For decades, aviation has served as a model for managing high-risk environments. Although not all practices translate directly, hospitals worldwide can learn from their approaches to improving patient safety.

With this in mind, the University Hospital of Liège (CHU de Liège) in Belgium invited French Boeing 747 captain Arnaud Maillé, instructor in nontechnical skills and collaborator with France’s Haute Autorité de Santé, to deliver a presentation on the Conference Day dedicated to Quality and Patient Safety in Intensive Care.

Following this, CHU de Liège department leaders launched new the Réanim’en Vol project offering Crew Resource Management (CRM) training, an aviation-based model for communication and teamwork, to 24 doctors and nurses to strengthen their patient safety and team leadership.

“This represents 10% of the team members. These people will become communication leads. They will help identify communication errors that could lead to risky situations, while also helping to implement new practices for better communication. This is just the beginning of a larger project that should enable us to strengthen quality and safety within the department’s seven units,” said Professor Bernard Lambermont, MD, PhD, head of the Intensive Care Department, CHU de Liège, Liège, Belgium. 

​​Speaking with MediQuality, a Medscape Network platform,Maillé emphasized the value of diversity among participants. “In aviation, everyone from the captain to the newest flight attendant attends CRM training together. Safety depends on everyone’s ability and legitimacy to speak. We want the same dynamic in the ICU.”

Communication breakdown is a leading cause of clinical errors, said Lambermont. “Information transfer happens constantly during admissions, shift handoffs, or emergencies. It is like playing whispers; messages can be distorted, leading to incomplete data and poor coordination. These errors not only compromise patient care but can also confuse families receiving conflicting updates,” he noted.

Maillé outlined three main benefits of CRM: tools to improve teamwork, safeguards against human error, and support for better decision making. “Technical skills alone are insufficient to ensure patient safety. A foundation for nontechnical skills, which are often overlooked during university training, is essential. CRM goes further, promoting a true ‘just culture’ that all department members must embrace. This includes valuing human error as a learning opportunity and being open to fair feedback,” he added. 

Integrating this culture took decades into aviation. How can CRM, in just a few days of awareness sessions and training, deliver real benefits to the ICU at Liège University Hospital? “The simple act of starting the program is already a successful first step,” said Arnaud Maillé. “Of course, it will not revolutionize the unit overnight. Communication will not become perfect instantly. However, the team will set a course that it will have to maintain. And I am convinced that it will bear fruit. More broadly, hospitals can adopt CRM methods much faster than aviation can, benefiting from the experience gained in other settings. We started from scratch,” he recalled.

Lambermont emphasized his commitment to long-term development. He is already considering inviting Maillé the following year to train additional staff members. “The goal is to create a snowball effect. The first 24 trained staff members will raise awareness among colleagues about communication challenges. I am confident that others will quickly volunteer for the next CRM training,” he said. 

Before the training began, Maillé observed ICU workflows to tailor the curriculum to real-world challenges.

Benefits

​​Anne-Françoise Rousseau, MD, PhD, anaesthesiologist intensivist and head of the Department of Intensive Care at the CHU de Liège, among the first 24 co-pilots trained. While she and her colleagues can draw inspiration from aviation, she believes that other medical fields also offer examples.

“This culture is already well established in laboratories, which can share their experience with us. We must acknowledge that we are behind. This applies to training and awareness.​ Every department member must understand that safety is everyone’s responsibility at all times. It must become part of our DNA,” she said.

While patients are the primary beneficiaries, Rousseau believes that staff will also gain. “Fully embracing these values gives meaning to our work. This is crucial when many healthcare workers are under stress. Initiatives like this can reduce burnout, improve working conditions, and ultimately foster loyalty to the institution,” she added.

​Maillé pointed to aviation as evidence of CRM’s effectiveness. “We often focus on what’s not working and forget what’s working well. But CRM works. A study showed an 18% reduction in mortality and a drop in errors from 31.0%-4.4%​ when this culture is applied in operating rooms. It motivates staff, encourages open discussions, and strengthens team cohesion. This initiative at the Liège University Hospital is innovative and highly promising. It may inspire other departments, even other hospitals,” he concluded.

This story was translated from MediQuality.