Crew Resource Management (CRM)

CRM in the High Reliability Organization Paul LeSage has been a Firefighter, Flight Paramedic, Company Officer, Technical Rescue Technician, and a Chief Officer for a large metropolitan fire department and a major flight program for over 30 years. For 24 months, he also was Interim Director of the Washington County 911 Center, Oregons 2nd largest emergency communications center. He is currently a Clinical Assistant Professor at Oregon Health Sciences University and Oregon Institute of Technology. Paul recently authored the book, Crew Resource Management, Principles and Practices, and as an owner and publisher of Informed, Inc., he has written several popular EMS and Fire Service Field Guides. This is an outline of the full class. The amount of material covered and number of examples will vary related to time allotted and number of case examples used for exercises. 1) Key Components of High Reliability Organizations a) Focus on mindful behavior b) Ability of all members to doubt, ask questions, and be informed c) A preoccupation with failure modes and critique d) The Just Culture A reluctance to simplify explanations for error e) A sensitivity to the operational environment and practices f) Commitment to resilience through training and systems g) Consistent attention to building and maintaining a Learning Organization 2) Whats the Need? a) A safer operating environment in operations b) Builds a learning organization c) Improves the work environment and culture d) More transparency for employees and customers 3) Improving Team Performance and Just Culture Attributes a) Emergency services and the airline industry b) Just Culture approach is critical i) Treats performance error (risky decisions) as an opportunity to learn (Coaching) ii) Treats behavior (recklessness) with appropriate corrective action iii) Engages in deep systemic cause analysis iv) Has Front-Line Operators on the analysis team c) Human error is a starting point, not a conclusion d) Strong commitment to high fidelity training e) Feedback Loops are encouragedanalysis to training

2011: LeSage, JP (www.cdm-hro.com)

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4) Why How we Decide is Important in Understanding Where to Start a) The decision process: Conventional and On-Scene b) RPD, NDM, and CRM i) RPD trades accuracy for speed c) The novice vs. the veteran d) Inherent conflicts: Primary decision method and investigations 5) Focus on Mindfulness a) Techniques for maintaining situational awareness (SA) b) Just what is SA anyway, and can you lose it? c) Did we really ever have complete SA? i) Complete SA is not possible on todays time compressed scene ii) Team SA is necessary (CRM) d) Training to develop SA resilience e) Why team SA is so important today vs. 10 years ago 6) Crew Resource Management: The Basics a) The Inquiry (Behavior, Statements, Orders, Observations, Actions) b) Advocacy (Two ways to say Yes, one way to say No i) Must be respectful, own your feelings and be curious ii) Includes: (1) Using the persons name or title, whichever is appropriate (2) Stating your concern without accusation or labels (3) Stating what you think will occur if action is taken or behavior continues (4) Giving an alternative (5) Asking for feedback (What do you think?) 7) Individual and Team components for success a) Team members must develop follower capabilities b) Leaders should work on social intelligence skills (defined) c) Make the situation safe to speak up (Trust = safety) d) Controlling bad stories is a must i) Stories are powerfuland can kill CRM efforts 8) Common Ground: The end goal of CRM a) CG is never as good as we think it is b) CG is continuously eroding on dynamic scenes c) Leaders must request and be open to feedback in order to maintain CG d) It is difficult for us to see other team members viewpoint e) Remember: 80% of our actions (Veteran) are based on what we learned On the Job and not what we learned from policy or in school f) Your 80% is NOT my 80% It takes a TEAM for good CG and SA

2011: LeSage, JP (www.cdm-hro.com)

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9) The Ability to Doubt, Inquire, and Update a) Organizational story and how it affects culture i) Story: The most powerful tool in the box ii) Story: How its good, how its bad b) Barriers to team communication i) Stories and style differences ii) Rank structure and expertise iii) Sense-making (Random statements = ) iv) Asymmetrical coherence (I didnt understand) 10)Preoccupation with Failure Modes a) Why failure and not success? b) Building those trend files c) How teams fail: i) Failure to Recognize, Failure to Notify, Failure to Correct d) Learning form the failure of others 11)A Reluctance to Simplify and the Just Culture a) What is a Just Culture and how do we get one? b) What are the danger zones? c) What do we analyze, and how? d) What information do we keep, and what do we do with it? e) What tools are available for this type of analysis? The Root Cause 12)Sensitivity to Operations a) Are rules Operations driven? b) What is Practical Drift, and why does it happen? c) What lends itself to formal policy vs. light guideline or protocol? d) What are the four Ps? i) What is the problem? ii) What is our policy? iii) What is our current practice? iv) What do you propose we do? 13) Commitment to Resilience a) Resilient behaviors and why we need to practice them b) The importance of high fidelity training c) Quality improvement drives the Operations bus d) What do we do when tragedy strikes?

2011: LeSage, JP (www.cdm-hro.com)

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