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Effect of crew resource management on diabetes care and patient outcomes in an inner-city primary care clinic
  1. Cathy R Taylor1,
  2. Joseph T Hepworth2,
  3. Peter I Buerhaus1,
  4. Robert Dittus3,
  5. Theodore Speroff3
  1. 1Vanderbilt University School of Nursing, Nashville, Tennessee, USA
  2. 2University of Arizona College of Nursing, Tucson, Arizona, USA
  3. 3Vanderbilt University School of Medicine, Nashville, Tennessee, USA; VA Tennessee Valley Healthcare System, Tennessee Valley Geriatric Research Education Clinical Center (GRECC), VA THVS Health Services Research Center for Patient Healthcare Behavior, VA National Quality Scholars Fellowship Program
  1. Correspondence to:
 Dr C R Taylor
 Vanderbilt University School of Nursing, 461 21st Avenue South, 316 Godchaux Hall, Nashville, TN 37240, USA; cathy.taylor{at}


Background: Diabetes care in our inner-city primary care clinic was suboptimal, despite provider education and performance feedback targeting improved adherence to evidence-based clinical guidelines. A crew resource management (CRM) intervention (communication and teamwork, process and workflow organisation, and standardised information debriefings) was implemented to improve diabetes care and patient outcomes.

Objective: To assess the effect of the CRM intervention on adherence to evidence-based diabetes care standards, work processes, standardised clinical communication and patient outcomes.

Methods: Time-series analysis was used to assess the effect on the delivery of standard diabetes services and patient outcomes among medically indigent adults (n = 619).

Results: The CRM principles were translated into useful process redesign and standardised care approaches. Significant improvements in microalbumin testing and associated patient outcome measures were attributed to the intervention.

Conclusions: The CRM approach provided tools for management that, in the short term, enabled reorganisation and prevention of service omissions and, in the long term, can produce change in the organisational culture for continuous improvement.

  • APN, advanced practice nurse
  • CRM, crew resource management
  • LDL, low-density lipoprotein
  • LEAP, lower extremity amputation prevention
  • MiAL, microalbumin
  • VHCC, Vine Hill Community Clinic

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  • Competing interests: None declared.

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