A team-based risk modification programme to make health care safer

Research studies have validated an epidemic of grossly underreported, preventable injuries due to medical management. Analysis of these events demonstrates that most are caused by weak systems. Patient safety improvement requires multi-level system changes, including addressing thorny challenges, such as attenuating the prevalent culture of ‘blame and shame’—singling out individual providers and blaming them for errors. Team training solutions have been offered as a way to make healthcare safer. Stand-alone team training of medical personnel has had limited effectiveness in this prevalent cultural context. Although individuals and teams trained in crew resource management may understand the benefits of crew management training, the cultural elements remain in the workplace to undermine lasting impact. An innovative team training risk modification programme is proposed to help inculcate safety into the organizational process. The clinical risk modification programme is built on three principles that have made commercial aviation safety a standard for health care to emulate: transparency; standardization; and simulation-based team training. Although, this risk modification model is based on initial work performed in aviation, significant differences require modifications to address the complex and unique issues in medicine. Clinical risk modification makes it possible to translate experience and expertise developed in other technologically advanced, hazardous industries and apply those lessons to the medical community. This paper proposes coupling these concepts with effective team training tools to make health care safer.