Safety culture is a facet of organizational culture that captures attitudes, beliefs, perceptions, and values about safety. A culture of safety is essential in high reliability organizations and is a critical mechanism for the delivery of safe and high-quality care. It requires a strong commitment from leadership and staff. In this course, a safe culture is promoted through the use of identifying and reporting patient safety hazards, accountability and transparency, involvement with patients and families, and effective teamwork.
Communication
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Setting the Stage for Success: An Eye on Safety Culture and Teamwork (Patient Safety II)
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Strengthening Safety Culture Through Teamwork
Research shows that many errors can be attributed to breakdowns in teamwork and communication. In this module, participants will learn how safety culture can be strengthened though teamwork and communication. Participants will learn skills critical in the prevention and mitigation of medical errors.
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Eileen Kasda
Hello and thank you for watching this video on communication.
Previously, we had talked about team training as a strategy for improving
a broad range of the skills we
need to manage our teams effectively and become an expert team.
In this video, we're going to dive a bit deeper into communication,
what exactly we mean by that and what
some specific approaches are to improving communication.
So, the basic elements of communication,
think of this as we have some communication channel.
Most basically, we're face to face talking to one another.
We can also be doing this over the phone of course,
which strips away some of the information we have,
our body language cues, our facial expressions.
We can be doing this over email,
or the electronic health record.
All of these things tend to strip away the actual information we
have but are still of course very common ways to communicate information.
Across that channel, we're trying to communicate some content.
What is it that I'm trying,
the information I'm trying to provide to you,
or receive from you some specific messages.
And of course, all of this happens within a context.
A context can involve lots of noise and distractions,
which can make communicating that content more difficult.
That context can include the hierarchy that we've discussed
previously that can inhibit our willingness to ask questions,
or provide information openly.
And all of this we're trying to communicate for some purpose to some aim.
So, these are the things we kind of need to think about when we go into
a situation and see what can we do to improve communication here,
what can we do about changing the way people communicate,
helping structure the content that they communicate,
or changing the context that they're communicating in.
These are all very valid ways to help improve communications.
So, it is about skills but there's a bigger picture there too that
involves technology and the organization and work processes and the environment.
But we're going to focus on a couple of things here,
which are the most common approaches to improving communication in healthcare.
And the first one is this idea of introducing structured communication tools.
So, what we do is we find kind of high risk communication points,
or points where we can build up resilience and we try to understand
what is the content that needs to get passed in that situation and we structure it.
We use checklists, or we change the work processes so
people have more of an opportunity to interact on a regular basis,
or use information technology tools,
alerts and warnings those types of things.
So, it's really trying to find where does communication consistently go wrong,
or has the potential to go wrong,
where there's really big impacts on the patient's care,
and let's try to introduce some structure to that to make it easier and more reliable.
The other approach is thinking of communication more as an adaptive skill.
It's something we do all the time.
It's something that we necessarily can't structure all of it.
So, we have to be good at it in those spaces between where things are structured.
And this is where our style matters a lot and we'll talk about at least one of
the examples of that and what good communication style looks like.
And also, this is where we create common ground with
the people that we're working with and where we build trust.
How we communicate with people openly,
honestly, can really impact how they see us and their willingness to communicate with us.
So, these two things really fit together quite nicely when
communication is high risk and predictable let's structure that,
but let's also build our skills so that we're communicating well
and building an environment where people are comfortable, willing,
and the expectation is that we communicate proactively on an ongoing basis.
So, some examples of structured tools you've probably heard many of them,
SBAR is one, I-PASS is one,
there's a lots of acronyms out there.
Here is one that is not too different from the others but has come from other industries.
It really encapsulates some of
the core positive attributes of a structured communication.
Some aspects of conversation you would want to
happen when communication really, really matters.
And the first piece of the STICC acronym is the Situation.
Here's what I think we face.
Here's what's going on currently.
The Task, here's what I think we should do in this situation.
And again my opinion what I'm offering to someone else,
here's what I think the most viable plan forward is.
An Intent, a rationale,
why this is the acceptable approach moving forward compared to others.
The Concerns, given this plan and why we're pursuing it,
what are some things we need to be wary of,
which we keep our eye on,
what's the worst that can happen in this situation that we need to be sensitized to?
And the last piece which I think is great, is Calibrate.
So, once I've provided this information to you,
let's start a conversation. Talk to me.
What do you think? Am I off base?
Am I missing something?
What's going on that we're not seeing?
And this is really kind of a transition between our structured communication and
a more adaptive conversation that's open and that's not structured.
And that's I think very important for the structured communication tools.
The challenge with structuring anything is,
when we put it in the work environment,
if it's not enacted mindfully,
it becomes an administrative task sometimes.
And we see this with operative briefings and debriefings.
We're not really paying attention when we go through the checklist sometimes.
And that's a constant battle to kind of fight that tendency.
So, having this at the end where we engage people in
conversation should be a part of most structured communication tools.
And that's something we see more and more often.
Another example where structure communication tools get used quite a bit are Handoffs.
And this is some data from the I-PASS study that was
published in The New England Journal of Medicine several years ago and they did
a phenomenal job of implementing
a structured communication tool to reduce risk of Handoffs in pediatric residents.
So, what they saw was a 23 percent decrease in the medical error rate,
a 30 percent decrease in preventable adverse event rate.
And they did this with not changing the actual adverse event rates and they did this
without causing a significant change in how long people were spending on Handoffs,
which is a critical thing.
It wasn't taking more time.
They were just using that time more effectively because it was structured
and organized in a logical way.
And if you look at what they did in terms of interventions to implement
this they really did everything you could probably almost imagine,
of what you would want to do to change behavior in an organization.
It wasn't just the acronym. It's bigger than that.
It's harder than that.
So, what they did was standardize the oral and the written handoffs.
They had a training program around how to use a structure,
they did faculty development
so that they were on board and knowledgeable of what it took as well.
And they had a structured observation feedback program where people were given
some critiques and some developmental feedback on how
well they were implementing this communication tool.
And of course, they had a sustainability program like we talked about last time,
it's all the things that happened before where they develop training,
they used Health I.T.
to support this as well and what happens after ongoing feedback to
the observation program and a sustainability campaign where they
manage this and communicated it over time,
its importance and that it wasn't going away.
So, close-loop communication is an example of an adaptive skill.
It's still structured to an extent but it's not tied to any specific interaction.
It's something we can use throughout our work day.
And in this situation, when someone provides a piece of critical information,
or the person receiving that information needs to
acknowledge that they heard what was said and really repeat back the intent,
or their interpretation of what was heard so that both the receiver and
the sender of that message understand that it was interpreted correctly.
And again, this is a piece of,
a piece of the puzzle that came to us again
from that aviation disaster we introduced before,
making sure that information doesn't fall through the cracks,
it doesn't get misinterpreted in high risk situations.
Another example of communication as
an adaptive skill comes to us from Edgar Schein and his idea about humble inquiry.
He re-juxtaposes different styles, or ways,
or modes of asking questions,
of interacting with our colleagues, or team members.
And he talks about humble inquiry as a way that maximizes my own curiosity
and interest in someone else's perspective and tries to minimize my own bias,
my own preconceptions about that other person.
In this style, we tend to use lots of open ended questions.
We tend to talk as little as possible about
ourselves and we ask questions about them and their perspective.
This tends to build trust.
This tends to elicit information you otherwise wouldn't have access
to because they trust that you're honestly interested in what they have to say,
and this can be a difficult skill to learn, it sounds simple.
It's a skill that takes time to build.
And he contrasts this idea of humble inquiry with a confrontational inquiry style,
where you're really essentially asserting your own ideas
or perspectives in the form of a question.
You're really looking for confirmation of what you already know
or what you already expect to be the case.
We ask leading questions.
We basically tell and aren't honestly asking questions.
And this gets us what people,
a response that's more socially acceptable.
We get the answer that they think we're looking for instead of what they actually feel.
And it builds a climate where they don't necessarily trust that you're
going to honestly listen to them and you get very little information from people.
So, that's an example of a more flexible adaptive skill.
We can use in an ongoing basis that will help build trust to help
us build better information flow in the team and it will get
us better information about what's actually going on and about what people are
thinking and feeling in the organization about different initiatives,
or about any one patient's plan of care.
So, moving forward, we're going to dig a little bit deeper
into a more complex teamwork competency,
or skill needed to be an expert team.
We're going to talk about leadership in our next video.
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