Communication and teamwork go hand in hand with regard to patient safety. One of the goals on the list of the Joint Commission's (JC) National Patient Safety Goals is improve the effectiveness of communication among caregivers. The Joint Commission requires healthcare organizations to establish processes that will help eliminate errors.

Communication is a two-way street. Differences in knowledge, perceptions, and decisions frequently surface when people communicate. This can cause disagreement, misunderstanding, and conflict. However, the communication process is not harmed if disagreement is managed constructively. Breakdown in communication was the leading root cause of sentinel events reported to the Joint Commission in the United States between 1995 and 2006. Interdisciplinary communication and teamwork is extremely important in fostering patient safety. The healthcare industry has looked at industries such as the military and commercial airlines for clues to make communication more effective. The key is to learn to contain the consequences of mistakes (because we are human), to train teams to work more effectively to detect and recover from errors, and to take a more proactive, rather than a reactive, approach.

 The World Health Organization (WHO), in conjunction with the Joint Commission, suggests the following strategies for effective communication:

• Ensure that healthcare organizations implement a standardized approach to hand-off communication between staff, at change of shift, and between different disciplines aUse of the SBAR - Situation, Background, Assessment, and Recommendation - technique. In 2001, Michael Leonard of the Kaiser Permanente of Colorado Group introduced the SBAR to the healthcare industry. SBAR is a technique that provides a framework for communication between members of the healthcare team about a patient's condition.  It is an easily remembered mechanism useful for framing any conversation, especially critical ones that require a caregiver's immediate attention and action. It allows for a focused way to set expectations for what will be communicated and how, which is essential for developing teamwork and fostering a culture of patient safety
• Allocating sufficient time for communicating important information and for staff to ask and respond to questions without interruptions wherever possible (repeat-back and read-back steps should be included in the hand-over process).
• Providing information regarding the patient's status, medications, treatment plans, advance directives, and any significant status changes.
• Limiting the exchange of information to that which is necessary to providing safe care to the patient.

• 2. Ensure that healthcare organizations implement systems which ensure - at the time of hospital discharge - that the patient and the next healthcare provider are given key information regarding discharge diagnoses, treatment plans, medications, and test results.
• 3. Incorporate training on effective hand-off communication into the educational curricula and continuing professional development for healthcare professionals.
• 4. Encourage communication between organizations that are providing care to the same patient in parallel (tradition and non-traditional providers).

Resources

Root Causes of Sentinel Events, all categories. The Joint Commission, Oakbrook, IL.

Available: http://www.jointcommission.org/SentinelEvents/Statistics/

The Joint Commission and World Health Organization. (May, 2007). Patient Safety

Solutions. Communication During Patient Hand-Overs. 1(3), Solution 3.

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