Command gradient error in Prehospital Care

Neil starts off by telling us a story about a plane that took off from JFK and flew to Portland. As they approached to land, they realised that they had a problem with the undercarriage. Instead of listening and taking advice from the flight engineer, who was on board and aware of the problem, the pilot chose to continue to fly the plane around in circles. This led to the plane eventually running out of fuel and a subsequent plane crash. Tragically, the plane crash killed multiple passengers on board, including the flight engineer. The moral of the story? Don’t be the captain who doesn’t listen and don’t be the flight engineer who didn’t speak up. Neil defines command gradient error as the actual or perceived difference in rank which inhibits communication, leads to a loss of the shared mental model and ultimately an undesirable event. We as healthcare professionals are doing much more to patients than we’ve ever done before. This sparks the need more than ever, to generate teams that are functional and collaborative. As we go through any single job, we may move between leading and following the situation. We should embrace this model of teamwork. Neil’s advice for those leading is to be receptive. We should develop an environment that allows people to question our actions and decisions. When following, we should be assertive. After all, it is usually the people following that have the bandwidth to identify a problem in the first place. In this podcast, Neil Jeffers explains how Command gradient error in Prehospital Care can ultimately lead to tragic circumstances. We should focus on collaborative teamwork and clear communication to ensure that we avoid tragic outcomes for our patients.

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