In the September 2013 edition of the British Medical Journal, Robyn Clay-Williams has published a thought provoking article on the modelling of clinical risk management on civil aviation practices, and questions whether a military aviation model may be more prudent when assessing and managing risk in the healthcare environment. The abstract can be found HERE.
The author questions the appropriateness of translating sometimes rigid civil aviation processes (and a zero tolerance for risk) into healthcare, as some healthcare systems (such as emergency departments and intensive care units) need more flexibility and autonomy in their workings and risk management. She suggests managing risk in high stakes clinical environments such as these would be more conducive to a military aviation model – the parallels being teams with limited resources who deal routinely with unpredictable situations, complex and time critical operations (as would happen frequently in the pre-hospital environment or the ED resus room).
Suggestions for improving the adaptability and resilience of health care organizations in the realms of risk management derived from a military model include:
- planning for the unexpected
- training for the worst: simulation training of worst case scenarios allows decision making under pressure and can help develop spare capacity
- training disparate teams together: multidisciplinary and inter-departmental simulation training
- learning about the limits of human performance
- supported simulation allowing development of
- contingency planning
- communication skills.
At Auckland ED we have begun multi-disciplinary simulation afternoons with other clinical departments, out first event included HEMS, Emergency Department, Trauma Surgery, Cardiothoracics, Anaesthetics and Operating Theatres. This was invaluable in ‘testing the system’ involving handover, clinical management, resourcing (labs, radiology, blood bank, theatre) and most especially inter-departmental communication and teamwork. Our first simulation has garnered resounding positive feedback from all involved.
I would be interested in comments from others who are doing inter-departmental simulation and team training.
Click HERE for the full version of the article discussed above (secure area limited to ADHB staff)