Top Gun Training Tactics Result In Better Care For Inner-City Diabetes Patients

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Employing training methods originally developed to save lives in the air, LifeWings Partners LLC, helped a resource-strapped inner-city clinic significantly improve care for their diabetes patients.

The critical need for better patient care is an imperative for medical facilities large and small. Increasingly stretched community clinics that provide a vital safety net to the most vulnerable populations are continually faced with the challenge of having to make improvements with dwindling resources. One such center successfully employed an innovative approach that allowed them to improve patient care and delivery processes using only current personnel and equipment.

The Vine Hill Community Clinic serves an inner-city population in Nashville, Tennessee. Approximately 90% of the clinic's patients are on a state form of Medicaid. Like many primary care clinics in the U.S., Vine Hill provides outpatient care to many patients with type 2 diabetes. Diabetes is the leading cause of adult blindness, kidney disease, and amputation. Although almost 18 million people in the U.S. have diabetes, less than optimal care is often provided, particularly in at-risk communities. Improving care for these patients is vital because many complications may be helped or avoided with good care and behavioral changes.

Recognizing the urgent need for improved diabetes care, the Vine Hill clinic contracted with LifeWings in 2004 to provide what is considered to be a very promising form of training for the healthcare industry: Crew Resource Management (CRM) based training. CRM is a team based approach to service delivery not usually found in the medical arena. CRM was developed in the 1990s to reduce the human error component of aviation accidents. CRM produces an inclusive, organized, collaborative environment in which potentially high-risk decisions can be made with the most possible information and high degrees of accountability and flexibility. CRM enables teams to make better decisions and have the best chance of avoiding negative outcomes. The methodology has worked remarkably in aviation, arguably the safest high consequence industry, resulting in no U.S. passenger deaths in three years.

The Vine Hill Community Clinic initiative included a formal study conducted on visits from 619 type 2 diabetes patients over a thirteen-month period. The conclusions of the study state that the CRM training was instrumental in improving the diabetes care process and the patient outcomes. The number of patients who met the recommended levels for blood pressure, amputation risk, body weight, and other factors improved after receiving care from the CRM trained staff. Further benefits to the clinic include improved organization of diabetes care team, decreased patient visit time, and shorter orientation periods for new staff: all very important cost-saving measures for the severely under-funded public health sector. Although follow-up training is important to the continued success, the improvements from this training are viewed as significant to this clinic.

The success of this effort, and others like it, are not going unnoticed by the medical community. With persistent press about the alarming number of preventable, error-induced deaths in the U.S., medical providers are desperately looking for innovative ways to improve patient care. Many medical care providers never receive formal training on teamwork, situational awareness, or conflict management. Critical communication skills that could save lives are often not taught, monitored, or measured. Protocols and checklists are often not a part of typical medical care delivery, in the clinic or in the operating room. Contrast this with the systematic, documented, and mandatory recurring training received by those in the aviation community and it is not hard to see why the numbers are materially better. CRM ensures all members of a crew flying an aircraft know their responsibilities, protocols, and obligation to speak up if they feel something is not safe. The medical community is learning that applying these principles to healthcare delivery can provide measurable improvements for their patients.

About LifeWings Partners LLC

LifeWings Partners LLC was founded in 1999 by a former U.S. Navy flight instructor and commercial airline pilot. The firm specializes in applying CRM based training to help healthcare facilities save lives and reduce costs. The firm has helped more than 40 facilities nationwide provide better care to their patients. Measurable results are found in many LifeWings initiatives including one hospital that reduced its surgery error rate from one every 60 days to one every 619 days, 10 times better than the national average. The firm also conducts "bootcamp" sessions to teach physicians from different facilities better communication and leadership skills.


Steve Harden, President, LifeWings Partners LLC


9198 Crestwyn Hills Dr

Memphis, TN 38125

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