management (CRM), its virtues, and how it's supposed to work, the book also delivers an eye-popping look beyond the supposedly sterile drapes in some of the United States’ most prestigious hospitals. Approximately 100,000 patients die in the U.S. every year as a result of medical mistakes, and some of the behavior that goes on in the U.S. healthcare system, as described in the book, is appalling. 'Health care needs . . . a radical cultural transformation, like the one that has taken place in aviation over the past 30 years,’ the authors argue persuasively. Three positive case studies show that it can be done."― Jan W. Steenblik, Air Line Pilot (July 2013)
"This book is full of information from air investigations and interesting facts. The first flight attendants, for example, had to be registered nurses in case any passengers became unwell. It shows that the everyday implementation of such things as checklists is part of a commitment by an industry to change the way it works. This commitment comes through leadership, but involves all the team, and is key for a nursing audience."―Dan Wolstenholme, Nursing Standard (July 2013)
"This is the fascinating story of the development and implementation of Crew Resource Management (CRM) in aviation and how it can and must be employed in health care. In spite of differences between aviation and health care, the similarities are more striking. Both are intrinsically hazardous endeavors, with complex technology, and dominated by one profession. Both developed a dysfunctional hierarchical culture that substantially increases risk for its customers and patients. Aviation has done something about it: CRM, with dramatic results. Flying is now incredibly safe. The lessons are clear, the cause is urgent, and the time has come for all health care organizations to act accordingly."―Lucian L. Leape, MD, Harvard School of Public Health
"This book is a revelation! Anyone who believes that toxic hierarchies and dangerously ineffective communication are inevitable in health care should think again. Beyond the Checklist heralds a new kind of hospital workplace―one that's already been flight-tested. The dysfunctions of our health care system are tragic and unnecessary, but they can be fixed. This book shows us how."―Theresa Brown, RN, clinical nurse and author of Critical Care
"Beyond the Checklist helps us understand that successfully providing safe and reliable care for our patients requires a multifaceted approach. Mechanisms such as checklists need to be integrated with effective leadership, teamwork, knowledge about human factors, and continuous learning. This book provides valuable insights on a journey that will provide a better care experience for patients, their families, and the people providing care."―Michael W. Leonard, MD, Co-Chief Medical Officer of Pascal Metrics and Adjunct Professor of Medicine at Duke University
"Beyond the Checklist recognizes that it takes more than just the standardized execution of processes to create a culture of safety. As the authors reveal, the team intelligence needed in more hospitals can flourish only in a workplace environment where there is proper training, mutual respect, and real cooperation among coworkers."―Veda Shook, President, Association of Flight Attendants–CWA
"The deeper I progressed into this terrific book, the more embarrassed I became for my profession of medicine. Behind our casual assumption as airline customers that we will arrive safely lies an enormously complex process that addresses all human and system issues that could possibly affect safety in air travel. With a few notable exceptions, we in medicine do not come anywhere remotely close to where we need to be to assure our patients of this same kind of safety commitment. There can be no excuse for medicine not pursuing this same all-engaging, relentless process. Our patients deserve nothing less. This is a must-read book for anyone with any connection at all to the delivery of health care services."―Terry R. Rogers, MD, The Foundation for Health Care Quality
"Beyond the Checklist takes us behind an apparently simple tool to lay out the complex social and organizational transformation that makes the checklist effective in aviation and to argue for a similar top-to-bottom transformation of health care. By shifting our attention to the detailed, sustained, and careful work that will be required to make health care safer, the book moves us forward on a long, difficult, but ultimately rewarding journey."―Robert L. Wears, MD, University of Florida and Imperial College London
"Beyond the Checklist provides a timely and insightful assessment of crew resource management (CRM), a key tool for averting disaster in the airline industry. The authors make a compelling case for its application to health care delivery. This book should become an essential text for health care professionals, educators, and policymakers seeking to improve interprofessional training and practice."―Scott Reeves, University of California, San Francisco
"The ideas presented in this book are so clearly developed and the writing so engaging that its audience will not be limited to patient safety experts. Patients, their families, and health care providers of all kinds will also benefit from the authors' insight into hospital safety improvement. The case studies are rich in detail and full of critical reflections on the connection between quality care and optimally functioning teams. The tone of Beyond the Checklist is hopeful but, for good reason, very urgent as well."―Sean P. Clarke, RN, PhD, FAAN, McGill University School of Nursing
"Some experts downplay the parallels between health care and aviation, but there is much we can learn from the system-wide change that greatly improved passenger safety on commercial airlines. This excellent book highlights the innovative programs of pioneering hospitals where better teamwork and effective communication guide every interaction―from the bedside to the boardroom."―Julia Hallisy, DDS, The Empowered Patient Coalition
"This important book brings both a sense of urgency and the hope of clarity in addressing a fundamental and widespread problem in health care. It is a must-read for clinicians and students who deliver care and a call for leadership from every member of the interprofessional team. Leadership is required to change the culture and systems of care delivery. Beyond the Checklist provides the inspiration and a path for that change."―Heather M. Young, RN, FAAN, Betty Irene Moore School of Nursing, University of California, Davis
"Beyond the Checklist shows us that Crew Resource Management principles help us deal with our human inability to always perform 'perfectly' while operating in a complex work environment. Little mistakes in aviation compound into huge problems. In commercial airlines, virtual strangers routinely solve complex problems without making critical mistakes. The culture of CRM provides for this as a normal way of operation. If embraced by the field of medicine, it will totally transform the way the industry operates."―Captain Gregory S. Novotny
About the Author
Suzanne Gordon is coeditor of the Cornell University Press series, The Culture and Politics of Health Care Work, and was program leader of the Robert Wood Johnson-funded Nurse Manager in Action Program.
Patrick Mendenhall is a Principal in Crew Resource Management LLC who is a pilot for a major commercial airline and belongs to the Air Line Pilots Association.
Bonnie Blair O'Connor is Professor of Pediatrics (Clinical) and Associate Director, Pediatric Residency, at Hasbro Children’s Hospital/Alpert Medical School at Brown University in Providence, R.I.
Most helpful customer reviews
9 of 9 people found the following review helpful.
Thoughtful advocacy of applying lessons from aviation safety to health care
By E. Jaksetic
The aviation industry, in conjunction with aviation regulators, developed a comprehensive system of safety practices and procedures to deal with a broad range of recurring problems that were causing aviation disasters and serious accidents. This book discusses the history of those safety efforts, identifies the critical elements of aviation safety, and argues that health care professionals can learn important lessons that could be applied to significantly reduce medical errors and improve patient safety.
The authors provide an informative look at the history of the development and application of Crew Resource Management (CRM) and threat and error management (TEM) by the aviation industry. They provide a realistic picture of the strengths, weaknesses, and limitations of CRM and TEM, and do not lapse into a simplistic or superficial advocacy of CRM and TEM as panaceas or "quick fixes" for health care professionals trying to reduce medical errors and improve patient safety. Also, the authors are careful to note both similarities and differences between the aviation industry and health care in their discussion, and avoid relying on facile or superficial analogies or comparisons that would undermine their contentions, arguments, and recommendations.
Overall, this book provides an excellent, thoughtful discussion of how the hard-earned lessons of aviation safety can provide insights and ideas that could help reduce medical errors and improve patient safety. Unfortunately, the three case studies about health care institutions used to support the authors' contentions, arguments, and recommendations have an uneven persuasive quality. The first case study provides support for the authors' contentions about the applicability of CRM and TEM to health care. The second case study is the weakest of the three because it does not provide any clearly discernable support for the authors' contentions about the applicability of CRM and TEM to health care. The third case study also provides support for the authors' contentions about the applicability of CRM and TEM to health care, but it is not as persuasive as the first case study.
Despite the criticism made about the uneven quality of the three case studies, I highly recommend this book to anyone interested in the subject of reducing medical errors and improving patient safety. The interdisciplinary approach taken by the authors is very helpful in providing useful insights and a different perspective that could help reduce the risk of occupational and professional myopia and "blinders" similar to those that the aviation industry had to confront and overcome before CRM and TEM could be effectively adopted and applied.
6 of 6 people found the following review helpful.
LOVE THE INFORMATION
By Amazon Customer
I have survived in flying a private plane for many decades... Found out (from this book) a lot about how I can improve my odds of lasting many more decades. I knew commercial pilots years ago who hated the changes that were happening in the airlines with CRM who were like me (old style seat-of-the-pants pilots) and only trusted themselves.They did not want to listen to input from others when decisions were to be made in the plane. They were THE CAPTAIN!
Those of us who survived being "Lone Rangers" of those years got ourselves in and out of trouble several times because we knew we had to do things on our own (macho). If we knew then what we know now, several pilots from years past would still be here instead of augered into terra firma.
This approach is needed in health care because I know nurses who've witnessed many critical errors in surgery, and in prescribing, that could have been avoided if they were allowed to suggest anything to the white coated autocrat. But, sadly, the heirarchy did not allow them to speak up for fear of losing their jobs.
Egos have taken many lives, and it is time for that to end. Gary Null researched the safety of medical care, and wrote "Death By Medicine". He reported that medical care kills almost a million people per year and is the leading cause of death in this country. Many physicians need to become accountable instead of relying on pharmaceutical reps, hospital management, etc. to tell them what to do (and protect them if they make a mistake). An attorney I know will not even do medical malpractice cases because he said "Good luck in getting an MD to testify against another MD." It is not a "transparent" group or organization.
The "standard of care" in medicine is not what should be done in so many cases! You and I have heard the stories of death and debilitation because of errors we knew were done... It is time for many doctors to refer out for other opinions with different providers, and get feedback from professionals outside their tight knit little cliques. They are dealing with people's lives, hopes, dreams, families, and friends, not just a "patient".
So many doctors really care about what happens to their patients, but are shackled by the system that feeds them. Time to get back to good doctoring instead of tight business procedures. It's time for them to care enough to stand their ground and become the great doctors they can be, instead of being pawns of drug companies, management, insurance companies, and other people/things that keep them from being exemplary in their work.
5 of 5 people found the following review helpful.
Save your money, Big Disappointment!!!
By Book Monster
I work in the hospital setting and really tried to like this book. I saw that it was written by a pilot and some health-caregivers. It also had a foreword written by "Sully" the pilot who flew the plane involved in the "Miracle on the Hudson."
For the first few chapters I saw a glimmer of hope that this book would be a fair attempt to point out what is wrong in healthcare.
As I delved further into the book, I saw how the authors made more and more reference to how physicians' egos are at the heart of the problem in healthcare. Gordon cites weak anecdotal stories of poor performing doctors and how they somehow should be used to represent the whole field of medicine. In addition, Gordon refers to physicians as if they are all males which is untrue. Her bias really shows through and takes away from her credibility.
The authors are upset because nurses and doctors speak two different languages (this may be true because of the 2 different levels of education). And that doctors never look at the nurses charting (lie). And that the charting for nurses, colored light rose, are separate from charting for physicians, colored grey-blue (lie).
The authors also complain that nurses are not allowed to write as if they have made a diagnosis in the chart and that they have to write in more descriptive style. Instead of just flattening the hierarchy, it sounds as if the authors want to rid what makes a physician different from a nurse and make them all equals in the patient care. I'd like to see a pilot delegate his expertise in flying a plane to a flight hostess when the plane is crashing (sarcasm). There is obvious minimizing of what physicians do.
Throughout the book the author uses airline CRM for examples that can be used in medicine. This is where things gets tougher. Anyone who has worked in healthcare knows that the airline industry only scratches the surface of how complicated healthcare is. I've had pilots say that airline CRM to what we do is extremely challenging. To say otherwise is naive.
Finally, this book ignores how patients can add to their own safety. Unlike in a commercial flight where passengers are passive customers, patients are customers who have much to gain or lose. As a clinician, I've seen a great many patients not even know who their doctors are or know what type of surgery they are having.
I am rather disappointed in this book. It had the potential to really make a difference but failed. If you end up reading this book, I really suggest asking yourself what the true motive of this book is.
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