# Transformation of Teamwork and Leadership into Obstetric Safety Culture with Crew Resource Management Programme in a Decade

## TL;DR

This paper evaluates a 10-year program using Crew Resource Management training to improve teamwork and safety culture in obstetrics.

## Contribution

A tri-phasic CRM training program is shown to improve attitudes and behaviors in obstetric healthcare professionals.

## Key findings

- CRM training increased 'ACLS' attitudes and behaviors by 22.7% (p < 0.05).
- Professionals showed improved character strengths in conflict management.
- Self-efficacy remained sustained under tough clinical conditions for 3 months.

## Abstract

In parallel with technical training on knowledge and skills of task-specific medical or surgical procedures, wide arrays of soft skills training would contribute to obstetric safety in the contemporary healthcare setting. This article, as a service evaluation, explored the effect of a specialty-based Crew Resource Management (CRM) training series that transforms the concept of human factors into sustainable measures in fostering clinical safety culture of the Department of Obstetrics and Gynaecology (O&G) in the Queen Elizabeth Hospital. Within the last decade, a tri-phasic programme has been implemented by an inter-professional workgroup which consists of a consultant anaesthesiologist, medical specialists and departmental operations manager from O&G, a nurse simulation specialist, hospital administrators, and a research psychologist. (1) Phase I identified different patterns of attitudinal changes (in assertiveness, communication, leadership, and situational awareness, also known as “ACLS”) between doctors and nurses and between generic and specialty-based sessions for curriculum planning. (2) Phase II evaluated how these specific behaviours changed over 3 months following CRM training tailored for frontline professionals in O&G. (3) Phase III examined the coping style in conflict management and the level of sustainability in self-efficacy over 3 months following specialty-based CRM training. The findings showed the positive impacts of O&G CRM training on healthcare professionals’ increased attitude and behaviour in “ACLS” by 22.7% at a p < 0.05 level, character strengths in conflict management, and non-inferior or sustained level of self-efficacy under tough conditions in the clinical setting up to 3 months after training. As a way forward, incorporating a scenario-based O&G CRM programme into existing skills-based training is expected to change service framework with an innovative approach. In addition, exploring actual clinical outcomes representing a higher level of organisational impacts can be a strategic direction for further studies on the effect of this practical and educational approach on obstetric safety culture.