Originally Posted by
Bad medicine
I'm not sure that "the most junior person in the operating theatre" should be able to call a halt to procedings. Give input...yes; offer opinion...yes, have everyone down tools and have a round-table discussion at a critical point in procedings...definitely not....
It is exactly the same for an aircraft Captain. When I'm aircraft Captain, I welcome and encourage input from all of the crew, often ask them what they believe is the best course of action, but ultimately, the decision and the responsibility reside with me. When I'm co-pilot, I offer information, solutions and assistance, but the Captain makes the decisions, and once made I support him to the best of my ability. Sometimes the decisions need to be made quickly, and without much in the way of consultation. Sometimes I believe the decisions to be flawed, but I don't argue in the cockpit - leave that for the debrief.
CRM doesn't mean that everyone has an equal role in the decision making process.
Anyway, that's my $0.02
Cheers,
BM
VERY true in my humble opinion.
In the late 80's and into the 1990's, the role of the Captain in aviation CRM had been found to be somewhat marginalized and the need to re-emphsize command leadership came about. One global carrier calls their CRM "CLR" meaning, "Command, Leadership, Resource-management" in place of the simple crew resource management badge.
Round table discussions work to great effect on the ground, or out of the Operating Room, during strategic planning. When tactical operations are in effect - in the OR or in the air, a whole different dynamic must be in place for good reason.
The point of CRM not being an easily substitutable program between industries is valid. I'm certain the timing of decisions and the variables of each process - medicine and aviation - lead to completely different CRM models. The one constant is that one specific model will work only in the context of the behavioral environment it operates in. Over time the aviation CRM model has evolved to adapt to the evolving culture of aviation. The same will be true for medical CRM. Where it starts today as a reflection of the environment will not be where it stands ten yerars from now, but it will be where it has to be, to suit the doctors and nurses above all else. CRM is a tool. Tools work for us, we should not work for the tool.