The 4 Critical Components of a Successful CRM Program

Successfully implemented CRM-based patient safety programs must follow a well-designed “flight plan.” The flight plan for a successful program can be reverse-engineered by analyzing those programs in both aviation and healthcare that have produced lasting results.

#1 Good Leadership

The single most important success factor for implementing CRM is the same as any other major institutional change initiative—leadership. Executives, supervisors, and managers in every successful organization are extremely busy. Therefore, to make this program work well, leaders must focus on a few, but critical actions on top of everything else they are currently doing. These actions must be performed consistently over the course of the project. Good programs take time: implementing a full CRM program in one large department can take up to eight months to complete, so constant leadership attention and focus are needed to avoid losing momentum or interest. The successful CRM project leader will ensure that his organization’s leadership team knows what these actions are and that they are equipped to do them.

#2 Skills-based Training Workshops

Next, the successful project leader will ensure that care providers are equipped with real teamwork and communication skills. He will design and use an effective training program to give staff the ability “to do”—to actually use specific behaviors in their daily work activities. Once the necessary leadership is committed, trained, equipped, and ready to guide the project to success, it’s time to training physicians and staff on the specific team skills to improve coordination, communication, and decision-making. Here are some guidelines to make sure the training meets that goal:

• Teach real skills
• Train everyone who has a stake in project success
• Train as teams
• Publish the training schedule far in advance
• Offer continuing education credit
• Offer rewards for training
• Limit class size
• Do not shorten the curriculum to save time
• Ensure participants know that the training is only the first step
• Train off-site

#3 Developing and implementing safety tools

No matter how comprehensive, applicable, integrated, and well-delivered, training alone cannot create a safe system. Providing trainees with personal skills, introducing the concepts of teamwork, and using all available resources are necessary to set the stage for improvement, but this in not sufficient to change the ingrained behaviors of the larger group. All high-reliability organizations “proceduralize” safe operations using specific tools to make it easy for people to do the right thing and difficult to make an error. For instance, aviators are taught not only to communicate their intentions to Air Traffic Control, but also to use a specific way to transmit that information so it is correct, concise, and complete.

Embedding specific error-prevention or mitigation processes—or tools—in a healthcare setting ensures that problems not only get fixed today, but also stay fixed. Additionally, the exercise of developing tools using the standardized methods borrowed from more-- experienced high-reliability organization teaches the team to create solutions that are consistent across the institution.

#4 Measurement and documentation of results

With trained leadership, effective skills training, and hardwired safety tools in place, how do you make sure the project produces results? Follow the measurement plan created at the beginning of the project. Use these guidelines to design an effective measurement plan for CRM projects:

Obtain leadership support for measurement.

Data collection requires the effort of both support staff and caregivers. Many organizations do not collect the baseline data they need to prove the results of their project and will discover they need additional data collection, over and above what is presently done. The extra effort and any additional data-collection burdens require the strong support of leadership and their constant attention to make sure measurement get done.

Define success for this project.

When designing the measurement plan for the CRM project, one of the most important steps is to identify the factors that define success. Once identified, CRM project leaders must gain agreement from the stakeholders on the success criteria.

Conduct measurement plan interviews.

An effective method to reach agreement among stakeholders is to conduct a series of 15-20 minute one-on-one interviews with them. In these interviews, ask these three questions:

1. How much do you know about the CRM project?
2. At the end of the project, what has to have happened for you to consider the project success?
3. For you, what would be an acceptable measure to prove that (the answer from question #2) has actually happened?

Improvement in Employee Satisfaction Surveys With LifeWings Teamwork Training and Tools

Specifically, in an academic health center, LifeWings worked with the office of the CMO. The goal was to improve staff satisfaction. The staff realized that not only is turnover costly in terms of replacement and recruitment costs, their care-giving teams need greater permanence to cut down on teamwork and communication errors.

The leadership wanted teamwork training that fostered a sense community among the staff and that would change the way the staff felt about themselves and the institution for which they worked.

The LifeWings teamwork training and tools implementation projects gave the hospital leadership the ingredients to meet their goal. The hospital found that employees (as measured by an Employee Satisfaction Survey) that attended the teamwork training and worked in departments using the Hardwired Safety Tools™ had a greater sense of teamwork and satisfaction with their place of work than those employees that had not attended the training and did not work in departments using the Hardwired Safety Tools.

Kirkpatrick’s 4 Levels of Measurement

If you do not measure it, it did not happen, right? Good news. Project measurement is conducted throughout all phases of a CRM-based project. Kirkpatrick’s 4 Levels of Measurement is a great way to demonstrate project success. Below are the 4 levels of measurement:

Level 1—Reaction evaluation. Did the participants find the training useful and relevant to their jobs? Did they change their attitudes as a result of the training?

Level II—Learning evaluation. Did the participants learn anything? For example, as a result of the training, can the learner accurately make an assertive statement?

Level III—Behavior evaluation. Are the skills actually being used in the workplace? For example, can we document evidence that physicians and staff are communication more frequently or more effectively?

Level IV—Results evaluation. Does the organization reap the harvest of the investment in the program in terms of improved outcomes, such as fewer wrong surgeries?

Levels III and IV are the most important types of evaluation for performance-based training. Level III evaluations assess on-the-job application of acquired knowledge and skills. Level IV assess whether organizational outcomes are enhanced as a result of the knowledge and skills acquired and applied.

Does the measurement plan provide all four levels? If not, determine what data must be collected to measure each level. Clearly, levels III and IV will be of the most interest to the stakeholders and deserve the bulk of the measurement effort.

Top Guns Swoop Down On Hospital Teaching Ways to Increase Patient Safety

“We all love the old western movies when John Wayne comes riding in and saves the day. John Wayne’s persona in his movie roles was, ‘I am the leader, get the heck out of the way and do not question me – big, bold and larger than life!’ …not unlike many surgeons, physicians or even Top gun combat pilots…”

Below are some helpful resources which provide tips and ideas on how to improve the overall culture of your healthcare organization.

Vanderbilt University Medical Center (VUMC), Nashville

VUMC continues to train in their hospital to meet the goal of training all personnel. Their last training classes took place at the end of October.

The Nebraska Medical Center (NMC), Omaha, NE

NMC has recently developed the capability to conduct the LifeWings’ skills training and safety tools development internally. They are in the process of training 600 more staff and implementing safety tools.

The University of Missouri Health Care (UMHC), Columbia, MO

UMHC continues to implement LifeWings’ training and safety tools that will carry on through next year.

The University of Texas Medical Branch (UTMB), Galveston, TX

UTMB recently celebrated their one year anniversary of working with LifeWings. LifeWings is now working in Woman and Infant Services and just completed the Leadership Workshop. Eight assessment days are scheduled for this month, along with training classes for 400 more staff.

A farmer who had a quarrelsome family called his sons and told them to lay a bunch of sticks before him. Then, after laying the sticks parallel to one another and binding them, he challenged his sons, one after one, to pick up the bundle and break it. They all tried, but in vain. Then, untying the bundle, he gave them the sticks to break one by one. This they did with the greatest ease. Then said the father, "Thus, my sons, as long as you remain united, you are a match for anything, but differ and separate, and you are undone."

- Aesop

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