By Drew Johnson
EMS1 Editor
Breakdowns in communication between responding crews lead to hundreds of deaths and thousands of injuries every year.
These communication breakdowns are pervasive, preventable, and result from the “punishment” culture that is widespread in firehouses and EMS agencies across the country, according to a session on Crew Resource Management at Fire-Rescue Med in Las Vegas.
The session, led by Bruce Evans, Jeff Dyar, and Paul LeSage, focused on ways agencies can reshape their communication strategies to allow team members to stay alert, question each other, and provide the feedback necessary to prevent potentially life-threatening accidents from happening.
“People who have studied high reliability organizations (where operator error can kill someone) have found that human error is not a cause, it’s a consequence,” LeSage, an EMT-P and owner of Critical Decision Partners, said.
Errors arise from crew members’ inability to recognize and openly identify mistakes that their peers and superiors have made in a high-stress environment.
The problem, LeSage and his colleagues argue, stems from a lack of mindfulness. Addressing this will require responders to be trained early on that it is acceptable — and even encouraged — to doubt each other and inquire when they see something that doesn’t look right.
“Error has to be looked at in a completely different way within your organization,” LeSage said. The key, he added, is figuring out what it is in your organization that keeps people from speaking up (often it’s a fear of punishment or a wish to avoid angering a peer), and creating a culture that encourages doubt and inquiry.
Bruce Evans, EMS Chief of North Las Vegas Fire Department, said managers must drive out the culture of fear, a culture which most firefighters and medics get drilled into them from their first days of training.
“If rookies are hazed, they’re much less likely to speak up about a problem they see,” he said. Counteracting this culture of fear means encouraging medics early on to have a keen situational awareness.
Responders need to be suspicious of every decision that’s being made on a call, and they should ask themselves what could go wrong with each decision, Evans explained. They should also use things like checklists to reduce their level of cognitive processing, and eliminate unnecessary distractions (like cellphones).
If a team member sees something wrong with one of their colleagues’ processes, they should speak up using non-confrontational communication techniques, Jeff Dyar, owner of Far View Group Consulting, said.
Dyar highlighted these four techniques for addressing a problem with one of your colleagues:
- Use your colleague’s name or rank when addressing them
- Use an emotional phrase when identifying a problem; for instance, use the phrase “I feel uncomfortable…"
- Offer an alternative solution
- Request feedback from your teammate, which will give them a sense of ownership of the solution
Teams that integrate these communication tools will reap huge rewards in reduced accidents and diminished conflict.
The system highlighted in the crew resource management session is, essentially, conflict management. To become highly functional, teams must accept conflict as a natural result of the diversity of their team.
Dyar warned that, for many agencies, changing their communication culture won’t come as easy as the technical skills medics must learn.
“It’s not something many agencies want to hear, but learning the people skills is going to be much harder than learning the technical skills,” he said. “But, in the end, they’ll pay off more.”