Overview of patient safety, communication and high reliability tactics for improving outcomes.

1. Communication & Patient
Safety: Setting the Stage
David P. Russo, DO, MPH
Columbia Pain Management, PC

2. Why Start With
Communication?
 The majority of adverse patient events (errors)
involve communication failures
 Patient Safety Net 2005 occurrence data - 21% of
contributing factors attributed to team factors
 10 years later?
 60% of all medication errors involved communication
errors
 84% of team factors involve provider communication
problems

3. The Need for Teamwork
Healthcare is an extremely complex environment
 There are:
 Surprises
 Uncertainty
 Incomplete Information
 Interruptions
 Multitasking

5. Psychological Safety
Effective Leadership
Does it feel safe to raise your hand & ask a
question 100% of the time?
 “Don’t just tell me what you think I want to hear.”
 When someone asks for help, come with a smile on your
face 100% of the time. (Fake it if you don’t really feel it.)
 “Lets frame a plan for Mr.___. Call me if he goes
out of the box” or “When do you want me
to call you?”

6. Psychological Safety…
Recognition that human error is inevitable
“Too Err is human; to blame is DEVINE”
 Complex systems
 Inherent Human Limitations – stress, limited memory
capacity, fatigue, & multitasking
 Safety is often ASSUMED, not ASSURED
 Culture of the expert of the individual
Solution:
Teamwork & Communication!

7. Psychological Safety…
Environment of Respect
 “A fundamental, non-negotiable respect for every
employee, everyday, by everyone”
 The work is recognized and acknowledged
Cultivate curiosity
 Ask questions?
Focus on skill development & learning
 What do you need to know for next time?

8. The Four Quadrants
High Safety
Low Accountability
“COMFORT ZONE”
(Lazy)
High Safety
High Accountability
Low Safety
Low Accountability
APATHY
(Wreckless)
Low Safety
High Accountability
ANXIETY
(Tunnel Vision)

9. Effective Communication
 Structure Communication (SBAR)
 Assertive communication
 Critical communication (key words)
 Debriefing

10. Different Communication
Styles
 National Culture
 Gender
 Roles (Physician, Nurse, Manager)
 Nurses: narrative & descriptive
 Physicians: problem solvers “just give
me the facts”

11. Structured Communication:
SBAR
If the phone goes dead in 10 seconds – will the person on
the other end know what is needed?
Situation – State what you are calling about (5-10
second punch line)
Background – State what you are calling about (including
objective date i.e. vitals, labs)
Assessment – State what you think the problem is
(diagnosis
not necessary – include severity)
Recommendation – State what you think needs to be done
for the patient (get a time frame)

12. Structured Communication
S –Mr. M has sudden onset of radiating chest pain
& shortness of breath
B – He has a history of MI’s, & his vitals are
186/76, 180, 24 & he is on 5L of O2 per nasal
cannula sats 84%
A – I think Mr. M might be having an MI
R – I need you to come evaluate the
patient, how soon will you be here?

13. Assertive Communication
Speak up (at the appropriate time and place) and state your information
with appropriate persistence until there is a clear resolution
What is it?
 Organized in thought and
communication
 Valued by the entire team
 Looking for clarification &
common understanding
What is it not?
• Aggressive or hostile
• Ridiculing
• Confrontational
• Ambiguous
GET PERSON’S
ATTENTION
EXPRESS
CONCERN
REACH
DECISION
STATE
PROBLEM
PROPOSE
ACTION
*

14. Assertive Communication
 Get the person’s attention…
 “I’d like to sit down and talk privately for 10 minutes when
you have a moment, when would be a good time to talk?”
 Express concern…
 “I’m concerned that…”
 Propose solution…
 “Is it possible to…”
 Reach decision
 “When can I expect to any action?”

15. Critical Language
Key phrases understood by all to mean “stop and listen to
me – we have a potential problem”
 United Airlines “CUUS” program:
I’m Concerned
I’m Uncomfortable
This is Unsafe
I’m Scared
 “I just need a little clarity”
Stop & make sure you are all in the
same movie! No surprises!

16. Debriefing
An opportunity for the individual, team & organizational
learning
What did we do well?
What did we learn?
What would we do differently next time?
Be specific, timely and to the point

17. The Difficult Conversation
When anticipating a difficult conversation focus on:
What needs to happen for us to do the right thing
for our patient?
 Focus on the common goal - high quality, safe care
 Depersonalize the conversation - focus on the patient
 Avoid judgment - don’t place blame
It’s not about you & me, it’s about the
quality & safety of our patient care!

18. Practice Time!

19. SBAR Practice
 A patient comes in for a scheduled procedure with
IV sedation. While checking the patient in you
detect an odor of alcohol. The patient seemed
confused in the waiting room and almost tripped
while being walked to the procedure room. You ask
if the patient felt okay and they said that they were
just tired from not sleeping the night before….

20. Assertive Practice
 The photocopier broke three weeks ago and you
emailed your Manager twice about the problem and
was promised it would be fixed ASAP. Nothing has
happened. The broken copier is causing delays in
clinic work flows and making people irritable.
GET PERSON’S
ATTENTION
EXPRESS
CONCERN
REACH
DECISION
STATE
PROBLEM
PROPOSE
ACTION
*

21. Critical Practice
 You notice that Dr. R. has not been diligent with his
handwashing lately. Prior to a procedure you
observe Dr. R. picking his nose. Now, he’s getting
ready to do a procedure and is not wearing any
gloves…
I’m Concerned
I’m Uncomfortable
This is Unsafe
I’m Scared