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Roles, Relationships and The Art of Talk

   by Nicholas Wolff, LCSW, BCD, TEP
      In the early nineties, the Air Force achieved a 60% drop in accidents after implementing a program called Crew Resource Management (CRM)training – which emphasizes the “human factor” skills of communication,situational awareness, decision-making and team performance. The pre-CRM cockpit featured a “a traditionally rigid hierarchy with an autocratic captain and subservient flight crew. The cabin crew was not even considered part of the flying team. This tradition closely mirrored the maritime industry’s concept of the captain being “master of the ship.” Since adopting CRM, U.S. air disasters (not related to terrorism) have fallen from approximately 20 per year to one to two per year”  ("Sustaining and Advancing Performance Improvements Achieved by CRM" Dynamics Research Corporation). Since that time, aviation professionals reached out to the medical/surgical field where CRM is gaining ground
      Medical, surgical and aviation teams operate in high-stakes situations with lives on the line that demand technical precision with little margin for error. Specialists in group dynamics will not be surprised to learn that when mistakes are made within teams – sometimes with catastrophic results - the majority are due to problems in communication within the team and interpersonal issues. A few examples:
  • “Communication Failures: An Insidious Contributor to Medical Mishaps” published in the journal Academic Medicine states that “Communication failures are complex and relate to hierarchical differences, concerns with upward influence, conflicting roles and role ambiguity, and interpersonal power and conflict.”
  • A study published in The Journal of the American College of Surgery found that “communication in the OR was perceived to be poor by the anesthesiologists, adequate by the OR nurses, and good by the surgeons” revealing a true disconnect among members of the same team.
  • Communication skills trainings significantly improved the communication between oncologists and patients that is critical to effective care, and more resources should be allocated to this work, according to a study reported in Lancet.  
   What works in a cockpit, surgical theater or EMS response unit is a powerful model for what works in any team that has a job to do. These studies point out the importance of talking openly and honestly and of creating a system of communication that allows hidden dynamics among people in groups to be examined and understood. Trainers and therapists can apply the Crew Resource Management model and improve the effectiveness of any group, whether that group is a company, marriage/ partnership, family or project team. Anyone who has served on a committee that talks a good game but accomplishes little, or sat through tortured meetings with policy-focused administrators unwilling to hear about the real problems their staff encounters day to day knows that communication breakdowns due to dysfunction within the group leads straight to burn-out. And the work suffers.
        Co-facilitating is a worthy test of relationship skills, as well as a check in the self-awareness department. Professionals who run groups are as vulnerable to role conflicts and hidden tensions in relationships as our trainees and clients. Symptoms that a training team needs some rehabilitation show up in post-processing after an event, the first of which is avoiding the debrief altogether. Just as troubling is a team whose members take the time to debrief but withhold questions or confusion about choices made by others during the event.  While our work does not usually have the life-or-death component that is always there for teams of firefighters or EMS personnel, the fact that people in our groups surrender a degree of control, lower their defenses and open their minds to us means we have a high degree of responsibility to both honest and respectful in working out our differences with one another. 
Read a Crew Resource Management Manual

 
Nicholas Wolff, LCSW, BCD, TEP runs a weekly training group
 in Experiential/Action Methods at Lifestage, Inc.

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