| dy in 2000 showed that there were about | | | | Hospital of Boston, our medical error rates have |
| 109,000 deaths per year as a result of | | | | dropped to zero after airline pilots taught us team |
| unnecessary surgery, wrong medication, and | | | | training, and team training resulted in lower death |
| preventable infection, making medical error the | | | | rates, and more satisfied patients in the cardiac |
| third leading cause of death in the United States. | | | | surgery program at another New England |
| But that doesn’t count deaths that result | | | | hospital.” |
| from “disruptive behavior” | | | | There are other ways as well to organize and |
| between doctors and nurses in the middle of an | | | | train teams for better information management, |
| operation. A new survey by VHA reports that | | | | and success may differ from country to country, |
| verbal abuse, shouting, arguments and passive | | | | from culture to culture. But one thing is clear: none |
| aggressive behavior in the operating room is | | | | of us knows as much as all of us know. Dealing |
| causing pain, poor medication, misdiagnosis and | | | | with more different views of the situation means |
| patient death. This is a fresh example of how a | | | | more work, that’s true. And authority is |
| breakdown in team decision making can have | | | | often challenged in the process. |
| deadly results. | | | | But it isn’t only lives that are saved by a |
| 17% of the doctors and nurses surveyed said | | | | more open and respectful dissent. A study by the |
| they had experienced episodes of rage in the OR, | | | | Department of Defense showed that among |
| and 76% of those said that the “adverse | | | | advanced research and development labs, the |
| event” resulted in injury to the patient. | | | | team characteristic with the highest correlation to |
| And it’s not just doctors shouting at | | | | success was the way it was organized. Some |
| nurses. A new generation of nurses are shouting | | | | were run by a single, authoritarian figure. Others |
| back. At least it is not as bad as it used to be. In | | | | had carefully crafted rules and procedures that |
| the old days, one OB/GYN said, we often threw | | | | everyone followed. But the labs with the best |
| scalpels and placentas at each other. | | | | record of breakthrough development were |
| The breakdown of information management | | | | collegial and open. All evidence was shared and |
| among medical teams, flight crews and project | | | | disagreements were respectfully discussed. The |
| participants is now understood to be a widespread | | | | labs were noisy and fun, sometimes behind |
| and preventable danger. Groups can learn behavior | | | | schedule and occasionally disorganized in their |
| that will mitigate rage, miscommunication, and | | | | presentations. But nobody threw calculators at |
| suppressed dissent. “Crew Resource | | | | anybody else, no shots were fired, and great |
| Management” is a widely employed training | | | | ideas were regularly brought to life. |
| protocol which encourages team members to | | | | The next time you go in for an operation, talk to |
| discuss their different interpretations of the facts | | | | your doctor about this. Politely. |
| with more respect. Dr. Gerald Healy, president of | | | | (Originally published at GoArticles and reprinted |
| the American College of Surgeons, has put CRM | | | | with permission from the author, Christopher |
| to work: | | | | Burns). |
| “At my department at Children’s | | | | |