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Abstract
1.1. Background
This thesis examines the potential of aviation-style CRM training to improve public health safety, by investigating attitude and behavioural changes in multidisciplinary teams resulting from implementation of a CRM intervention in the Australian health care field.
1.2. Aims
The research met two aims: firstly, to develop and evaluate a one-day, classroom-based CRM course for health care workers; and secondly, to test the effectiveness of classroom- and simulation-based CRM training, in combination, for health care workers in improving the teamwork attitudes and behaviours of the participants.
1.3. Method
Aviation CRM knowledge, skills and attitudes were translated to learning outcomes for health care, based on a combination of a pre-training needs analysis, a review of the current evidence base for team training, and an expert panel review. The resulting competencies were developed into a one day classroom based CRM course, which was delivered via adult experiential learning methods to health care professionals working in complex time critical environments in an Australian area health service. A total of 157 recruits were randomised into one of four groups, consisting of three intervention groups and a control group. The intervention groups were then given one day of CRM based training in the classroom, in simulation, or in both. Pre- and post-test quantitative data were gathered on participant attitudes to working in teams, and post-test quantitative data were gathered on trainee reactions, knowledge and teamwork behaviours. Qualitative data were gathered by interviewing a sample of participants at the conclusion of the evaluation. A research diary was kept, and observations recorded on insights gained while conducting the study.
1.4. Results
A total of 94 doctors, nurses and midwives completed the pre-intervention attitude questionnaire; between 59 and 61 clinicians completed the post-intervention assessments, and 10 clinicians were interviewed. The classroom course was successfully developed and delivered; evidence was gathered in support of the training using Kirkpatrick’s framework. Reactions to the course were universally positive, and positive changes were found in knowledge and behaviour when the classroom only trained group was compared with the control; however these changes were not found in the group that received classroom followed by simulation training. No positive change in attitudes was found associated with the training. Other than in regard to improvement in self-assessed teamwork behaviour associated with classroom-only training, the hypotheses that attitudes and behaviour would display positive changes associated with the training were not supported. Contrary to this quantitative result, qualitative data supported the effectiveness of the training for both classroom intervention groups, and uncovered a number of ancillary benefits to the training, such as improved confidence and the ability to perform in crisis situations. The research diary revealed a number of systemic and practical differences between aviation and health care that should be considered when designing future CRM interventions.
1.5. Conclusion and Original Contribution
The study produced various outcomes, including original, randomized attitude and behavioural data by which evidence based judgments on the efficacy of CRM training can be made. A set of teamwork competencies for health care workers was also determined. A classroom-based CRM course was successfully developed and delivered, providing confirmation that training concepts can be effectively translated for the Australian environment from aviation to health care. The research uncovered evidence in support of the importance of training health care teams in multidisciplinary groups, and the need to utilise multi-method realist evaluation approaches for future studies. Finally, a new team skills training model was proposed which is available to form the basis of a multidisciplinary health care team training strategy for the clinical workforce.