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Did you know that more people die from medical error than breast and lung cancer combined?

  • Up to 25% of patients in acute care are harmed by medical error (Health Foundation 2011)

  • Medical errors are the third leading cause of death in the US alone

  • A patients length of stay is increased by 8.5 days on average as a result

  • Costing the NHS £2 billion /year

  • Frequently overlooked impact on staff when something goes wrong leading to psychological problems, stress and sickness.

  • The majority of these are due to human factors

Surrey Crisis Resource Management (SCReaM) is an innovative multidisciplinary safety initiative developed in 2014 by clinicians at the Royal Surrey NHS Foundation Trust in Guildford to improve: 

  • Team performance

  • Staff wellbeing 

  • Patient safety

As healthcare workers, we are exposed to medical error on a daily basis and working under ever increasing pressure in an already overstretched NHS. Do you ever feel you fire-fight everyday to keep patients safe? It's all too easy to keep grinding away and keep doing things the same way and expecting a different outcome, impacting patients, the NHS and just as importantly, ourselves. As highly trained individuals, we want to do the best for our patients, but currently that’s not always enough and we need to change the way we think and work. 

In 2015, we developed and implemented the first UK Emergency Theatre Prompt Cards to improve team performance during theatre emergencies and developed, in partnership with Orchard Team Solutions, this multidisciplinary Human Factors (HF) & Crew Resource Management (CRM) aviation style training programme. The course is facilitated by clinicians with an interest in human factors, and aviation pilots who are accredited CRM trainers. The course provides participants with the opportunity to gain a solid understanding of HF and its impact on healthcare, and includes modules such as:


  • Threat and Error Management (TEM)

  • Stress and Fatigue 

  • Communication 

  • Leadership and Team Synergy

  • Situational Awareness

  • Safety Culture 

  • Decision Making


Since its inspection SCReaM has evolved as we recognised that in the NHS we work in Teams rather the Crews. In addition, SCReaM is not just about dealing with crises/emergencies when they happen, but rather trying to proactively change the way we think/work on a daily basis - thus we now emphasis that we provide HF and Team Resource Management.

We understand that with any training there will always be some level of degradation of knowledge over time, so in 2018 we introduced a rolling programme. This programme allows more in-depth discussion of the core CRM principles over 2 separate days with recurrent training every 1-2 years and reduces degradation.














Whether you are new to human factors or have experience in this area, this facilitative rolling training aims to help healthcare workers understand that, as humans, we make mistakes, and to promote and maintain insight, tools and techniques to help capture these in themselves, their teams and the environment in which they work. We encourage participants to anticipate and react to the longstanding but increasingly acknowledged epidemic of medical error by improving their performance, maintaining their own well-being and keeping patients safe.

In order to support the training and encourage them to put into practice their learning, participants are encouraged to produce a 'pledge' at the end of the course. This is to use one simple technique or tool they have learnt during the day and make a SMALL change in order to improve their individual practice or department.


Originally launched in October 2016 within operating theatres, we have since provided expanded training to other areas including Maternity, the Emergency Department and wards and are currently successfully delivering other tailored training to teams involved in specific Serious Incidents and Never Events.


Click here for more course details

Any initiative is only as good as the dedicated people who are passionate and enthusiastic to bring it to life. At RSCH, these trail-blazers exist in all areas of theatres and are rapidly expanding throughout the trust. If you are interested in joining us, and becoming a SCReaM champion, please contact us and tell us what you've been inspired to change through SCReaM or your ideas to push the wellbeing, performance and patient safety agenda. 


If you work at RSCH, speak to one of your local SCReaM champions to find out more about SCReaM or tell us how you think the project should evolve to support you.


Theatres HF Initial Training: Day 1
Theatres HF Initial Training: Day 2
Theatres HF Training: Recurrent
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