Learning objectives:
LO 1: Recognise that standardised protocols and tools facilitate clear communication, using SBAR as an example
LO 2: Understand that speaking up for patient safety is everyones' responsibility
LO 4: Outline important aspects of written communication that ensure continuity and coordination of care
LO 5: Explain the purpose of briefings in building an efficient team
Recommended study time: 12 minutes.
Did you know that most adverse events in healthcare originate from communication failures!
2.1 Learning from Established Systems: Aviation
Research in the late 1980s showed that 70% of aviation accidents stemmed from communication breakdowns, as opposed to technical aircraft failures! This led to the development of standardised communication, teamwork and decision making protocols known as Crew Resource Management (CRM). CRM has revolutionised aviation safety and efficiency.
CRMs success is relevant to healthcare as it teaches us the power of standardised systems for streamlining communication in high pressure settings. Let's look at some established standardised communication protocols in healthcare.
There's lot to learn from other fields! Stay curious and be open to recognise and incorporate new skills and strategies you've come across outside of medicine into your medical practice.
2.2 SBAR: A simple communication tool
What is it? A four tiered communication protocol that enables clear, rapid and thorough transfer of relevant patient information between team members, especially in critical situations.
Pros?
Clear structure enables logical discourse
Allows sender to prepare thoughts before hand
When can I use it? Any clinical situation, for example to escalate a clinical problem or during handovers.
Video: An example of SBAR in action:
Did you know SBAR was first developed for US Military communications in nuclear submarines!
SBAR can help overcome barriers to communication:
Hierarchy - The R in SBAR encourages even a junior sender to voice their own recommendations and suggestions.
Communication styles - SBAR overcomes contrasting communication styles (eg. narrative vs concise) by allowing the receiver and sender to operate within a shared mental model, improving information delivery and retention.
Below is an example of an internal and external barrier to communication:
Activity: Can you think of another barrier for each category? Write them in the comment section.
2.3 Speaking up: Protecting patients
Speaking up can be very difficult. As medical students, experiencing stressful and upsetting situations for the first time can be paralysing. Here is some general information and guidance:
Who is responsible for patient safety? Everyone in the healthcare team (both clinical and non-clinical members).
Do medical students have a legal duty to speak up? No, only doctors are legally required to raise concerns and promote a culture of speaking up. However, medical students have a moral duty to raise concerns, hence speaking up is equally relevant.
What should I speak up on? Any situation where patient safety, dignity or comfort is compromised. Remember to speak up in a timely fashion.
Which team member should I talk to? A trusted senior. Consult your medical schools guidance if unsure.
How can I relay my concern effectively? Avoid hinting and cues. Speak clearly and assertively.
Professionalism is about striving for excellence, and not about doing the bare minimum. Although you currently don't yet have legal duties to ensure multiple aspects of patient care, you have a moral responsibility to do the right thing.
2.4 Written communication: Ensuring continuity and coordination of care
Recording notes ensures that observations, plans and exchanges with the patient remain transparent and accessible to the MDT. These will be of primary reference during handovers, and a source of up to date information on the patients progression. Hence, written notes must be clear, reliable, accurate and legible.
Double Check! As a learning exercise your consultant asks you to write notes for a patient you've just seen on a ward round. What must you remember?
2.5 Briefings: Planning together
Briefings are short team gatherings that help prepare a team for a task ahead. They can span anywhere from 30 seconds to 15 minutes. The purpose of briefings are to:
Outline the task ahead
Introduce team members by first name (especially if they change daily)
Define roles
Anticipate difficulties/errors and plan for and around them
Emphasise the value of speaking up if anyone is concerned
Answer lingering questions
Briefings can be carried out anytime a team gathers to deliver care, for example, before a ward shift or prior to a procedure. Briefings should not be overlooked during routine tasks, as they serve as a safety blanket to prepare the team in the instance things do not go to plan.