The Quadruple Aim provides broad categories of goals to pursue to maintain and improve healthcare. Within each goal are many issues that, if addressed successfully, may have a positive impact on outcomes. For example, healthcare leaders are being tasked to shift from an emphasis on disease management often provided in an acute care setting to health promotion and disease prevention delivered in primary care settings. Efforts in this area can have significant positive impacts by reducing the need for primary healthcare and by reducing the stress on the healthcare system. Changes in the industry only serve to stress what has always been true; namely, that the healthcare field has always faced significant challenges, and that goals to improve healthcare will always involve multiple stakeholders. This should not seem surprising given the circumstances. Indeed, when a growing population needs care, there are factors involved such as the demands of providing that care and the rising costs associated with healthcare. Generally, it is not surprising that the field of healthcare is an industry facing multifaceted issues that evolve over time. In this module’s Discussion, you reviewed some healthcare issues/stressors and selected one for further review.
CRM has evolved in different states. The initial CRM program, which can be regarded as the first generation CRM was initiated by United Airlines between 1980 and 1981. The first generation of CRM programs was developed by consultants who had been indulged in formulation of management programs to improve management effectiveness. The first United Airline CRM module was formulated like Managerial Grid which had been used in psychology (Helmreich et al., 1999). Under the program, training was conduction in a seminar setting and it mainly involved diagnoses of individual managerial style and skills. Most of the CRM programs which were developed during this era were heavily reliant on management training approaches. They were mainly aimed at changing management styles and correction of individual deficiencies. For example, they aimed at correcting individual lack of assertiveness for the juniors to eliminate the concept of “captain is always right” and to remove the authoritarian approach of the captains. These courses were mainly physiological and based on general concept of leadership. Although the advocated for strategies to improve personal behavior, they did not give a clear definition of the appropriate personal behavior in the flight deck. These CRM programs were also made recurrent rather the episodic and they used games and exercises, some which were not related to aviation concepts. However, these programs met resistance especially from pilots who described them as ‘charm schools’ that were merely aimed at changing their personalities. The second generation CRM programs were developed to improve on the programs discussed above. In 1986, NASA held a workshop which was aimed at discussing the emerging challenges facing the implementation of CRM programs (Helmreich et al., 1999). From the conference, it emerged that CRM would soon cease to be a stand-alone training when it would be incorporate in flight training and also in flight operations. Around this period, there was new generation of CRM programs that were coming into the market. These programs changed the name cockpit and replaced it with crew in order to reflect the diversity of the targets since it become evident that apart from pilots, other crew members, including mechanics, had a major role to play in flight safety. The new programs became a blue print of Delta Airlines program that was focused more on the given aviation concepts, which were related to flight operations (Helmreich et al., 1999). The new programs were also modular and team oriented compared to the earlier programs. They were also delivered through seminars but dwelt on important aspect of flight like team building, briefing strategies, stress management, and others which had been eliminated from initial trainings. The depth of the module was implanted on the decision making strategies and the strategies that crews could use to break chain of errors that were likely to land the flight into catastrophe. However, there was no much distinction between these programs and the first generation program since training was mainly carried out through exercise and demonstrations which sometimes were not related to aviation. These programs were accepted more than the first generation program. They were however criticized for being ‘psycho-babble’. Most of these second generation program continue to be used in United States and other parts of the world as well. Third generation CRM were mainly involved with broadening the scope. These programs emerged in 1990s and CRM training was beginning to take a trend to multiple paths. The training started becoming more related to situation in aviation system which reflected the way crew functioned with inclusion of multiple factors like organizational culture and others which determined safety. Third generation programs also began to show signs of integration of CRM with technical training and there was focus on specific skills and behaviors which could be employed by pilots to b>GET ANSWER