CRM in aviation has another factor. Two pilots with equal credentials. One does the work, the other supervises the work. An hour or 3 later they swap roles.
Imagine a medical practice where two docs (Doc A and Doc B) walk into your exam room. Doc A interacts with you and your issue while Doc B sits there quietly paying attention. At the end of the exam, A turns to B and says “What else do you want to add or change? Anything I skipped or misunderstood?” Now Doc B may poke and prod at the patient themselves, or just ask questions, or say “Nope; I agree that was thorough and I agree w your conclusions.” Now they both look at what was entered into the case notes (paper or computer) and both sign them.
Your encounter is over and they move on to the next exam room. Where Doc B takes the lead role while Doc A watches.
Tomorrow Doc A won’t be paired with Doc B. Instead Doc A will be with Doc J, while Doc B is working with Doc T today.
The same process would apply to every specialty in an operating procedure. One to do and one to throw the penalty flag as soon as they see the beginnings of a mistake. Because mistakes / oversights / non-optimal play happens continuously. Every procedure has them. And until there’s real-time monitoring by someone of equivalent stature / expertise, there won’t be goof reduction / more optimal play.
That continuing mixing and matching of equals is an utterly necessary part of the program. If the system can’t / won’t pay for the redundancy of two equal experts, the system will fail.
Semi-related to the above, the medical biz has the problem of docs & nurses who have different, but overlapping expertises. The situation is not at all analogous to pilots and flight attendants.
In reality now, medicine uses nurses as an informal “copilot” to the doctor’s “captain”. But without the official credentials to be a real copilot. Although often they have similar or better expertise for the particular event or error about to be committed.
A very loose analog might be the many bizjet operators in the old days who’d use any unqualified warm body lightplane pilot as their copilot. That person was more useful than a bag of salt, but far less useful than a truly qualified experienced copilot rated on that jet. And the captains in those situations expected to do everything themselves, where the copilots’ role was specified to be: “Sit there, shut up, and do just what I ask when I ask for it. Period.”
With the expected high accident rate.