CRM-HRO Full Class Notes-2011.317143507

8/3/2019 CRM-HRO Full Class Notes-2011.317143507

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2011: LeSage, JP (www.cdm-hro.com) Page 1

Crew Resource Management (CRM)

CRM in the High Reliability Organization

Paul LeSage has been a Firefighter, Flight Paramedic, Company Officer, TechnicalRescue Technician, and a Chief Officer for a large metropolitan fire department and amajor flight program for over 30 years. For 24 months, he also was Interim Director ofthe Washington County 911 Center, Oregons 2nd largest emergency communicationscenter. He is currently a Clinical Assistant Professor at Oregon Health SciencesUniversity and Oregon Institute of Technology. Paul recently authored the book, CrewResource Management, Principles and Practices, and as an owner and publisher of

Informed, Inc., he has written several popular EMS and Fire Service Field Guides.

This is an outline of the full class. The amount of material covered and number ofexamples will vary related to time allotted and number of case examples used forexercises.

1) Key Components of High Reliability Organizationsa) Focus on mindful behaviorb)Ability of all members to doubt, ask questions, and be informedc)A preoccupation with failure modes and critiqued) The Just Culture A reluctance to simplify explanations for errore)A sensitivity to the operational environment and practicesf) Commitment to resilience through training and systemsg) Consistent attention to building and maintaining a Learning Organization

2) Whats the Need?a)A safer operating environment in operationsb) Builds a learning organizationc) Improves the work environment and cultured) More transparency for employees and customers

3) Improving Team Performance and Just Culture Attributesa) Emergency services and the airline industryb)Just Cultureapproach is critical

i) Treats performance error (risky decisions) as an opportunity to learn(Coaching)

ii) Treats behavior (recklessness) with appropriate corrective actioniii) Engages in deep systemic cause analysisiv)HasFront-Line Operatorson the analysis team

c) Human error is a starting point, not a conclusiond) Strong commitment to high fidelity traininge)Feedback Loopsare encouragedanalysis to training


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4) Why How we Decide is Important in Understanding Where to Starta) The decision process: Conventional and On-Sceneb) RPD, NDM, and CRM

i) RPDtrades accuracy for speedc) The novice vs. the veterand) Inherent conflicts: Primary decision method and investigations

5) Focus on Mindfulnessa) Techniques for maintaining situational awareness (SA)b) Just what is SA anyway, and can you lose it?c) Did we really ever have complete SA?

i) CompleteSA is not possible on todays time compressed sceneii) Team SA is necessary (CRM)

d) Training to develop SA resiliencee) Why team SA is so important today vs. 10 years ago

6) Crew Resource Management: The Basicsa) The Inquiry (Behavior, Statements, Orders, Observations, Actions)b)Advocacy (Two ways to sayYes, one way to sayNo

i) Must be respectful,ownyour feelings and be curiousii) Includes:

(1)Using the persons name or title, whichever is appropriate(2)Stating your concern without accusation orlabels(3)Stating what you think will occur if action is taken or behavior continues(4)Giving an alternative(5)Asking for feedback (What do you think?)

7) Individual and Team components for successa) Team members must developfollowercapabilitiesb) Leaders should work on social intelligence skills (defined)c) Make the situationsafeto speak up (Trust = safety)d) Controllingbadstories is a must

i) Stories are powerfuland can kill CRM efforts8) Common Ground: Theend goalof CRM

a) CG is never as good as we think it isb) CG is continuously eroding on dynamic scenesc) Leaders must request and be open to feedback in order to maintain CGd) It is difficult for us toseeother team membersviewpointe) Remember: 80% of our actions (Veteran) are based on what we learnedOn the

Joband not what we learned from policy or in schoolf) Your 80% is NOT my 80% It takes a TEAM for good CG and SA


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9) The Ability to Doubt, Inquire, and Updatea) Organizational story and how it affects culture

i) Story: The most powerful tool in the boxii) Story: How its good, how its bad

b) Barriers to team communicationi) Stories and style differencesii) Rank structure and expertiseiii) Sense-making (Random statements = )iv)Asymmetrical coherence (I didnt understand)

10)Preoccupation with Failure Modesa) Why failure and not success?b) Building those trend filesc) How teams fail:

i) Failure to Recognize, Failure to Notify, Failure to Correctd) Learning form the failure of others

11)A Reluctance to Simplify and the Just Culturea) What is a Just Culture and how do we get one?b) What are the danger zones?c) What do we analyze, and how?d) What information do we keep, and what do we do with it?e) What tools are available for this type of analysis? The Root Cause

12)Sensitivity to Operationsa)Are rules Operations driven?b) What is Practical Drift, and why does it happen?c) What lends itself to formal policy vs. light guideline or protocol?d) What are the four Ps?

i) What is the problem?ii) What is our policy?iii) What is our current practice?iv)What do you propose we do?

13)Commitment to Resiliencea) Resilient behaviors and why we need to practice themb) The importance of high fidelity trainingc) Quality improvement drives the Operations busd) What do we do when tragedy strikes?

CRM-HRO Full Class Notes-2011.317143507

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