In March 2012, the Centers for Medicare & Medicaid Services (CMS) issued a call for applications for a new initiative designed to increase the nation’s primary care workforce by supporting facilities that train Advanced Practice Registered Nurses (APRNs). Under this new initiative, CMS will begin making payments from the $200 million of funds available in 2012 to eligible hospitals, helping them offset the costs of clinical training for APRN students.

Houston, Texas—Simulation Center at Texas Children’s Hospital has begun providing Pediatric Simulation Training for Emergency Pre-hospital Providers (Pedi-STEPPs) to members of the Houston Fire Department (HFD) EMS. A grant from the Cullen Trust for Healthcare, as well as a community benefit donation from Texas Children’s Hospital will allow this innovative training to be offered free of charge to the City for 500 firefighters over the next two years.

AHRQ announces free training opportunities for TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety), a set of evidence-based, practical tools that helps hospitals and other health care providers strengthen teamwork among caregivers with the goal of improving patient safety. AHRQ and the Department of Defense designed the TeamSTEPPS program specifically for health care providers for use in a variety of care settings.

By Steve Kreiser, CDR, USN Ret., MBA, MSM

People make decisions, or choices, based on their knowledge of the current operating environment and their past education or experience. This past education or experience is stored in the human brain in the form of rules. The human brain perceives a situation, scans for a rule from its long-term memory, recalls and then acts to apply the rule.

By Steve Kreiser, CDR, USN Ret., MBA, MSM

Situational awareness is the degree to which knowledge and perception of a given situation mirrors reality. Figure 4 shows how threats such as distractions, miscommunication, poor attention to detail, workarounds or other problems can cause a situation to deteriorate and get off track. A team with good situational awareness recognizes these “red flags” and the reality of the situation, then applies the necessary resources to adjust back toward the goal of the plan of care.

By Steve Kreiser, CDR, USN Ret., MBA, MSM

Element #5 – Adaptability

Adaptability is all about working well with others and being flexible enough to adjust to changes in the situation or plan of care. Remaining flexible when new information becomes available is critical to making a team function well, especially during unplanned situations and emergencies.

By Steve Kreiser, CDR, USN Ret., MBA, MSM

Element #4 – Assertiveness

In the 1960s and 1970s, Dutch psychologist Geert Hofstede conducted extensive research on how humans interact in a culture or organization. One of the measures he used to define this interaction is known as the power distance index, or PDI. This index measures power distance among cultures and indicates attitudes toward hierarchy – in particular, how a culture values and respects authority. The higher the power distance in a culture, the less likely those in subordinate roles will question the actions or directions of individuals in authority.

By Steve Kreiser, CDR, USN Ret., MBA, MSM

Element #3 – Communication

The Joint Commission believes the majority of all events of harm in healthcare are due to breakdowns in communication. This is a fairly broad statement that fails to answer the “whys” of the communication failures.

By Steve Kreiser, CDR, USN Ret., MBA, MSM

In December 1972, Eastern Air Lines Flight 401 was on its final approach to the Miami International Airport late at night when the crew noticed a green “landing gear down” indicator light was not illuminated. The captain made the decision to abort the landing attempt and circle the airport to troubleshoot the problem over the vast darkness of the Florida Everglades

By Steve Kreiser, CDR, USN Ret., MBA, MSM
The success of any team – whether in sports, business, or healthcare – starts and ends with its leader. Some leaders are collaborative by nature and some are not. Those leaders with a dictatorial style that inhibits the flow of information will have a difficult time making crew resource management (CRM) work in their team settings.