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FROM CRM TO TRM - THE HEALTHCARE MODEL In the UK and US, the healthcare industry has begun to adapt the aviation model and Team Resource Management (TRM) training is increasingly becoming an essential tool in the kitbag of hospitals wishing to improve patient safety and reduce medical errors. This is a relatively unfamiliar term in healthcare within the Middle East region and its practical application may be little understood. Many of the individual elements of TRM have been part of healthcare


training for a long time. It encompasses training on the limitations of human performance – those environmental, organisational job factors and individual characteristics, which can influence both performance and behaviour at work. Phil Higton is the Director of Training at Terema Limited, an


organisation offering TRM training within the NHS in the UK. He offers the following insight: “From a personal perspective TRM is about giving healthcare professionals skills to work effectively together, manage their human vulnerability and engage with the hospital systems and processes of care. The purpose is to deliver improved safety and quality of care. It is about generating the will, insight and ability to exercise the skills, which support their clinical excellence. It is a mechanism for delivering those skills and that knowledge more consistently when under pressure or in complex situations. It is not a substitute for outstanding clinical skills and clinical knowledge”.


We all face situations at work where we know we should challenge


a colleague, albeit a senior member of staff. We often fail to do this for a variety of reasons, including respect for rank, fear of retribution, lack of self-confidence or perhaps not wishing to show someone else up and making them lose face. In healthcare, certain actions or omissions can lead to catastrophic consequences making such challenges vital; and yet, in healthcare, the perceived status of physicians often makes such challenges almost impossible for junior staff to vocalise. We need to move to a culture where sharing insight and information


or constructively challenging colleagues is viewed positively and is rewarded appropriately – for example when a junior nurse speaks up to a consultant during a ward round to offer information that has been overlooked. In a hospital where TRM is the accepted norm, the consultant would readily take on board the new information and would thank the nurse for her input.


THE FUTURE OF TRM IN THE MIDDLE EAST Within healthcare in the Middle East region it is vital to support the development of cultures, which actively and systematically enable people to exchange views, listen and talk openly about problems or safety concerns. The adoption of TRM and Human Factors training and assessment is now recommended by a number of authoritative sources


A very significant change in air transport operations in the past several decades has been recognition that safety and efficiency require a team effort


Having its roots in the aviation industry has meant that TRM has


developed in a unique and potentially more dynamic and influential way than other programmes aimed at improving patient safety. By introducing powerful examples from the world of aviation, healthcare professionals are able to see correlations very clearly and this enables them to make direct comparisons using case studies in their own areas of expertise. Typically a TRM training programme will cover the following topics:


Leadership, Situational awareness, Decision making, Communication, Personal limitations (stress, fatigue), and aims to reduce the incidences and effects of human error, enhance teamwork and communication and increase safety and productivity by ultimately reducing medical errors. TRM is not a universal panacea but is rather a bundle of knowledge, skills and understanding which in any circumstance allows you to get the best from yourself, the best from the people you work with and the best from the tools, technology and systems which you use (Phil Higton, Terema).


EMBEDDING HUMAN FACTORS TRAINING IN HEALTHCARE As a medical professional do you accept that a junior member of your team has the right to question your judgement when he or she feels patient safety is an issue? Furthermore, do you actively encourage your team to do so and give your permission for this openly? Do you respond appropriately when the team member is mistaken and their fears are ungrounded, or do you squash any future potential query on your authority?


018 HOSPITAL BUILD & INFRASTRUCTURE MAGAZINE ISSUE 1 2012


as best practice and something that will enhance patient safety. There is an opportunity to introduce and standardise a common Human Factors syllabus and curriculum, including it in the core curricula of all health professionals and managers throughout their training and professional life. The participation in training and other team development activities to exchange ideas will hopefully start a process of networking and sharing of expertise within this region. The ultimate goal is to agree common standards, syllabi and procedures in this and other areas, and produce a well-defined regulatory framework for developing and measuring professional practice. Effective organisational communication requires a climate or culture that supports and promotes trust, openness, reinforcement of good practice, and shared responsibility for supportive systems and processes. In healthcare it is becoming increasingly evident that understanding these issues can help to prevent harm and loss and also can improve the quality of the overall patient experience.


REFERENCES References available on request (magazine@informa.com)


AUTHOR INFO Jill is an aviation management professional who has many years of experience working in non-clinical training and consulting in the healthcare sector in the UAE.


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