Development of Behavioral Markers for Team

Human factors are the most relevant issues contributing to adverse events in obstetrics. 13 Specific training of Crisis Resource Management (CRM) skills (i.e., problem solving and team 14 management, resource allocation, awareness of environment, and dynamic decision-making) are 15 now widespread and are often based on High Fidelity Simulation. In order to be used as a 16 guideline in simulated scenarios, they need to be translated into specific and observable behavioral 17 markers. To this purpose, we developed a set of observable behaviors related to the main elements 18 of CRM in the delivery room. The observational tool was then adopted in a two-days seminar on 19 obstetric hemorrhage where teams working in obstetric wards of six Italian hospitals took part to 20 simulations. The tool was used as guide for the Io and as a peer-to-peer feedback. It was then rated 21 for its usefulness in facilitating the reflection upon one’s own behavior, its ease of use, and its 22 usefulness for the peer-to-peer feedback. The ratings were highly positive, around 4 in a 5-point 23 scale. The CRM observational tool is therefore a useful, quick and easy solution to facilitate the 24 debriefing, the peer-to-peer feedback and, most of all, the transfer of safe behavior from simulation 25 to everyday practice. 26