Research Institute: Crew Resource Management (CRM) has NO Proven Value
One of the more popular solutions to the problem of medical errors involves adopting policies and protocols that have been "proven" to reduce errors in other industries. The most widely endorsed of these ideas is known as Crew Resource Management ("CRM"), wherein we adopt airline-type procedures and protocols. For the purpose of this discussion, I will overlook the fact that this approach involves emulating an industry which is notorious for its poor customer service and multiple bankruptcies, and will instead focus on the error-reducing aspects of CRM.
The logic behind adopting CRM is as follows:
- The practice of medicine and the piloting of an aircraft are very similar activities in that both involve complex situations and critical decision-making.
- CRM has been proven to reduce mishaps in airplanes.
- Therefore, CRM can reduce medical errors.
Unfortunately, as the following analysis demonstrates, none of these statements are valid.
The practice of medicine and the piloting of an aircraft are very similar activities.
I have practiced medicine and am an instrument-rated pilot. However, despite 1,500 hours in the cockpit, at no time have I ever thought to myself, “Flying this airplane reminds me of practicing medicine.” Perhaps the similarity between practicing medicine and flying an airplane is apparent to persons who have never done either. But, it is not apparent to me.
CRM has been proven to reduce mishaps in airplanes.
In analyzing this statement, it should be first said that CRM does not have a uniform definition. CRM refers to a non-standardized, heterogeneous body of training that each airline has conducted in its own way over the past 30 years. The training can be as limited as a few lectures or as involved as several days of simulation. From a scientific perspective, it is therefore difficult to say that CRM training has been “proven” to do anything. But, even if we disregard the lack of standardized practice, no version of CRM has never been shown to reduce the rate of human errors or accidents. In fact, an extensive U.S. Navy study showed that CRM training had NO effect on mishap rates. (Wiegmann DA, Shappell SA. Human error and crew resource management failures in Naval aviation mishaps: a review of U.S. Naval Safety Center data, 1990-96. Aviat Space Environ Med 1999; 70:1147-51.)
Although the Navy’s direct analysis demonstrated that CRM was of no value, CRM proponents point to the fact that airline safety has dramatically improved over the past thirty as evidence that the programs have worked. While air safety has certainly improved in conjunction with adopting CRM, every scientist knows that the existence of a correlation does not prove causation.
According to the National Transportation Safety Board, most of the improvement in airline safety over the past three decades has been the result of improvements in technology. In other words, the planes themselves are safer. And, the biggest contributor has been the development of onboard weather radar, which allows pilots to better identify and avoid bad weather.
Listening to stories about airplanes can be enjoyable. But, CRM has no value in terms of reducing medical (or aviation) errors.