RE: For whom the bell tolls

James Gosnell (gosnell_at_zeus.bwh.harvard.edu)
Thu, 14 May 1998 14:50:01 -0400


Gordon,
I do understand your thoughts, but I am afraid that you are only
looking at one side of this coin. I am once again defending my position as
a Flight Nurse Crewmember aboard the C-130. We have a lot of input into the
aspects of our missions. We rely very heavily on CRM in order to accomplish
all of our tasks for the flight with the rest of the Crew. Greg Deen has
been very instrumental in helping me to become a facilitator so as to bring
the important aspects of all of this coordination to the rest of the
Aircrew. We are not clients. We work together! Our situational awareness in
the back can help avoid potential catastrope in more ways than one! Our
training dictates it!

Maj.Jim Gosnell, NYANG

At 11:25 AM 5/14/98 -0400, you wrote:
>
>Just a comment on Greg's quote below, and Tony's following that.
>
>I usually agree totally with Greg's comments, but I think his quote below
>is exactly one of the problems Tony addresses so well in his piece. "An
>audience other than crewmembers" are NOT clients of the CRM
>program--beneficiaries maybe-- but definitely not clients. The biggest
>problem with the CRM Program, as I see it, is we have forgotten that our
>clients are, in fact, the aircrews. It all started when we changed
>"Cockpit" Resource Management to "Crew" Resource Management. I believe this
>change was a major reason leading to the corruption of disciples of the
>program and the subsequent looking around at the emergency medical, and
>public safety areas as potential beneficiaries of CRM. This is not to say
>that the principles don't apply in these areas, but why not let the ORMers,
>or some such other ABC program work these "clients". Our problem is that
>folks "in the cockpit" still make deadly mistakes and errors, and these are
>the folks who should be receiving dedicated CRM Training so the
>"beneficiaries" in the back can ride in peace. When was the last time a
>flight attendant crashed a jet? Sure, there may be that odd spilled cup of
>McDonalds hot coffee in the aircrews lap, but that's like saying we
>shouldn't wear seatbelts because one jammed while stalled on the railroad
>tracks. It's the folks up front, folks, who gave rise to CRM, and all the
>reasons for focusing on the aircrew are just as valid today as they were
>when the program was birthed. It would be very interesting to have a study
>done of all the programs that started out for very valid reasons, made vast
>strides very quickly, and were then totally obliterated by some folks who
>just had to expand the concept and create new names/acronyms, until the
>original concept just disappeared. Where's MBO, TQM etc. etc. etc. now? I
>sure hope the "Real" CRMers in this group don't allow the program to "Grow"
>any further. Let's leave that for other Gurus to handle. We need to keep
>the focus on CRM as in "Cockpit Resource Management". What makes up the
>Cockpit can be defined in, but if we don't focus on the folks who have the
>"Stick" we'll lose them--literally and figuratively. The "Crew" as always
>will go along for the ride. CRM works!
>
>Gordie Breault
>
>Greg writes:
>
>"And as for the true "clients" of the CRM program? It is not the
>aviators, themselves. They CHOOSE to take the risk of flying. I teach CRM
>for
>an audience other than the crewmembers, who don't have the choice.
> Consider
>those who are the true beneficiaries of our programs, or the victims of not
>having a quality program.
> Raise your sights, folks. Someone else needs this training to be better
>than it is."
>
>Tony writes:
>
> It appears that we may have come full circle from "CRM is the savior"
>to "CRM has gotten such a bad reputation that is has become the symbol
>of everything wrong in our human factors training programs -- the
>enemy." The godfathers and godmothers of CRM are moving out of flight
>operations at an alarming rate, to bring the gospel of teamwork,
>communication, and conflict resolution to the medical, space, and other
>fields. I recently reviewed a journal article for a major publication that
>challenges the validity of the entire CRM approach.
> Is this the first distant echo of the death knell of CRM as we know it?
> If
>so, where did we go wrong along the way. Over the past year we have
>hit some hot button topics that indicate we may have forgotten the
>operator along the way. Focusing on "what we teach" and "how we
>teach" we may have lost track of "who we teach." The discussion on
>"what is professionalism" was trivialized into statements such as
>"professionalism to me is the smile of a satisfied customer." If that is
>the best we are capable of, no wonder we have lost our way. What about
>OUR CUSTOMER, the flight personnel and maintainers we train? How
>many smiles do we see on their faces?
> I began a project about this time last year to define the "next
>generation" of CRM. I got sidetracked into the literature and haven't
>moved out as smartly as I should have here, and I apologize to those of
>you who signed on for the tiger team for a lack of follow-up. I am more
>and more convinced that I posed the wrong question then. Instead of
>how will CRM be taught in the future, perhaps the better question is "In
>the next ten years, what will be the most effective way to accomplish the
>objectives that are currently met by CRM?" Which begs another, more
>fundamental question -- what ARE the objectives of CRM? Safety
>certainly, but what about effectiveness, efficiency, job satisfaction,
>retention, recruitment? Are these not legitimate human factors
>concerns? Is fifth generation CRM the MOST effective method for
>accomplishing these goals? Where is the RECENT research on CRM
>effectiveness? Not in terms of student satisfaction -- but rather of
>performance. Dr Nullmeyer and a few others are pushing this side of the
>equation, but more serious performance based criteria and inquiry needs
>to be done if CRM is not to crumble faster than the Berlin Wall.
> All of these questions need to be answered -- and soon -- if we hope to
>reinvigorate CRM into its full potential before more jump ship and move
>to "something else" -- whatever that may be. One of the greatest
>philosophers of our age -- the great Mel Brooks -- stated (in History of
>the World Part 2) "Gentlemen, we must protect our phony-baloney
>jobs." Let's not have it come down to that.
>
> Tony Kern
>
>
>
****************************************************************************
*******
James L. Gosnell R.N. Research Coordinator
Work Phone: (617) 732-5196 or 8222 Anesthesia Department
Fax Number: (617) 277-2192 Brigham And Women's
Hospital
Pager: (617) 732- 6987 Number: 11217 75 Francis St. Boston,
MA 02115
****************************************************************************
*******