Raise the Bar on Your Communication Effectiveness
Communication continues to be at the forefront. A few days after writing my last blog, I had occasion to speak to a Quality Assurance Manager of a large metropolitan Atlanta hospital.
She shared that her organization had launched a new initiative on improving patient safety. As part of that push they are actively encouraging reporting significant events. These are not all near misses (events which are so serious that there is the potential for harm or death to a patient), but important none the less.
I asked what they were doing to create a just culture of "no blame" in which employees are encouraged to report errors committed by themselves and their colleagues, confident that they will not be punished. She admitted that was the most significant challenge.
The next biggest headache is the quality of reports submitted during investigations. Laboratory managers and supervisors are familiar with the pain of soliciting reports while investigating incidents. Since formal incident reports capture only the barest of details, additional written reports are often necessary. However because writing styles and acumen vary widely, reports also vary quite a bit in quality, length, content and format.
That's where SBAR comes in. This is a communication technique used in some healthcare organizations. SBAR (Situation-Background-Assessment-Recommendation) is an easy to remember mechanism that can be used to frame any critical communication-from report writing to verbal conversations.
Situation: Summary of what happened.
Background: What caused the problem? Summarize how X caused Y.
Assessment: Dig a little deeper; what did not work as designed? What extraordinary thing happened? What policy/procedure was not followed?
Recommendation: What can we do to fix the problem now? What ideas do I have to minimize the possibility of this situation occurring again in the future?
Here is a very simple way in which SBAR might be used. The ED medical director calls the lab director complaining that "everything went crazy on the weekend, labs were all late and several patients could not be treated, discharged or admitted as they waited hours for lab results." A simple SBAR report might look like this:
Situation: Chemistry analyzer ABC6000 was down for 2 hours causing a delay in reporting ED results including BMP and cardiac enzymes
Background: Results seemed spurious and not reproducible. QC was out of range for troponin, glucose and BUN. Therefore no results were reported.
Assessment: It was found that the onboard water supply had failed; under-hydrating the cartridges. All cartridges had to be unloaded manually and new cartridges were loaded on the backup instrument, calibrated and QC'd.
Recommendation: Run a line for a backup water supply, calibrate and run controls on the backup instrument as part of daily maintenance. Direct the laboratory shift supervisor to inform the ED charge nurse of any anticipated delays in TAT and provide updates until the problem is corrected.
This sounds simple and commonsensical. Right? But it works. SBAR captures only the vital information, communicates a shared set of expectations, and the conversation ends by coming up with a resolution to THIS problem or recommendations for improved service delivery going forward.