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d7759 - ESC 2016 European Hospital-v1.indd 1 03/02/2016 13:56 NEWS & MANAGEMENT Lufthansa and the DGOU bring aviation training to hospitals Physicians will learn assertiveness In the 1970s aviation researchers found out that roughly 70-80% of all aviation accidents were caused by human error. Thus specialised train- ing formats were introduced to help prevent errors both by on-board crew members and air traffic con- trollers on the ground. An important component of this training is Crew Resource Management (CRM). this aims to build an extremely impor- tant though often neglected factor: social skills. That is not so much about being polite, but being asser- tive in critical situations. Neither a comparable research discipline nor a comparable train- ing approach exists in healthcare, despite how much more difficult it is for physicians to detect criti- cal events or incorrect treatments – not to mention identifying their causes. Obviously errors do happen. According to international estimates each year approximately one per million hospital patients die due to avoidable treatment errors. With roughly 19.1 million patients admit- ted to German hospitals in 2014 that would translate to 19,100 patients who died from avoidable treatment errors. The fact, as such, is not new. Then why have leading members of the German Society for Orthopaedics and Trauma (DGOU) decide now to approach experts at Lufthansa Flight Training GmbH to devel- op a CRM-like training for physi- cians? ‘It was an idea whose time had come,’ said Professor Bertil Bouillon, Director of the Clinic for Orthopaedics, Trauma Surgery and Sports Traumatology in Cologne- Merheim, Germany, who is also a certified trainer for the new pro- gramme. He underlined that eco- nomic pressure in hospitals increas- es physicians’ workload – which in turn increases stress and the error risk. In the end, however, it was the individuals’ dedication that made the new training format happen. What is unique about the inter- personal competence (IC) training is that it was developed jointly by phy- sicians and safety trainers, explained Martin Egerth of Lufthansa Flight Training. A certified CRM trainer he is one of the main architects of the new course format. Egerth sees many parallels between the work environment in aviation and in hos- pital care: a strict hierarchy, much routine work, complex situations, high stress levels and the need for effective communication. For Egerth, who seized the chance to gain an in-depth look behind the scenes of a hospital, there is one particularly important skill: asser- tiveness. What is known in avia- tion is that airplane crashes usually happen after a chain of five to six errors. If this chain can be bro- ken, an accident can be avoided. However, that requires errors to be recognised early and corrected immediately. Whoever is on the scene needs to speak up as soon as he or she notices an error. ‘But when you are new in the team, when you have the feeling the oth- ers know more and when you are a bit scared to make a fool of yourself, speaking up can be really difficult,’ Egerth says. Therefore assertiveness is the core social skill that is being looked at in IC training. The new programme was designed for junior physicians, but an extension up the entire clini- cal hierarchy is planned. In the long run other disciplines might be included because, right now, IC training targets only orthopaedic and trauma surgeons. Anaesthetists as well as nurses, for example, would benefit from such training, in line with the core idea of safety training in aviation: a team where everyone works hand in glove – the best way to avoid errors and break the error chain. Most accidents result from ‘the human factor’ – long acknowledged in aviation. Thus all crew members receive regular safety training to help prevent errors on board and on the ground. Now experts at the German Society for Orthopaedics and Trauma (DGOU) with those from Lufthansa Flight Training have developed a similar training programme for physicians. This Interpersonal Competence Training was pre- sented in Berlin during October’s German congress for orthopaedics and trauma surgery (DKOU) Continued from page 3 The free ride is over! Interventions (EAPCI). The cardiologists call for a post- ponement of the phase-out of pay- ments to physicians, as the socie- ties’ congresses are planned far in advance and they need an oppor- tunity to determine how deeply the new rules will cut into attendance at meetings. The editorial followed a crash meeting held by the three authors and other leading cardiologists with Bernasconi and Europe MedTech executives in October, 2015 at a hotel in the Charles de Gaulle Airport (Paris, France). The physicians position in the dis- cussion was that the proposed code of conduct is a one-sided document written by-and-for the interests of industry without consultation from the physicians and that this has provoked, ‘a lot of confusion and misunderstanding within our pro- fessional community,’ according to statements in an editorial. ‘Whilst both parties agree that direct sponsorship can be perceived by the public as an issue in creating inappropriate interactions, we as physicians are concerned that [the] proposal may significantly impact the future of CME, create major restrictions for smaller meetings, and severely impact larger confer- ences,’ the editorial states. In Europe, France led the charge toward greater transparency pass- ing a Sunshine Act in 2011 that was enacted in May 2013. Portugal, Denmark and Slovakia have also enacted rules for greater physician- industry transparency. The impact of these fragmented actions have not tipped the scale as the reformed Code of Conduct among Europe’s leading companies in the medical technology industry. While there is not currently a movement by the European Union to enact a pan-European Sunshine law, Bernasconi said, ‘perhaps that would be better.’ ‘What we have today are different legislation and recommendations at various country levels, which becomes very complex. We have 28 different ways to manage the rela- tionship. In France every time you buy a cup of coffee for a physician you need to report it. ‘The Netherlands says you can subsidise half the expense of a physician going to a congress. The Italians say you cannot pay for a doctor going to a congress, unless he has the approval of his boss. The Nordic countries say you cannot pay for a physician to go to a meeting,’ Bernasconi added. According to Bernasconi the phar- maceutical industry in Europe has taken an approach to transparen- cy that leaves current practices in place, but requires sponsorships and financial support to be made public. ‘We looked at that, but saying it publically, posting it on a website does not address the conflict of interest that is evident to anyone, and no one today is going to believe there is not an influence,’ he said. ‘We have gone one step further into what we call transparency-plus. What we want is that if industry is going to continue supporting medi- cal education, we want to be sure we are not going to be criticized for the way we do it,’ he said. ‘The objective of industry is not to suddenly take away its funding of medical education, but to change to a different model,’ he said. ‘They will have two years to figure this out, to create educa- tional activities and programs that industry wants to support,’ he said. Otherwise in a given specialty area, companies will figure out ways to create their own programs for CME. Interactive exchange between trainers and trainees. Professor Bertil Bouillon (top left), certified DGOU IC trainer. Source: DGOU 4 EUROPEAN HOSPITAL  Vol 25 Issue 2/16 d7759 - ESC 2016 European Hospital-v1.indd 103/02/201613:56

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