Monday Lesson From History

I recently finished the HBO series Chernobyl, the dramatic portrayal of the 1986 nuclear disaster in the Soviet Union.  Overall it is a satisfying work, an apparent comprehensive description of the major events surrounding the explosion of the Soviet nuclear power plant, though of course with accepted theatric license that has been criticized elsewhere.  But what struck me is the core (no pun, seriously) issue that led to the disaster, the conflict that repeats itself in history with all too much frequency  and in this case led to unmeasurable suffering.  This would be the failure of effective communication within a hierarchical structure. 

Crew Resource Management (CRM) is an idea that grew out of the airline cockpit culture, to allow for free expression and questioning from all crew members, regardless of their place in the traditional hierarchy.  CRM was meant to replace the authoritarian, top-down, never question the captain culture with one of open collaboration.  This idea is present now in medicine, seen most clearly in surgery and the ICU, where a more team approach is fostered as opposed to the physician being an unquestioned commander that should not be challenged.  When used effectively, this can allow any member of the team to speak and question freely without fear of repercussion.  Of course, theory and practice are often not in sync, but this continues to be the goal of most medical care teams. 

There was no such theory or practice in the nuclear reactor control room at Chernobyl.  Fear of superiors was present at all levels of the hierarchy, which accelerated the errors that eventually led the plant’s explosion.  It is about time that we reflect on this example and finally learn that cooperative environments foster more consistent success than autocratic systems.