William S. O'Keefe

William S. O’Keefe has spent 25 years training CRM to high-risk occupations. He has trained healthcare, NASA astronaut and flight controller, firefighter, oil drilling, maritime and military teams. (Concerning the book A Practical Guide to Crew Resource Management for Healthcare Teams): In my 25 years as an US Air Force pilot, I lost many friends in accidents. During my 30 years at the NASA Johnson Space Center, I was an instructor on the training team for the Space Shuttle Challenger, and present for the Columbia accident. One thing that these accidents had in common was human errors contributed to the tragedy. I have spent most of my adult life trying to find ways to make operations safer and more effective. That effort led me to Crew Resource Management (CRM). But in the dozens of books that I read over the years, I never found one that gave me the concrete, evidence-based skills and tools I needed, or scenarios where I could see good and bad CRM in practice. Other books were aimed at organizational change, where I needed ways to improve my team on their next shift. That is what our book does that is different to similar titles. Thinking about CRM, STEP and STAR: Let’s start with definitions. CRM (Crew Resource Management) has been defined as how humans safely and effectively interact with hardware, software and their fellow human beings. We have narrowed this definition to focus on team interactions that enhance safety and effectiveness. Our CRM model is based on teamwork and is modified from that of TeamSTEPPS and Team Dimensional Training. Our CRM model has four skills: Exchanging Information, Communicating, Leading and Following, and Mutually Supporting. STEP (Status, Team, Environment and Progress) was also modified from TeamSTEPPS. It is a mnemonic that serves to remind one of the four areas necessary to achieve “big picture” situation awareness (SA). STAR (Stop, Think, Act and Review) derives from NASA’s Johnson Space Center Flight Operations Directorate (Houston, TX) and the Callaway Nuclear Power Plant (Fulton, MO). It is a mnemonic signifying the steps necessary for the execution of sound plans made from wise decisions. So how do these three concepts tie together? For a team to be safe and effective, every member must have “big picture” (referred to as Total SA in the book). STEP is used to acquire the “big picture.” CRM skills are employed to ensure that all team members possess the information that they need. Finally, STAR is utilized to assure the execution of plans derived from logical decisions.