Communication In an assessment of the factors leading up to serious adverse events in hospitals, communication problems were the most frequently identified root cause, occurring in almost three-fourths of cases (18). Assuring clear and timely communication between all caregivers is perhaps the single most important measure to improve the safety and quality of medical care. In the health care setting, structured communication techniques are referred to under the title “team resource management.” The basic principle of team resource management is to foster an atmosphere where individuals with different roles are brought together to achieve a successful outcome to a complex operation (19). Despite differing roles, training, and ranking within a perceived hierarchy, and the fact that some individuals may not have worked together as a team before, it is understood that each participant has an overarching responsibility. That responsibility is to communicate with all team members whenever they see anything that is potentially unsafe or when other team members are not acting appropriately in a given situation. This concept is particularly applicable in the operating room, by nature a highly complex environment. Everyone present—physicians, nurses, house staff, and technicians—must keep patient safety foremost in their minds. No one should be hesitant to raise questions and concerns when an unsafe situation is observed.
There are excellent formalized systems to train health care providers in this important skill (19). One of the most comprehensive and well-recognized systems is Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), a joint project of the Agency for Health Care Research and Quality and the Department of Defense (20). The TeamSTEPPS logo (Fig. 3.1) is a visual model representing the four basic teamwork skills of leadership, communication, situational monitoring, and mutual support. The program teaches how the interaction of these skills produces the three desired team outcomes for knowledge, attitudes, and performance, and how these outcomes further reinforce those skills in a reciprocal manner. TeamSTEPPS includes the principles of team resource management, as well as many specific techniques for effective communication. One of the most useful is represented with the acronym SBAR: Situation, Background, Assessment, and Recommendation (or Request) (21). It is a structured method for relaying information about a changing clinical situation. The initiator of the exchange gives a brief description of the clinical change or concern that is prompting the communication. This is followed by the clinically relevant background information about the patient. The initiator then gives his or her assessment of what he or she thinks is happening with the patient and makes a recommendation or request for action by the other party. It is frequently used by nurses to update on-call physicians about a patient’s clinical status, but can also be used between residents and attending physicians or any other pair of providers where concise, clear communication is required.
Figure 3.1 The TeamSTEPPS program logo. (From Team STEPPS Program of the U.S. Agency for Healthcare Research and Quality [AHRQ]).