Anyone who has ever had to look for a job is very familiar with the phrase “applicant must have good communication skills.” In fact, most organizations would likely list effective communication as one of the biggest challenges they face. The healthcare field is no different, except in one key aspect: poor communication in healthcare could kill somebody. Most studies that have been done on hospital error-related patient injuries and deaths have found that communication breakdown was at least a factor in the error. As a registered nurse for nearly five years, I can attest to the fact that poor communication is the root cause of so many day-to-day problems, both large and small that we face in the hospital, all because we do not make the effort to speak to each other effectively. This is true across all occupations, disciplines, and departments. So how do those of us in healthcare improve our communication skills to deliver clear, concise and accurate information? Through tools and techniques such as SBAR, write down-read back, and changes in hospital culture.
SBAR: Situation, Background, Assessment, Recommendation
Most of us who work in healthcare are taught about SBAR when we’re in school. This acronym stands for Situation, Background, Assessment and Recommendations. First used in the military, SBAR communication was adopted in healthcare because it is such an effective tool to quickly and succinctly pass on all relevant information, which is especially helpful in an emergency. As an example, a nurse should not call a physician and say “Mr. Jones is having chest pains; what do you want to order?” Instead, a better call would be “Mr. Jones in 517 started having moderate, tight chest pain five minutes ago (this is the Situation). He was admitted yesterday for a broken femur, scheduled for surgery tomorrow (Background). His current BP is 170/90, heart rate is 110, O2 sat 96% on room air, unlabored breathing. No cardiac history (Assessment). We are in the process of getting an EKG. Would you like me to draw blood and order a chest xray?” (Recommendation). This second scenario is concise while still delivering all the relevant information for the physician to make a more informed decision.
Write Down – Read Back
The second technique we can use is “write down-read back.” This is very simple and is just what it sounds like: when someone tells you something, write it down, then read it back to that person to confirm you have correctly understood the message. This is extremely important for messages such as lab results, and in fact has become policy in many hospitals because it has been proven to prevent errors. For example, if the lab calls the nurse to report, “Mr. Jones in 517 has a potassium level of 6.2,” the nurse should write that down and state back, “Mr. Jones in 517, potassium of 6.2,” and the lab would confirm that’s correct or clarify if it’s not. This technique is also very useful when delivering messages containing misheard numbers, such as 15 vs 50. The person taking the message should say “fifteen, as in one five” to make sure nothing was misheard. This extra step takes only a second and could prevent a critical medication error.
Hospital Communication Culture
Despite all of us in healthcare being taught and trained about these and other effective communication techniques, many of us fail to use them. There could be a variety of reasons for this, but usually it boils down to inexperience, nervousness, being busy or rushed, forgetfulness, even arrogance or just plain laziness. Therefore, it is critical that a hospital works to foster a culture where effective communication is prioritized amongst all staff members, including providers. Beyond training employees on communication skills, hospitals should remove barriers to good communication. One barrier can sometimes be behavior related. For instance, there may be a provider who is known to be short tempered and gets angry when asked questions or asked to repeat himself. A zero tolerance policy for rudeness/condescension towards a person making an honest effort to do right by the patient should be instilled and enforced. Too often mistakes are made because staff members are afraid to speak up to demeaning individuals or are afraid to call a provider to clarify an order or ask a question, for fear that person will become angry. Hospital culture should be such where this behavior is not tolerated, and employees should have a way to report a verbally abusive provider or other staff member without fear of retribution. Another barrier could be technological in nature; many times providers and staff are not properly trained on the computer system, and orders are either placed incorrectly, or missed, or misunderstood. Proper computer training for all individuals should be implemented.
Although sometimes difficult to achieve, a highly communicative workplace is entirely doable. With proper training, enforcement, and incentive, staffers will be able to succeed in creating a safer environment for their patients. Ultimately, if good communication skills are valued hospital-wide, the hospital will be sure to experience fewer errors and better patient outcomes.
