Introduction to Crew Resource Management
Crew Resource Management (CRM) is the application of human factors knowledge and skills to the conduct of flight operations with the objective of efficiently using all available resources (equipment, systems and people) to achieve safe flight operations. CRM combines individual skills and human factors knowledge with effective crew coordination.
Commercial air transport remains one of the safest methods of moving people and goods from one point to another. The number of fatal incidents per mile travelled is extraordinarily low however the industry suffers a paradox of very low accident rate but a very high potential for loss of life when an accident does occur.
It has been widely quoted during the past several decades that around 75% of accidents are caused by human error but what this term fails to recognize is that humans are but one part of the wider environment – they must interact with many components including weather, technology, social systems etc. Despite this, humans are at the most very basic level the root cause of almost every incident because humans ultimately design and/or interact with all elements of the wider environment.
The core reason for the existence of air carriers is to safely transport people and goods from one place to another. Management of risk and threat is the key to managing safety and therefore many aviation systems (such as weather planning, air traffic control and flight deck warning systems) exist to manage risk.
Modern crew resource management focuses upon the management of all available resources to reduce error including all groups of aviation specialists (e.g. air traffic controllers, pilots, cabin crewmembers, mechanics and dispatchers) through goal setting, teamwork, awareness and both pro- and reactive feedback (Helmreich).
The training of Crew Resource Management for commercial aircrew has become a mandatory practise under the majority of the world aviation regulatory environments (CAA, FAA, JAR, EASA) and practice of Crew Resource Management is an integral part of commercial airline operations.
The successful application of CRM in aviation has been recognized and equivalent training methods are now widely applied in a range of other high risk industries including, for example, medicine, fire department and maritime.
Crew resource management as a model of safety management
Crew resource management is a model of management used to manage threat and error in aviation.
The core elements of CRM are
- the goal of a safe flight (goals),
- cooperation and communication between pilots, ATC, cabin crew and dispatch,
- monitoring of internal (intra-crew and aircraft) and external situation for threats (e.g. poor teamwork, weather, terrain, fuel state, location of aircraft in regards to flight plan) and
- feedback to enable practices to be adjusted and threats to be evaluated
These core elements allow throughputs to be created which enhance system performance.
- Awareness of the current state of both internal (onboard the aircraft) and external operations (air traffic instructions, environment, weather) and threats
- Threat detection (through awareness of the situation),
- Threat response through expertise (training/standard operating procedures), coordination and communication (between the crew and air traffic control, intra-crew, crew and dispatch etc),
By using the core elements and throughputs of goals, teamwork (communication/cooperation), situational awareness and feedback the crew practice threat detection and error avoidance behaviours.
Example application of the crew resource management model
A commercial flight is approaching an international airport that has heavy convective (thunderstorm) activity nearby. The air traffic controller (TMA controller) is issuing multiple instructions to the flight crew to sequence the airplane with others towards the ILS approach. Because of the delays being caused by the weather and extended vectors the flight is running behind schedule.
The situation posed here presents several threats to the flight (weather, demands of ATC, schedul adherence)
The flight crew detects these threats using the core elements of monitoring and expertise (recognizing the bad weathers impact through awareness of the environment and their expertise of meteorology, air traffic control and their training in CRM/human factors).
These threats have been detected and the flight crew responds to the threat using the throughputs of situational awareness, expertise, communication/cooperation (teamwork) and feedback.
- Awareness of the current state of the threats and the situation (state of the aircraft in relation to fuel, capabilities and where the aircraft is in relation to other traffic and the flight plan)
- Expertise is used to manage the threats through the flight crew’s knowledge of the situation and options available to manage it – e.g. diverting, holding
- Communication/cooperation between the flight crew, dispatch, ATC, cabin crew is used to discuss threats, formulate a plan of action and various options available to the flight.
- Feedback on how the plan of action is working
The flight crew formulates a plan of action by discussing amongst themselves and dispatch (sharing expertise through communication) that they will attempt one approach and if they must go around (miss the approach) the flight will divert to the alternate airport (awareness of the situation and options available to them – i.e. alternate airport).
The output of the action taken is compliance with the plan of action, ATC requests and standard operating procedures.
Safety of the flight (i.e. decision to only make one approach and divert if unsuccessful) is the outcome.
CRM & Aviation
‘Natural limitations on human performance and complexity of the environment make error inevitable’ (Helmreich Pub.257). In the aviation industry, safety is the utmost priority even though they (aviation industry) can justifiably or boast about how much safer it is to travel by air then on road. The field of human factors has been a great concern since the early days of commercial aviation (Hawkins 1987). Human factors evolved from an initial combination of engineering and psychology with focus on ‘knobs and dials’ to an multidisciplinary field that draws on the methods and principles of behavioural-social sciences, engineering and physiology to optimise human performance and to reduce human error (National Research Council 1989).
One of the most outstanding developments in aviation safety for the past decade has been the implementations of training programs aiming to increase effectiveness and efficient in crew’s teamwork as well as flight-deck management (Foushee & Helmreich 1993). This development was first introduced when aircraft investigators concluded that ‘pilot error’ documented in past accidents and incidents were reflected to team-communication and coordination rather then pilots ‘stick and rudder’ skills proficiency (Murphy 1980). The original label for such training was known as cockpit resource management, but with recognition to its applicability of the approach to others members of the aviation community; it changes into Crew Resource Management (CRM) (Helmreich, Merritt & Wilhelm 1999).
CRM training aims to develop effective performance which consists of technical proficiency and interpersonal and team skills. The primary focus will be directed to team coordination, the attitudes and behaviours of individual (Jensen 1995). CRM courses are designed to address human behaviour which is a product of knowledge and thought process, personality, attitude and background. It is not design to change ones’ personality (Helmreich, Foushee, Benson & Russini 1986).
In order to achieve those key-points mentioned above most CRM syllabus worldwide contain a common set of elements. (Table 1).
Table 1: Structure of CRM
Crew Resource Management
- Workload Management
- Conflict Resolution
- Team Management
- Stress Management
Crew Resource Management, Awareness, Cockpit Efficiency & Safety
Communication and Decision-making Skills is the first cluster of CRM modules. These skills are the primary core factor in good CRM. It is to build up interpersonal skills in which crew will need to ensure optimal performance. Personnel attending CRM must know that information must be requested, offered or given freely in a timely way to permit accurate, effective decision-making. CRM training will also provide knowledge on communication styles used by others for interpretation as well as to determine the proper emphasis for a response (Jensen 1995). With poor information due to poor communication, there will be a lack of critical information or data which will subsequently affect decision-making.
On 25th January 1990, Avianca Flight 052 crashed while making a second attempt to land at JFK International Airport, New York (NTSB aircraft accident report HK2016). NTSB reported that flight crew did not communicate an emergency fuel situation to the ATC before fuel exhaustion occurred. Communications was reported as not clear and the captain did request the first officer to repeat information louder as the captain could not hear it. A fatal communication error occurs when the first officer relay the message to turn starboard instead of turning port. This massage made the B707-321B fly a longer loop thus burning more fuel. Communications between the ATC and the first officer clearly shows a misinterpretation about fuel level. The first officer assumed that the ATC had acknowledged the low fuel status of the Flight 052 but in fact, the ATC interpreted the transmission as ‘Flight 052 has sufficient fuel’. Words like ‘emergency’ was not used by the first officer thus it leads to a different outcome of interpretation.
This air accident shows us a total breakdown in communication by the flight crews in attempt to relay important situations to the ATC. The flight crew was reported to have limitations in their individual abilities in English language. Proper knowledge of CRM training which focus on inter-personal communication will perhaps prevent this accident as the pilots may have better proficiency in English language, communicate better and clearly, standardisation of phraseology which will prevent misinterpretations and the pilots may repeat to the other party about the message and make sure they understood what the situation was before engaging in other conversations (Shari Stamford Krause, Ph.D.), With good attributes of CRM, decision-making by the captain or the first-officer to declare an emergency and seek for help from the ATC might prevent this fatal accident. CRM training in communication and decision-making allows aviation personals to increase team effectiveness, reduces fewer errors which eventually increases the safety aspects (Helmreich, Foushee, Benson & Russini 1986).
Communication and Crew Resource Management
Table 2: FAA required topics on CRM courses.
Situation Awareness Group Dynamics Workload Management
Effective Communication Risk Management Stress Awareness
Mission Planning Human Factors Decision-Making
Source: USAF flight Standards Agency. December 1998 (ATM06A)
The second clusters of skills will be Team Building. Team building consists of two major concepts which are leadership and team management. Large aircrafts like the A380s or the B747-800s are flown by teams not by individual pilots. Teams are often used in aviation as the complexity of task increases as technology advances. Teams are used to also provide redundancy in order to provide an extra safety factor which is critical for aviation (Ginnett 1993). CRM focus on how people behave in teams/groups. As people behave differently in teams/groups as they do alone, CRM training teaches personnel to adapt to such situations and to optimise performance rather then getting ‘affect’ from team-working. CRM aims to reduce problems which might be created in teams such as, bystander effect, conformity, social loafing, decision-making in teams and groupthink (Jensen 1995).
On 23rd March 1994, an Aeroflot Russian International Airline A310-304 crashed near Mezhduretshensk, Russia killing 75 passengers onboard (ICAO Adrep Summary 2/94 #4).The aircraft crashed after a captain allowed his children to fly the plane. While the boy was flying, he inadvertently disengaged the autopilot linkage to the ailerons and put the airliner in a bank of 90-degrees which caused the nose to drop sharply. The co-pilot tried to remedy by pulling back on the yoke to obtain level flight but the plane stalled. After several stalls, the aircraft crashed into the ground.
This Example display how poor team performance can have disasters consequences. Conformity affects the co-pilot as he agrees with the captain to allow unauthorised personnel to handle the aircraft. The co-pilot knew that this was against procedure and worst of all; to let someone without any qualifications on flying to handle the aircraft. The co-pilot was perhaps under pressure from the captain when he gave in towards the decision. Normative-influence occurs in order to not to offend the captain. In another aspect, the captain did not show leadership capabilities as he had breech safety policies to allow non-pilots to fly the commercial airliner.
If the co-pilot had been properly trained with CRM, he would reject the captain’s idea. CRM teaches a person to use proper communication skills as well as assertive behaviour in order to handle such situations. Therefore, from this example, we can conclude that CRM is critical and it will be able to prevent such fatal accidents.
These include concepts like mission planning, stress management and workload distribution. Accidents often happen when workload demands are greater than team capabilities. In pilot’s perspective, most accidents happen during take-off and landing phrases. These phrases are periods on high workload. But surprisingly, low workload can also cause accidents. In flight crew perspective, during the long cruise segments, the pilots may be less attentive then when they are working frantically. This low workload periods are times where complacency is the most common. This is known as the low-arousal level factor from the Yerkes-Dowson Law (Wickens & Hollands 2000).
On 3rd September 1989 2045hour, VARIG airline flight RG 254 made a forced landing into a jungle near Sao Jose do Xingu, Brazil due to fuel exhaustion (ICAO Adrep Summary 5/89 #11). The flight, a B737-241 took off at 1725hour from Maraba towards Belem, Brazil. The flying time was approximately 45mins. The flight crew entered into the flight computer 270degrees instead of 027degrees. After 2hours of flying, the captain finally realized that they were flying towards the wrong direction. Amendments were made to fly back to their original route, but it was too late. The plane was 600NM off course.
Fuel exhaustion occurred which leads to the forced landing in the jungle. The navigation mistake went unnoticed because the flight crews were reported listening to the World Cup Qualification Match between Brazil vs. Chile.
From this example, we can see that how poor workload management contributes to such an accident. If the crew/team manages to priories their workload and if the crew doubled-check their computer inputs, such accidents will not even occur. With quality CRM training, teams are train to follow procedures and to double-check their work. Good leaders will distribute even workload to each member’s capacity, in order to have optimal performance. From this accident, if captain has order the co-pilot to make scheduled checks on the flight computer, such accidents could be prevented. Distractions such as listening to radios should be minimised. The pilots should increase their arousal level by going through cruising procedures in order to have optimal performance during cruising. CRM training for personnel will prevent such accidents which increases aviation’s safety.
From the three examples given above which demonstrated human factors being a key failure which result in massive destruction, proper CRM training must be applied in order to increase safety in aviation. CRM knowledge will reduce the above mentioned slips/mistakes which will prevent the accidents.
The evolution of CRM training can be traced over three decades. CRM history has been sub-divided into five generations (Foushee & Helmreich 1993).
First generation of CRM is started by United Airlines in 1981. These programs emphasize on changing individual styles and correcting deficiencies behaviour (Helmreich, Merritt & Wilhelm 1999). First generation of CRM is psychological in nature with focus on psychological testing as well as developing general attributes like leadership (Helmreich, Merritt & Wilhelm 1999). There are no clear definitions of appropriate behaviour at its learning outcome of CRM training. CRM was also integrated with simulation training known as Line-Oriented Flight Training (LOFT). During this humble beginning, there are still many rejections on CRM training as they felt that such programs attempts to manipulate their personality (Foushee & Helmreich 1993).
The Second generation of CRM was held by NASA in 1986 (Orlady & Foushee 1987). By this time, there are many airlines conducting CRM programs. The term ‘Crew ‘was used rather then ‘Cockpit’ as research believed that other aviation personnel would require such skills as well. This also began adding more skills into its core program such as team-building, decision-making.
The third generation which occurs in 1990s display a vast number of improvements. Human factors issues have been accepted and CRM issues are addressed with concerns to flight-deck automation (Helmreich, Merritt & Wilhelm 1999). CRM has been extended to other aviation personnel such as cabin crews, engineers.
The fourth generation of CRM training are emphasizing on integration and proceduralisation. One of the main introductions to CRM training at this period would be the culture perspectives of different regions. CRM trainings are to integrate with its local/organisational culture in order for it to have optimal effect on performance (Helmreich, Merritt & Wilhelm 1999).
The fifth generation of CRM are heading towards a universal rationale (Helmreich, Merritt & Wilhelm 1999). It is also known by many that CRM trainings are countermeasures with three lines of defence for human errors. Its focus has shift to the basis of limitation of human performances which in terms will reduce human errors. Organisational culture is also one of the main concerns in CRM in recent years as it enhances safety towards another level. If company culture has been ‘safety first’, with CRM training, the results will prevent less human errors (Helmreich & Merritt 2000). Again, Culture does not affect its primary goals of safe and efficient flight. It is merely the environmental factors which may determine the level of air safety at different part of the world (Helmreich, Kanki & Wiener 1993).
After understanding briefly the evolution of CRM training as well as it three main cluster of skills, we can conclude that CRM indeed serves it purpose to increase safety. CRM has affected or influence the growth and development of civil aviation in many ways.
Firstly, human factors topic added in to pilot training. Human factors have been recognised as a ‘core technology’ in aviation. ICAO Assembly set the foundation of human factor programs in 1986. In 1989, ICAO revise the ANNEX 1 which from then all requires all contracting states pilots to be familiar with ‘human performance and limitations’ In 1997, when the European Joint Aviation Regulation (JARs) became effective, CRM is a mandatory all professional pilots and those studying for their licenses (McAllister 1997). As CRM evolves till today, it is recognised as a compulsory training for all pilots, controllers and even other aviation personnel.
Secondly, with CRM regulation and its usefulness to reduce errors, aviation training in airlines, flight schools, and military-flying has changed dramatically. For example, airline pilots training are now focusing on training for technical skills as well as behavioural and resource management skill in order to fly safely and efficiently in today’s environment. Pilots are to know about human strengths, limitations and small-group-performance in which they will take advantage of them in which may reduce errors (Orlady 1993). CRM research has also lead to changes selection of pilots. Modern pilot selections are now focusing on individual’s cognitive and psychomotor skills then their personality factors.
Thirdly, CRM provides countermeasures to errors, thus Safety in aviation equals to money for companies. Although CRM trainings are expensive to conduct especially annually for personnel, it minimised the possibility that any company will occur in an accident (McAllister 1997). By economical comparison, training fees as compared to the cost of an aircraft such as an A380 is more worthwhile. Another major indirect cost would be customers’ reaction to safety training. If the public thinks that particular airline is ‘unsafe’ they will boycott such airline thus suffering financial damage on sales. Therefore, CRM and other safety programmes are actually cost-effective and would end up saving/earning revenue for airliners.
In summary, safety is the utmost priority in aviation even if it is safer then travelling on road. Human factors are a great concern since the early days of aviation as 75% of the accidents in aviation are caused by ‘pilot error’. CRM is an application which reduces errors committed by humans. CRM training aims to allow all aviation personnel to have effective team-performance which consist of technical proficiency and interpersonal skills. CRM courses worldwide are similar in terms of its content having three main clusters of skills which are communications and decision-making skills, team-building and workload. By acquiring knowledge taught in CRM programmes, slips or mistakes will be greatly reduce in order to increase safety in aviation.
CRM has now been an intangible topic in aviation training. It had actually started two decades ago. CRM has been sub-divided in to five generations. It evolves as a programme concern with only emphasizing on changing individual styles and correcting deficiencies behaviour in the first generation, to the second generation with more core skills like decision-makings. The term cockpit was changed to crew at this point of era as they realised that other aviation community require CRM training as well. The third generation has major development such as including human factors concepts into its programme. The fourth generation integrated organisational culture into its context. Till today, the fifth generation of CRM training are still evolving and consistently monitored for any changes to improve in safety. CRM training now shifted its focus to limitation of human performance as compared to the first generation which is psychological in nature.
As CRM research continues, many regulatory and government bodies such as JARs, ICAO, NASA and FAA have all recognised the potential benefit of CRM and they have implemented rules to include CRM and human factors as one of its core modules for most aviation personnel training worldwide. CRM have globalised into a necessity in aviation. Secondly, training for airliners, flight schools and the military diverted their focus from mostly technical skills to an even-mixture of technical and resource skills for pilots as well as other aviation personnel. One major influence from CRM will be the selection process of pilots in airlines as well as schools. Selection criteria shifted from personality factor to applicants cognitive and psychomotor skills. With CRM training to reduce errors, it directly means having more profits for airliners. Safety is money. With less accident rate, airlines will cash in more money as compared to the cost of an aircraft. With CRM trainings, they may in one way attract market-share which allows airlines to earn more profit. CRM and other safety programmes are actually cost-effective and would end up saving/earning revenue for airliners.
To conclude, CRM training has evolved dramatically. It has helped the aviation industry to be safer in all aspects of the industry. As error is inevitable, CRM research will continue to change and grow with its aim to reduce more errors in human performance in order rise to another level of aviation safety.
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