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Check Six
What is Check Six?Check Six is fighter pilot terminology for watching out for your teammates’ backs. Check Six team training is based on the field of Crew Resource Management (CRM), a set of concepts and skills developed and proven in aviation to reduce human error and airline crash rates. Recognized by The Joint Commission (TJC), Institute of Medicine, and AHRQ, team training is a valuable strategy for enhancing patient safety. In a nutshell, Check Six aims to transform teams into active error avoidance systems. What are the key elements of Check Six Training?Training begins with raising awareness of the prevalence of medical errors and the significant impact inadequate teamwork and communication have on errors. Students are introduced to the field of CRM and learn about the similarities between aviation and healthcare – both fast-paced, high-risk environments, requiring close coordination between team members to accomplish their mission and avoid errors. Basic tenets of Check Six include:
Leadership and MembershipMedicine’s hierarchal structure, in which leaders may be regarded as infallible and unapproachable, creates an environment of inadequate communication and increased potential for error. Check Six aims to break down this “hierarchy gradient,” so that all healthcare providers feel empowered to speak up and ask questions. Team members become more engaged in the care and safety process; leaders benefit by improved flow of vital information and many sets of “extra eyes” looking out for their patients. Situational AwarenessSA refers to an awareness of one’s surroundings. Loss of SA is a major factor in human error. Maintaining SA throughout the shift becomes a principal goal for safety-minded teams. Students learn about the common threats to SA (e.g. rapid changes in patient volume and acuity) and are taught appropriate countermeasures. Board RoundsA key focus of the program is to develop a daily routine for “Board Rounds.” Board Rounds, or interdisciplinary briefings, bring together physicians and emergency department staff several times each day for team briefings. During these briefings, teams review patient and operational issues in an efficient, systematic manner. Successful implementation of Board Rounds is a major step forward for any department, and a key marker of training success. Communication and Conflict ManagementFlawed communication is a common factor in both medical and aviation errors. Check Six teaches the importance of open, precise, and verified communication. Training provides specific skills to help manage high-risk communications, such as verbal orders and patient handoffs. Students learn and practice positive conflict management skills. They are taught to inquire when something doesn’t look right and are provided specific scripts to use for these challenging conversations. Active listening techniques are reviewed and rehearsed during the course. How is Check Six Training Provided?
Check Six training is delivered in a three-hour interactive course, utilizing didactic methods, videos, and role-playing. Ideal class size is from twenty to thirty-five students, and should include a mix of physicians and staff for each class. Up to two classes can be provided per day. Training is delivered jointly by Dr. Marc Taub, a board-certified emergency physician and a CEP America Partner, and Major Doug “Oyster” Price, Air Force fighter pilot and United Airlines officer. This training partnership provides students with a unique opportunity to learn CRM skills and how they translate from aviation to medicine. Our instructors have successfully trained hundreds of emergency providers in these principles and look forward to imparting the principles of CRM to your teams.
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