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International Journal for Quality in Health Care Advance Access originally published online on May 6, 2008
International Journal for Quality in Health Care 2008 20(4):254-263; doi:10.1093/intqhc/mzn018
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© The Author 2008. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved

Effect of crew resource management training in a multidisciplinary obstetrical setting

Guy Haller1,4,5, Philippe Garnerin1,4, Michel-Ange Morales2, Ricardo Pfister3, Michel Berner3, Olivier Irion2, François Clergue1 and Christian Kern1

1 Department of Anaesthesia and Intensive Care, Geneva University Hospital, Geneva, Switzerland
2 Department of Gynaecology and Obstetrics, Geneva University Hospital, Geneva, Switzerland
3 Department of Paediatrics, Geneva University Hospital, Geneva, Switzerland
4 Quality of Care Unit, Geneva University Hospital, Geneva, Switzerland
5 Department of Clinical Epidemiology, Geneva University Hospital, Geneva, Switzerland

Objective. To assess the effect of a Crew Resource Management (CRM) intervention specifically designed to improve teamwork and communication skills in a multidisciplinary obstetrical setting.

Method. Design-A before-and-after cross-sectional study designed to assess participants' satisfaction, learning and change in behaviour, according to Kirkpatrick's evaluation framework for training programmes. Setting-Labour and delivery units of a large university-affiliated hospital. Participants-Two hundred and thirty nine midwives, nurses, physicians and technicians from the department of anaesthesia, obstetrics and paediatrics. Intervention-All participants took part in a CRM-based training programme specifically designed to improve teamwork and communication skills. Principal measures of outcome-We assessed participants' satisfaction by means of a 10-item standardized questionnaire. A 36-item survey was administered before and after the course to assess participants' learning. Behavioural change was assessed by a 57-item safety attitude questionnaire measuring staff's change in attitude to safety over 1 year of programme implementation.

Results. Most participants valued the experience highly and 63–90% rated their level of satisfaction as being very high. Except for seven items, the 36-item survey testing participants' learning demonstrated a significant change (P  <  0.05) towards better knowledge of teamwork and shared decision making after the training programme. Over the year of observation, there was a positive change in the team and safety climate in the hospital [odds ratio (OR) 2.9, 95% confidence interval (CI) (1.3–6.3) to OR 4.7, 95% CI (1.2–17.2)]. **There was also improved stress recognition [OR 2.4, 95% CI (1.2–4.8) to OR 3.0, 95% CI (1.0–8.8)].

Conclusion. The implementation of a training programme based on CRM in a multidisciplinary obstetrical setting is well accepted and contributes to a significant improvement in interprofessional teamwork.

Keywords: patient safety, programme evaluation, teamwork, training programmes

Address reprint requests to: Guy Haller, Quality of Care Unit and Department of Anaesthesia and Intensive care, Geneva University Hospital, 24, rue Micheli-du-Crest, 1211 Genève 14-Switzerland. Tel: +41 22 372 90 39; Fax: +41 22 382 90 35; E-mail: guy.haller{at}hcuge.ch


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