Cr Crisis R Res esource e Manag agem ement i in Aviation on - - PowerPoint PPT Presentation

Cr Crisis R Res esource e Manag agem ement i in Aviation

• n a

and H Hea ealthcar are

Fernando Salvetti - J.D., P.P.E., M.Phil., Ph.D.

Centro Studi Logos, Turin, Italy Logosnet, Lugano, Switzerland and Houston, TX, USA

Roxane Gardner - M.D., M.H.P.E., M.P.H., Ph.D.

Center for Medical Simulation, Boston, MA, USA Brigham and Women’s Hospital / Children's Hospital / Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

Rebecca Minehart - M.D., M.S.H.P.Ed.

Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA Center for Medical Simulation, Boston, MA, USA

Cristiano Galli - B.Sc., MSc Aviation, M.IA

Global Aerospace Logistics / Air Defense Institute of the Emirates Air Force, Abu Dhabi, UAE

Barbara Bertagni - B.Sc., B.A., M.A., M.Phil., Ph.D., Clin.Psy.D.

Centro Studi Logos, Turin, Italy Logosnet, Lugano, Switzerland and Houston, TX, USA

Cr Crisis Reso esource e Manag agem ement in A n Avi viation and He Heal althcar are

Simulation

• n – both i

in aviation

• n

and i in hea ealthcare – contributes es en enormousl sly t to enh enhancing teamwork rk d duri ring a a cri crisi sis, a , as s well a as foster ering situation

• nal

awaren enes ess, con

• ntextual

intelligence, e, and cogn

• gnitive

e retenti tion of es esse senti tial s step eps a s and procedures t s to be p be per erformed during c crisis. s.

Mod

• der

ern a aviation

• n c

crisis resou

• urce m

e manag agem emen ent focuse ses o s on speci ecifi fic skills a and com

• mpeten

encies es a areas: com

• mmunication
• n, s

situation

• nal

al awaren enes ess, decision

• n m

making, problem em s solving, t teamwor

• rk

k and l lea eadersh ship.

Steps t to

• fol
• llow in a

abnor

• rmal s

situation

• ns

Until 1977, an Aircraft Com

• mmander

er wa was res espon

• nsible fo

for almost all deci ecision ions in non- sta tandard situations. Crew an and Cockpit Res esou

• urce

ce Management training ng em emer erged afte ter the he rec ecognition

• n that the technical

al skills

• f
• f piloting an aircraft we

were insuffici icien ent to en ensure safet ety an and best per erfor

• rmance

ce: acc cciden ents we were oc

• ccu

curring fo for reason

• ns other

than an inad adequate piloting skills. An An impor

• rtant innov
• vative approa
• ach wa

was intr trod

• duced

ced to assig ign cock

• ckpit

roles

• les

that pos

• sitiv

tively ely influenced team dynam

• amics. Once

al aligned on

• n the runway and rea

eady fo for take-off, f, new ew function

• nal roles
• les are es

established: PF and

• PM. PF stan

ands ds fo for Pilot Flyi ying an and PM fo for Pilot

• t

Moni nitori ring

• ng. Thes

ese fu function ctional roles are not

• t

rel elated ed to crew sen enior

• rity

ty.

Al Also ca cabin crews ws are activ ctively ely involved in crisis management. Since ce the he 1980s, thes ese programs focu

• cus on
• n “non-tech

echnic ical” l” skills that are critical fo for en enhanced ed op

• per

erational per erfor

• rmance,

ce, such ch as lea eader ership, situati tion

• n

awaren enes ess, deci cision ion making, teamwor

• rk and

co communica cation. Our hypoth

• thesis—cu

curren ently under te test an and review—fo for enhan ancing teamwor

• rk is that

sim imula lation within a setting based ed on

• n mixe

xed,

• r
• r hybri

rid, reality called led e-REAL allows ws fo for better res esults lts com

• mpared

ed wi with those rea eached ed within the ot

• ther

er se settings availa lable le today, y, such ch as CAVE-like envi vironmen ents, virtual reality head-mo mounted disp splays, or

• r

co compute ter based ed e-learn rning en envi vironmen ents ts.

Te Tests are expec ected ed to be per erfor

• rmed

ed within the e-REAL immersive labs at the Polytechnic Sch chool

• ol of
• f Milan an

and at the Univer ersity ty Marconi in Ro Rome. Te Tests will be focu cused ed on

• n tea

eamwor

• rk,

crisis management an and deci ecisio ion ma making. Startin ting Septem ember er 2020, the te tests per erfor

• rmed will be des

esig igned ed as an es escape game within an e-REAL setting— in wh which a tea eam of

• f players co

cooperative vely discovers clues es, solv

• lves

es puzzles, an and acc ccomplishes tasks in

• r
• rder t

to

• progress a

and acc ccomplish a a speci ecific c goa

• al in a

a limited ed amou

• unt

t o

• f

time.

Effec ecti tive t e tea eamwork d during a cr crisis is also

• a core el

elem emen ent of t of expert p t practi ctice i ce in hea ealth thcare, w wher erei ein prof

• fessionals a

are e ch challen enged ed t to

• rec

ecognize a a situ tuati tion

• n th

that t req equires es r rapid inter erventi tion, , communication, kn knowledge sh shar aring, deci ecision

• n-making a

and managem emen ent o

• f

unfor

• res

eseen en e even ents ts—all th the e while e also

• taking into
• con
• nsider

erati tion cr criti tical con

• ntextu

tual f fact ctors s such ch as a lack ck o

• f

ti time, s e, scarci city ty of

• f res

esou

• urce

ces a and tool

• ols,

, and a multi titu tude of e of i impactf tful l fact ctor

• rs.

“Name-Cl Claim-Aim,” a a cr crisis managemen ent t organizati tional a approa

• ach

ch th that t uses es a mnem emonic d devi vice, w ce, was developed a at CM CMS S in Boston an and is s bei eing used ed in or

• rder

er t to faci cilitate cr crisis managemen ent a t and d deci ecision m making. .

Kn Knowledge an and technical al skills are es essen entia tial componen ents of

• f the dec

ecision

• n-

making proc

• cess an

and action ctions per erfor

• rmed

during cr crises, but they ey are not suffici icient to manage the entire situ tuati tion

• n, wh

which includes the he en envir vironmen ent, the equipment and the pat atient care team wi with its organizational behavior. Theref efore, an “Even ent M t Manager er Check ecklist” w was cr crea eated ed t to

• faci

cilitate effectiv ective r e rol

• le d

e des esignati tion

• n. P

. Parti tici cipants ts have b been given this s cognitive ai aid, desi signe ned as an as an I ID bad adge-sized ed c card, t , to ea easily acces ccess d during th thei eir simulati tion cou

• urse.

The The ro role of

• f “Ev

Event Manager er,” rath ther th than “Tea eam Lea eader er,” is is ex expressly pro romoted at at CMS MS to facilitate distribut buted lea eader ersh ship in crises

• ses. Thi

his disti tincti tion has pro roven to be be ef effective ve in tea eams

• f
• f

ex expert practi titioners bec ecause se it del eliber eratel ely see seeks to flatt tten hier erarchies es th that may oth therwise inhibit sp spea eakin ing-up up behav avior from te team me memb mbers. The The Ev Event Manager er coordinates the he communication and the he tea eam’s effort

• rts, over

erseei seeing th the or

• rganization
• n and applic

licatio ion of

• f CRM

RM principles, in in additi tion to acti tively soliciti ting input nput and nd dec ecisi sion- making re regard rding med edical ca care, if nec ecess essary. Mo Moreover, th the Event Manager er acts to facilitate ro role designati tion, as we well as orchestrate an and coor

• ordin

inate te team functi tion. A few ye years ago, the he “Name me-Cla laim im-Aim” m” and nd “Ev Event Manager Ch Checkli klist” we were re adopte ted by th the Massa sachuse setts Gen ener eral Hosp spital in Bos Boston

• n, fo

for inclusion in th the lat atest ver ersi sion of

• f the

heir Emerg rgency Man anuals ls.

e-REA EAL allo llows fo for bett tter res esults fo for lea earning how to use a mn mnemo monic like ke “Name me-Cla laim im- Aim”, ”, th that en enab ables a multi tilayer vi visi

• sion. The

The many ny le levels ls of

• f th

the situ tuati tion are re ma made availa ilable le si simultaneo eousl sly by

• ver

erlaying multi tisource info fo—e.g. wo words, num numbers, images, es, etc tc.— sim imila ilar to to an au augmen ented rea eality disp splay, but but witho hout ut needi ding ng to to wear ear sp spec ecia ial glasses ses. e-REA EAL impro roves th the lea earners’ s’ cogniti tive retent ntion by making the he rela latio ionship ips betwe ween topics vi visual, wh which ch yiel elds bett tter resu esults compared ed wi with those from the other er systems. e-RE REAL o

• ffers a unique u

user experience: a a combination of visual c communicati tion a and direct t interacti tion wi with the c content—by gestur ure o

• r spoken c

n commands ds—that i imme mmerses pe people e in a n an e n entirel ely inter eractive e e ecosystem em.

The The e-REA EAL exper erien ences es are re designed to have th the lea earner ers wor

• rkin

king on

• n task

sks th that sim imula late an asp spec ect of

• f ex

expert rea easo soning and nd pro roblem-so solvi ving, wh while receiving tim imely ly and nd sp spec ecific feed edbac ack fro rom bot

• th the trainers and fello

ellow lear earners. These ese el elem ements of

• f del

eliber erate practi tice and nd feed eedback are re gen eneral re require rements fo for developi ping ng experti tise at at al all level els and di disc sciplines es. During an e-REAL sessi session, a nu numbe ber of

• f skills

and comp mpet etencies are re challen enged ed: on

• n one si

side technical knowledge and nd know-how are re tested and, on

• n th

the othe her si side, e, beh ehavior

• ral, cognitive and

nd metacognitive skills, s, suc uch as lea eader ersh ship and nd follower ersh ship, team-wo work facilitati tion, team sp spirit and effec ectivenes ess, knowledge ge circulation, ef effective ve communicati tion, rel elationsh ships and nd powe wer distance, e, fix ixatio ion erro ror managem emen ent and nd meta tacognitive flexibility. Feedba dback is is pro rovided th throughout sessi sessions wi with a focus on ke key perf rform rmance indicators.

Fo For Crisi sis Resource Managem emen ent and tea eamwork in hea ealthcare, e, we we perf rform

• rmed a nu

numbe ber of

• f exper

erimen ents within th the e-REA EAL Virtu tual Room at at th the Envi vironmen ental Desi esign and nd Multi tisensory Ex Experience Lab fro rom the he Polytechni hnic School

• ol of
• f

Milan (It Italy). Thi This was the he firs rst rese esearch phase se, th that wi will be followed ed by a sec second on

• ne to

to be perf rform rmed at CMS MS in Bo Boston from Oct ctob

• ber 2020.

Te Tests we were desi esigned to co compare th the lea earning outc tcomes of

• f th

the sa same Teamwork and Cris isis is Reso esource Managem emen ent Cour urse, se, but del deliver ered ed wi with thre ree di differ eren ent met methodologies es:

• Cl

Classroom-based ed lesson

• Virtua

ual reali eality he head-mount nted di disp splays

• e-REA

EAL imme mmersive sett tting. Fo For the first phase of the resea earch, we we eva valuated a sam sample le of 62 parti ticipants ts that we were enr nrolled ed in in a 1-day traini ning ng program cal alle led “Tea eamwork and Cris isis Resource Managem emen ent.” Participants ts and traini ning ngs we were div ivid ided into to 6 di differ eren ent cohort rts that ran from Oct ctob

• ber 21, 2019,

to to Marc rch 6, 2020. Each cohort rt wa was co composed of unde dergradua uate med edic ical students ts, graduates es from sever eral he healthcare progra rams, student nt nu nurses ses and pr profes essi sional firs rst responde nders— in in ord rder to to reproduce an an inter erprofes essi sional te team.

The The training started wi with an intr troducti tion of

• f th

the ma main concepts in a traditi tional classr ssroom based sed setti

• ting. After on
• ne

hour, the he student nts we were divide ded int nto th three differ erent gro roups and nd expect cted to to lea earn th the ch check cklist fo for managing critical event nts (Name me-Cl Clai aim-Aim) m). The The first gro roup wa was invo volve ved in a trad adition

• nal classr

sroom-based sed lesso esson, th the sec second gro roup wa was provided wi with vi virtual rea eality hea ead-mo mounted ed dis ispla lays to use use in a sel self-learni ning ng mo mode, and nd th the th third gro roup was involved withi hin the e-REA EAL sett tting. The e training pr program was the s same, w whi hile t the e activi vities w were di e differen ent bec because e learner ers w s were di e divi vided in t n three ee groups—tw two o

• f t

them, i i.e. t those n not e experiencing g the e e-REA EAL s sett tting, wo working a as control g groups. Ear arly ly f fin indin ings sh s show t that l lear earners t s that en entered t the e e-RE REAL e L experience w were more s self-confident i t in t the checklist t learned i in t the s simulati tion a and r ready t to a apply i it wh when t they h had t to play i it o

• ut once b

back i in t the main c

• classroom. Also,

the quality ty o

• f t

the c communicati tion i in t the team wh who e experienced the e e-REAL s system em w was more c e clear, e effec ective, e, and nd pr prec ecise. e. The focus of the experiments ts wa was on:

• Speed

ed and ease ease of lear earning

• Eng

ngagem emen ent and enjoyment nt during ng lear earnin ing

• Effecti

tive unde derstandi ding ng

• Cogn

gniti tive re retention

• Co

Confidence and readines ess in in ap apply lying the lear earnin ing output puts in in cris isis is situa uations ns.

Early find nding ngs show th that lea earners th that enter ered ed th the e-REA EAL experience ce we were mo more re sel self-confident nt in the he ch check cklist lea earned in in th the simulati tion and nd re ready to apply it when th they had ad to play it out ut once back in th the ma main classr

• sroom. Also,
• ,

th the quality of

• f the

he communication in th the tea eam who experience ced th the e-REA EAL sy system wa was more re clea ear, effecti tive, and nd pr prec ecise. 64% o

• f t

the s students ts i in t the t two c contr trol groups reported t that p t practi ticing t the checklist f t for t the first time during t g the simulation w was emotionally o

• verwhel

elming an and v ver ery dif ifficult lt bec ecause m mos

• st of
• f t

their ir attentio ion w was as devoted t to

• fac

acin ing the e case a at ha

• hand. A

Add dditionally, 38% o

• f t

the s students ts i in t the second g group r reported a a sense o

• f s

sickness from the V VR he head-mounted ed di disp splays. s. Learners w s who ho e exper erien enced ed the e e e-REAL si simula latio ion r repor

• rted an

an a aver erage p per erformance g gain ain of

• f 43%

43% in t ter erms s of

• f

increas ased sp speed an and ease of ease of l lear earnin ing, w when hen c compared ed t to a traditional face-to to-face c class assroom l less esson or

• r a

a self self- lear earnin ing VR p

• program. 88% o
• f e-REAL learner

ers a s also reported ed i increa eased ed e engagem emen ent a and nd enj njoymen ent. Ov Over erall, the s students ts t that e t experienced the e e-REAL system were a able to p perf rform rm t the ch checklist w with a a good d degr gree o

• f a

autonomy (5 o

• ut o
• f 7

7 on a a Likert s t scale), w whi hile e the s students ts f from t the two contr trol groups needed a act ctive input f from t the trainer r to e effectively perf rform rm t the same ch checklist ( (2 out o

• f 7
• n a Likert

rt scale t those from t the VR g R glasses c control group, 3 out o

• f 7 those f

from t the other r control g group). .

Cr Crisis R Res esource e Manag agem ement i in Aviation

• n a

and H Hea ealthcar are

Fernando Salvetti salvetti@logosnet.org Barbara Bertagni bertagni@logosnet.org Roxane Gardner rgardner1@bwh.harvard.edu Rebecca Minehart rminehart@mgh.harvard.edu Cristiano Galli cristiano.galli@nolec.training