1. Section of Neonatology Children’s Mercy Hospitals and Clinics
Communication A Chiasm of Perspective If men are from Mars and women from Venus, where are doctors and nurses from?
Jodi Jackson, MD
Section of Neonatology
Children’s Mercy Hospitals and Clinics
Kansas City, MO
Some slides adapted from Michael Leonard, MD presentation on “Effective Teamwork and Communication in Delivering Safe Care”
December 2005

2. Example 2 am Lots of detail Very tired provider Unclear expectations
Communication failure

3. Before We Start
Please take a few minutes, and discuss with the people around you a recent phone call you made or received to/from a colleague, nurse, doctor consultation, other
Write down purpose of call
Who call was to or from
Pertinent issues you remember
Why the call was made
What were the expectations of the call
Did the call meet your expectations
Anything else significant

4. Was the purpose of the call clear to the caller and person receiving the call
Yes or No

5. Where the expectations of the call met
Yes or No

6. Video Example

7. Your Examples

8. Example 1 Title— Purpose of call— Call from— Call to— Expectations—
Pertinent issues—
Expectations met—
Opportunities for improvement—

9. Example 2 Title— Purpose of call— Call from— Call to— Expectations—
Pertinent issues—
Expectations met—
Opportunities for improvement—

10. Example 3 Title— Purpose of call— Call from— Call to— Expectations—
Pertinent issues—
Expectations met—
Opportunities for improvement—

11. Why Communication?
The overwhelming majority of untoward events involve communication failure
The clinical environment has evolved beyond the limitations of individual human performance

12. Where Do Things Fall Through the Cracks ?
Systems – information, tests, diagnoses
Communication
Hand offs

13. An Institute of Medicine report concluded in 2000 that up to 98,000 Americans die each year because of medical mistakes. The report called on governments, doctors, and private industry to launch a massive effort to increase error prevention.

14. Effective Communication Requires:
Structured communication – SBAR
Assertion/critical language – key words, the ability to speak up and stop the show
Psychological safety – an environment of respect

15. Misunderstandings
Movie Clip

16. JCAHO Communication Patient Safety Goals
Structured Communication

17. Need for Communication
“The less innate understanding there is concerning a specific task, the more disparity there will be between the intended result and the actual result.”

18. Human Error Is Inevitable Because:
Inherent human limitations
Complex, unsafe systems
Safety is often assumed, not assured
Culture of the expert individual

19. Error Is Inevitable Because of Human Limitations
Limited memory capacity – 5 to 7 pieces of information in short-term memory
Negative effects of stress – error rates
tunnel vision
Negative influence of fatigue and other physiological factors
Limited ability to multitask – cell phones and driving

20. THEN WE HAVE HUMAN JUDGMENT

21. Error Management
The best approach is effective teamwork and communication – everyone in the same movie
And having predictability, so people know what is supposed to happen

22. MD–RN: Different Communication Styles
Nurses are trained to be narrative and descriptive
Physicians are trained to be problem solvers “what do you want me to do” – “ just give me the headlines”
Complicating factors: gender, national culture, the pecking order, prior relationship
Perceptions of teamwork depend on your point of view

23. Example Communication of frequent desaturation events
Does communicator have an expectation regarding response to call
Is the communicator concerned or just reporting
Does the communicator know how this relates to previous findings

24. Example Call from outside referral
No context in which to frame information
No order to information given
No clear reason for all

25. Situational Briefing Model
S-B-A-R
Situation
Background
Assessment
Recommendation

26. SBAR in OB S – Impending uterine rupture B – VBAC, dense epidural,
persistent breakthrough pain,
complete
A – I’m concerned, something’s wrong
R – I think she needs a C-S. I need you
now

30. When Receiving a Call --Situation How often are you given a clear:
Never Always

31. When Receiving a Call --Background How often are you given a clear:
Never Always

32. When Receiving a Call How often are you given a clear: --Assessment
Never Always

33. When Receiving a Call How often are you given a clear:
-- Recommendation
Never always

34. When Receiving a Call
How often to you really understand the expectation of the call:
Never always

35. When Receiving a Call
How often do you ask (in a subtle way) “why are you calling”?
Never always

36. SBAR Situation – the punch line 5 to 10 seconds
Background – the context, objective data, how did we get here?
Assessment – what is the problem?
Recommendation – what do we need to do?

37. Assertion – What Is It?
“Individuals speak up, and state their information with appropriate persistence until there is a clear resolution.”

38. Assertion
Model to guide and improve assertion in the interest of patient safety *

40. Some Data
Baseline data regarding information shared during phone calls
Percent

41. SBAR QA Form Situation Background Assessment Recommendation
NICU data, CMH
Situation Y N
Background
Assessment
Recommendation
ID of caller
Gestational Age
Vital Signs
What I need from you
Patient Name
Day of life
Exam / Observations
Timeframe of Need
Admitting Diagnosis
Current level of support
Pertinent Labs / Tests
Orders given
Specific Concern
Plan of Care
Interventions
Clarification –
Write down / Read
back
Stability of Situation
Conclusion Stated
Callback Specifics
Directions:
Once you have taken and completed a call, please fill out the questionnaire on SBAR.
The Y means “yes” the caller gave you the information without you asking for it. The N means “no” you did not get the information or you had to ask for it.

42. Practice Please form some small groups Look at your examples
See if formatting into a form is helpful
Report back

43. Your Examples
Who has examples they would like to share?

44. Next Steps JCAHO recommendation for all caregivers
In order to be effective, doctors need to accept and mentor nurses in their transition to using SBAR
Recommendation part is hard to get around
why is recommendation accepted or not
a great teaching opportunity to make sure everyone is on the “same page”

45. Thank you for your attention.
Comments?