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Human factors and team performance

Despite modern equipment, increasing emphasis on patient safety, and excellent training facilities medical care frequently results in unintentional harm to patients. Human Factors (HF) appear to play an important role in adverse events, especially in high risk clinical departments. A sound safety climate is considered essential, as it is positively related to safety outcomes.

This thesis focused on HF and critical team performance in clinical medicine.
First, an overview of existing literature, our healthcare CRM training curriculum, and a three-phase implementation structure were described.

An open source safety climate assessment tool (Safety Attitudes Questionnaire-NL) was validated and an aviation-derived HF awareness / team concept (Crew Resource Management - CRM) was adapted to the clinical setting. Additionally, CRM was implemented in multiple hospital departments and its impact on patient safety assessed. 

A study into the impact of a CRM-intervention in a large ICU yielded an association of CRM with a reduction in serious complications, and lower mortality, in critically ill patients. Also, safety climate improved.

CRM implementation in the Trauma Room of a level 1 Emergency Department (ED) was associated with an improved safety climate, although the time spent by trauma patients in the ED increased.

CRM implementation in 17 high-risk clinical departments was associated with an improved safety climate. The results were related to perceived implementation success factors as well as threats to success. Also, points for improvement formulated by healthcare providers and potential barriers to transfer of CRM training to the work floor were provided.

Finally all research findings, current issues and future perspectives for healthcare CRM are discussed. The challenge of adapting the medical organizational context to fully integrate HF principles into daily health operations was described and operational, educational, standardization and inspectorate/judicial aspects of this challenge identified.