CRM and Patient Safety from an RN's Point of View

I met Michelle Swift at a performance of our play Bedside Manners that I put on recently for the Utah Society of Risk Management.  Michelle is an RN and attorney who works in Patient Safety and Risk Management for The Doctors Company.  After the performance, she told me a great story that happened when she worked briefly as a flight attendant.  As you read it, ask yourself how these tools could be applied to healthcare to enhance patient safety and eliminate medical errors and injuries.  The lessons are totally applicable which is why I asked Michelle to write it up so that I could share it with those who follow this blog.  Here it is:

Crew Resource Management (CRM) is a set of training procedures for use in environments where human error can have devastating effects. CRM is used primarily for improving air safety while focusing on interpersonal communication, leadership, and decision making in the cockpit and between the entire flight crew.  One important aspect of the training is to recognize that, when issues are reported– regardless of the source, regardless of the question of credibility– all reports must be taken seriously without repercussions to the flight crew.
I want to share a true story that illuminates what happens when you have strong direction from leadership so that everyone understands that all reports must be respected and acted upon, without minimizing people’s concerns or  retaliating against the crew member.
I had taken a few years away from nursing and wanted a fun job.  So I worked as a flight attendant in Anchorage, Alaska on a local commuter airline.  Each aircraft had one flight attendant along with the first officer and captain.
Cindy was from the East coast and new to the airline industry.  She was a flight attendant and was considered, “dizzy” by most accounts.  On one flight to Homer, Alaska, a passenger told Cindy she smelled smoke.  Cindy sniffed around and confirmed that she could also smell smoke!  She notified the captain, who asked the 1st officer to go back and “check it out.”  The 1st officer did–he didn’t smell anything unusual.  Cindy emphatically stated she smelled smoke.  The captain then sniffed around the cabin area; he didn’t smell anything.
However, given CRM training, the captain notified the passengers they would make an emergency landing in Homer, Alaska.   The fire department would be there and to please exit the aircraft in an orderly manner, following all directions.
The local airline ordered another aircraft to fly to Homer ASAP to pick up the departing passengers since this aircraft was “grounded.”  As the passengers were departing the air craft, one passenger said to the captain, “Do you think it was my smoked salmon?”
Of course, it was—
But here’s what happened.  No one was reprimanded.  In fact,  all employees were warned that anyone caught talking about this or “making fun” of the flight attendant faced termination.  The company encouraged these types of reports-and respected the employees that came forward, regardless of the outcome of the information. It’s no surprise that that airline has not had an accident or injury in over 20 years.  Wouldn’t it be great if we could take the same attitude toward mistakes in healthcare?
Michelle Swift,BSN, RN, JD
Patient Safety and Risk Management
The Doctors Company

  • Jackie Tatelbaum

    Dear Ms. Swift ,

    I too have a former aviation career and found your article most intriguing.
    I was a Commercial Pilot (though I still have current licenses ).

    I also enjoyed reading after someone who has (likewise) had more than one career goal. I left the cockpit to promote a product that I developed as a pilot from the years of travel and frequent stays in hotels. The research on the cross contamination germs and bodily fluids on the average hotel TV remote control was more than I could ignore. So I developed a TV remote control cover that is currently being used in hospitals and hotels in the US and Canada. So simple and it has “taken off” (pun intended).

    I too decided to speak up about a solution to an epidemic and previously ignored problem.

    I look forward to reading more of your work .

    Jackie Tatelbaum

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