Safety Management Systems (SMS) is based on four pillars as established by the International Civil Aviation Organization. Due to its success in reducing accidents, this process of risk identification and management has been adopted throughout the entire world of commercial aviation. SCSI has developed a four phase program for the healthcare community which draws from the lessons learned in the aviation industry through countless hours and billions of dollars invested. Each of these phases is customized and scalable to match the unique needs of various healthcare organizations.

Phase 1: SMS Overview—All targeted departments send lead managers from each for a one day SMS training course. This course aligns expectations and perceptions of the leaders within the hospital explaining what’s required of them, their subordinates, and what the benefits will be. The course is based on six modules each of which is loaded with case studies that draw the connection between medical error and corrective SMS procedures. At the end of the one day training session, management is given several tools including The Organizational Effectiveness Algorithm.

Introduction to System Safety– Begins by developing a link between high consequence industries and the healthcare community. It also creates an understanding and acceptance of the statement “Safety is something an organization does, rather than something an organization has.” (Hollnagel 2004)

The Organizational Accident– Moves past a “single root cause” to show the decision chain involves systematic procedural influences at each link. Every one of the links in the decision chain leads to the end result. Improve the system, improve the result.

Human Error & Human Performance– Error is a symptom, not a cause. Understanding the challenges of high performance under stress leads to individual coping strategies creating relief of the symptoms.

Leadership and Teamwork– Development of an effective authority gradient that facilitates peak performance within teams. Introduce the concepts of Crew Resource Management, the concept of effective utilization of all available resources be they people, equipment, or information to achieve successful outcomes consistently.

Communication in High Performance Teams– Through case studies, discussions, and models develop enhanced communication skills that improve the critical link among team members. This includes a graduated form of response to assist subordinates and leaders on how and when to intervene when a safe outcome is being compromised known as P.A.C.E. (Probing, Alerting, Challenging, Emergency Warning).

Safety Culture– Understanding what constitutes a truly effective safety culture: TRUST, JUST CULTURE, REPORTING CULTURE, LEARNING CULTURE, and a FLEXIBLE CULTURE.

Phase 2: Onsite Assessment– Once management is informed of the goals and processes, SCSI conducts a thorough assessment of the hospital staff with its experienced medical team. This allows for an independent review with tools such as interviews, surveys, and onsite observation to identify gaps in safety providing a hierarchy of target areas for improvement. The team deployed has 10 years experience conducting this type of assessment and has done so for some of the largest hospital chains in California.

Phase 3: Online Training– Based on the results of Phase 2, a customized online training program is deployed. These programs are tailored to the needs found and provides management with a unique insight of the abilities and opportunities for improvement for their teams. Each custom module comes with instruction on specific CRM and SMS principles that address the relevant issues for each department followed by brief multiple choice tests that ensure comprehension.

Phase 4: Problem Based Learning– Now that management is fully aware of the strengths and weaknesses of the various departments within the overall system and individual staff members have been instructed on areas relevant to them, we shift focus to the hands-on skills involved in CRM. Here, the theories of SMS which everyone is aware of by now are put into action with specific team building exercises including operating room demonstration videos and interactive dialogue delivered by specialized trainers to individual teams. This is the fine tuning element to the overall SMS for Healthcare program. The fourth pillar of SMS set forth by the International Civil Aviation Organization is one of continual improvement and this program mirrors that approach.