Healthcare, according to the Joint Commission on Accreditation of Healthcare Organizations, is an information business and should be thought of as such. The thinking goes like this (from the Joint Commission’s Guide to Improving Staff Communication, second edition):
“Information from the clinician’s education, training, experience, literature review and online resources is combined with …
“Information solicited from the patient, the patient’s family and diagnostic testing to generate new …
“Information about the patient’s condition and possible therapeutic interventions.”
All this information and more must be efficiently and clearly shared, and understood by all stakeholders in a patient’s well-being. Any breakdown in communication along the chain of information can lead to a breakdown in patient care, which could prove catastrophic.
In its guide, the Joint Commission cited communication failure as a leading cause of errors in dispensing medication, treatment delays, wrong-site surgeries and even fatal falls. The National Institutes of Health defines healthcare collaboration as healthcare professionals “assuming complementary roles and cooperatively working together, sharing responsibility for problem-solving, and making decisions to formulate and carry out plans for patient care.”
The NIH further explains that teamwork increases each members’ awareness and understanding of the type of knowledge and skills possessed by teammates, and that effective teams are characterized by “trust, respect and collaboration.”
It is incumbent upon organizational leaders to manage information flow, which means a system that enables efficient communication and teamwork is vital. In fact, Joint Commission standards require that accredited organizations develop and maintain clear channels of communication to ensure patient safety.
This means that in addition to responsibilities such as patient care, employee management and research projects, those who occupy leadership roles in nursing must be diligent when it comes to facilitating and encouraging clear communication among staff members at every level.
Nursing leaders reach the management level because they have demonstrated that their skills and credentials match their experience and medical knowledge. Still, no matter how much experience or skill a manager possesses, effective communication can only occur if the human element is considered.
“Effective communication between nurses and other caregivers is critical to patient safety,” wrote Joint Commission Patient Safety Services expert Deborah M. Nadzam. “Yet, numerous challenges contribute to poor communication and an unhealthy reliance on individual action.”
The key to developing a culture that enables and encourages efficient communication and teamwork, Nadzam wrote, is for managers to take a proactive role in establishing communications protocols – and for them to remember that staff members are people, first and foremost. In setting up and maintaining efficient lines of communication, Nadzam wrote, managers should:
- Avoid the blame game. Seek and solve problems within the system first, before jumping to conclusions about potential individual shortcomings.
- Get to know how the staff members think and communicate. Consider testing different communication methods to determine what works best.
- Encourage development of “active” listening skills. Consider implementing training to help staff members listen more effectively.
- Encourage and enable open communication and shared knowledge/ideas among staff members.
One familiar example that requires sharp communication skills and well-understood protocols is the shift hand-off in hospitals. Nadzam suggested the following specific actions that a manager can implement to improve staff communication around the clock:
- Hold regular briefings — short discussions that allow staff members to compare notes, lay out goals and help anticipate potential obstacles.
- Make group rounds that allow all members of a care team to visit a patient simultaneously to communicate issues, develop ideas for solutions and anticipate potential problems together, rather than on an individual basis.
- Employ the SBAR (situation-background-assessment-recommendation) technique to standardize the type of information team members communicate whenever a patient is discussed.
- Employ a customized version of the U.S. Forest Service’s STICC technique (situation-task-intent-concern-calibrate) to identify specific problems, potential solutions and specific limitations.
Once communication protocols have been established, nursing leaders and other managers must implement best practices for maintaining open lines and adjusting the system when necessary. Nadzam recommends implementing a system that is:
- Easy to understand
- Provides consistency and predictability
- Provides redundancies to ensure that failures in one area can be covered by success in other areas
- Uses “forcing” functions, or tasks that make it simple to do the right thing and difficult to do the wrong thing
- Minimizes reliance on memory and ensures that people can’t easily work around the system.
An occasional communication audit will help managers determine if adjustments to the system are required, as well as identify areas that are working well. An audit, or needs assessment, can take the form of personal observation, group discussions, employee or patient feedback through questionnaires, tests or work samples.
Flexibility, courtesy and shared understanding are vital components of teamwork in any setting, and could mean the difference between adequate and inadequate care in a medical setting. The bottom line for nursing managers is to always be mindful of how efficiently information moves through the organization, and to be ready to make changes if inefficiencies emerge.