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 JCAHO, 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:
- Humans are fallible
- Healthcare is a high-risk environment
- Faulty communication and hierarchal barriers
are common root causes of medical error
- Healthcare providers do not receive adequate
training in communication, teamwork, and assertiveness skills
- Errors can be reduced through a definable set of teamwork concepts and skills.
Leadership and Membership
Medicine’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 Awareness
SA 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 Rounds
A 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 Management
Flawed 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 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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