Ara Darzi is quoted as saying 80% of adverse events are caused by poor communication. Now I am not sure of the exact stats but having read a fair few incident reports and investigations as well as studied the national reporting and learning data and joint commission (US) reports communication is most definitely a major causal factor for harmful events.
Understanding the problem is key to finding the solution.
- Analyse just a few of your incidents and you will find some patterns emerging.
- Ironically talk to your staff and patients – especially those new to your area. They will soon tell you what could be improved.
- One interesting tip is to track a piece of communication and see what happens as a result. Did it result in the action intended?
- Make the information interesting and relevant. Gossip spreads like wildfire. Guidelines take 17 years to be embedded.
- Consider the three main issues below.
First– inability to speak out – Human beings differ in the way they interact. Introverts versus extroverts. Shy people versus confident people. Male versus female. Individual versus crowd. One profession versus another. This means some are heard and listened to, others not.
Generally speaking, extroverts who are confident, male, not influenced by the crowd and in a perceived higher status are heard and listened to. So in order to prevent patient safety incidents provide the conditions for the introverts, shy females. Provide the conditions and tools to hear from everyone. Staff and patients. Importantly hear and listen and act.
This could lead to someone seeing a potential error and not stopping it because of this ability to say something.
Solutions include; leaders who seek feedback from all around them, huddles that have no hierarchical structure, give opportunities to those that think before they speak such as pausing before continuing especially at crucial stages e.g before scalpel to skin. Look out for that person who has not spoken, read the body language. Check back and check independently.
Second – stifling language – Plain and simple language anyone from your grandmother to your child can understand is crucial. That means crafting the information so that it says exactly what you wanted to say in as short amount of words as you can.
Solutions are as simple as abc. Don’t use acronyms if you can help it and try hard not to get into the specialist language that only a small collection of people know. Acronyms stifle voices who are frightened to admit they have no idea what people are going on about. This has lead to people having the wrong treatment and procedures.
Third –talking to and not with patients– The patient or the person who accompanies them know their own story better than any healthcare professionals- they may not know the answers but they know how they feel. Listen to the mums, the daughters the husbands and the patients themselves. If they are worried or question an action, listen. Don’t be too proud and too late.
Solutions include; Making patients (and colleagues) feel their voice is worth listening to – ‘hello my name is’ (the fantastic campaign by Kate Granger) is a great first step. Not hearing those voices can lead to unnecessary delay in picking up deterioration. Checklists that include patients and carers.
Oh and if you like writing read Stephen Pinker – The sense of style – the thinking persons guide to writing in the 21st century.