Years ago, when the commercial airline industry was first beginning to implement Crew Resource Management (CRM or “TeamSTEPPS” as it is called today), I was teaching one of the very first CRM classes to 50 of the most senior pilots at FedEx.
We were discussing the need for the Captain to conduct a crew briefing prior to the first takeoff (very similar to the briefing given today by the surgeon in a properly executed WHO Safe Surgery Checklist).
One of the very experienced Captains raised his hand and asked me, “Steve, is FedEx going to pay me extra to do this briefing?” Perplexed, I asked him why he thought he was entitled to extra pay. He responded, “I know what is in the policy and procedures manual backwards and forwards, and there is no written requirement for us to provide the sort of briefing you are describing, and I wondered if we would be paid extra to do something that is not formally required.”
That captain was being sarcastic, but he had a very valid point. If we as an organization believed it was important to the safety of our flight operations to conduct this sort of briefing, we sure ought to put it in writing and revise our P&P manual to require it.
So before the next CRM class was taught, the entire P&P manual was revised to add a written requirement for crewmembers to use every teamwork and communication behavior we thought was critical to safety. These requirements included the obligation for all crewmembers to speak up and be assertive if they saw something non-standard or something that caused them concern about the safety of flight.
This revision of our manual fundamentally changed the dynamics in the classroom for the remaining CRM courses. Now we were able to say, “Here’s the written requirement in the P&P manual, now wouldn’t it be great to learn the behaviors you need to be in compliance with the manual?” The receptiveness of flight crews to learning and using the teamwork and communication skills increased remarkably in the later CRM courses. So much so that we wished we had taken that approach from the very beginning.
The Lesson?
The lesson you can learn from aviation’s experience is that one of the key methods of getting your staff to take you seriously about the need to speak up is to put the requirement in writing in every written instruction that guides the way you do business in your institution. Then reference that written requirement in every training session about using stop-the-line language. (You are conducting training on this aren’t you?)
Here’s an example of how one hospital revised their P&P manual...
“Every Hardin Medical Center employee is an important member of the healthcare team. Each employee is expected to use teamwork and communication skills in his or her daily work with other team members, patients or residents, and patient’s or resident’s families. Hardin Medical Center advocates, expects, and empowers its employees to ‘Speakup.’
When there is doubt regarding the safety of care being provided, always question the team leader and ensure that concerns or discrepancies are resolved before that care is rendered.
Acknowledge any deviation from policies/procedures or acceptable care and make it known to the team and team leader in an assertive but respectful manner.
Be vigilant and ensure that the corrective action achieves the desired result.
Speak-up using assertive statements that will:
• Get attention
• Express concern
• State the problem, and
• Propose a solution.”
If your P&P manual doesn’t have language like this, you need to start the revision process today. It is worth the effort.
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