
Crew resource management - tosh
https://en.wikipedia.org/wiki/Crew_resource_management
======
nkanetka
For those that are interested, here's the original workshop proceedings from
John Lauber, one of the forefathers for CRM. As a pilot it was an interesting
read. Cool to see how something that is engrained into pilots today came
about.

[https://ntrs.nasa.gov/archive/nasa/casi.ntrs.nasa.gov/198000...](https://ntrs.nasa.gov/archive/nasa/casi.ntrs.nasa.gov/19800013796.pdf)

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FabHK
Originally developed in aviation as a consequence of accidents where highly
trained pilots made (sometimes silly) mistakes, often while other cockpit
occupants recognised a problem (and sometimes even spoke up, to no avail).

Anatul Gawande has an entertaining and insightful book, _The Checklist
Manifesto_ , in which he describes some components of CRM (such as checklists,
huddles, non-hierarchical team structure & communication), and how they can be
transferred to medicine, specifically hospitals. Good read, and I'd much
rather be treated in a hospital where they use checklists & good CRM!

Edit to add: [http://atulgawande.com/book/the-checklist-
manifesto/](http://atulgawande.com/book/the-checklist-manifesto/)

~~~
assblaster
Unfortunately the push for checklists has been made more for the purposes of
decreasing physician autonomy and increasing reliance on mid-level
practitioners as a "cost saving" tool.

The big difference between aviation and medicine is that human patients are
more complex and variable than machines like airplanes. Sure checklists can
improve some things, but they're not the definitive fix for anything. In fact,
checklists can actually slow down decision making unnecessarily, especially in
situations when seconds matter.

~~~
NikolaeVarius
The fact that things are complex is the exact reason checklists exist. It
forces you to go through steps and actually verify things that are easily
preventable.

[https://www.npr.org/templates/story/story.php?storyId=122226...](https://www.npr.org/templates/story/story.php?storyId=122226184)

"How did surgeons respond to the suggestion that they should change the way
they operate? Says Gawande, many were resistant at first.

"You can imagine the response" to the idea of running through a checklist
before surgery, Gawande says. But when his team surveyed the doctors who used
the checklist, "There was about 80 percent who thought that this was something
they wanted to continue to use. But 20 percent remained strongly against it.
They said, 'This is a waste of my time, I don't think it makes any
difference.' And then we asked them, 'If you were to have an operation, would
you want the checklist?' Ninety-four percent wanted the checklist.""

~~~
philwelch
Checklists are great for not forgetting about things, and forgetting about
things is a common source of human error (oh man, I forgot to run unit
tests/recover those foreceps from the abdominal cavity/etc). It’s not
_sufficient_ , because sometimes you have to make judgment calls and creative
decisions, but even then, I’d rather be free to think about that stuff without
having the back of my mind worrying about some fiddly steps I may forget.

~~~
NikolaeVarius
It's isn't just about not forgetting about things, it's also about PROVING
that you're actively doing what should be doing.

The point of checklists is to massively reduce the chances that you ever have
to make a "creative" decision.

Thinking that checklists is a waste of time is what lets things like leaving
tools inside a patient happen.

