Crew Management Processes Revitalize Patient Care
- Sunday, 01 November 2009
Originating Technology/NASA Contribution
In January 2009, birds struck the engines of US Airways Flight 1549 and forced an emergency landing into the Hudson River. Everyone on board survived, and the crew was lauded for remaining calm under pressure and keeping passengers safe. The pilot, Captain Chesley Sullenberger, is a former U.S. Air Force pilot, trained in Crew (or cockpit) Resource Management (CRM) which originated at NASA in 1979. Even before they knew they had an emergency, the crew was using specific training for safe and effective operations: all parts of key NASA CRM methods required by US Airways since 1995.
In June 1979, John Lauber in the Aviation Safety Research office at Ames Research Center chaired a workshop that presented formal studies and discussions on human error in aviation. The workshop, Resource Management on the Flight Deck, presented research from over a dozen commercial and military pilots, university researchers, as well as Ames employee Hugh Patrick “H.P.” Ruffell Smith, whose data showed human error was the primary cause of aviation accidents.
Lauber and Ruffell Smith suggested that these human errors were caused by failures on a variety of levels: interpersonal communications, inadequate leadership, failure to prioritize and delegate, preoccupations with minor mechanical problems, and lack of situational awareness, which is the ability to recognize warning signs and anticipate potential danger. Another problem the researchers discovered was a failure to use available resources, including maps, navigation equipment, or others’ expertise.
Initially referred to as simply Resource Management, the proposed solutions evolved into CRM, a series of management techniques geared at reducing human error and improving safety through effective coordination of all resources. These skills, which can be improved through mock situations and simulations, include effective teamwork, meaningful communication, task coordination through checklists, and situational awareness.
In order to keep workflows predictable and as error-free as possible, CRM advocates using simple checklists to coordinate both tasks and communications among crewmembers. Without clear, predictable steps, disasters have occurred when captains assumed co-pilots had handled a seemingly minor problem, such as a malfunctioning light on an instrument panel. With CRM, crewmembers are taught to make no assumptions, but to follow printed checklists, communicate clearly, and maintain constant awareness.
In CRM, everyone learns to articulate a discrepancy between what is happening and what should be happening—a moment in which one’s training in situational awareness becomes critical. Untrained operators may not notice this discrepancy, or may ignore it, which can lead to a serious situation, mistake, or fatality. CRM techniques include clearly expressing concerns and problems, after which everyone commits to a solution. While this may sound like common sense, the 1979 research showed that subordinates regularly hesitated to correct their supervisors out of a traditional—but sometimes dangerous—respect for authority.
Ruffell Smith also suggested a CRM-related program now known as Line Oriented Flight Training (LOFT), in which crews fly complete, realistic missions in simulators. In debriefings after the simulations, crew and instructors discuss, in detail, what areas need more training.
The Federal Aviation Administration (FAA), the military, several commercial airlines, and of course NASA, use NASA’s CRM and LOFT to prepare flight crews—like that of US Airways Flight 1549—for both routine and hazardous situations.