Effective communication in patient safety and healthcare

A Strategy for Patient Safety in Healthcare
Dr. Taher Y. Kagalwala, M. D.
(Paediatrics), India
Specialist Paediatrician, Head of the Department of Paediatrics
and Director, Patient Safety,
Al Muwayh General Hospital, Al Muwayh, Taif, Makkah Region, K. S.
A.

Communication is the response you get when you
send a message, regardless of YOUR intent.
Dr. Taher Y. K. ps/eff comm 15-10-2014 2

 Communication is an interaction between two individuals in the
transfer of information.
 It is important because it is the front-line safety net at the front-line
of patient care in critical and urgent situations.
 It is also important because effective communication, or the lack of
it, has been strongly linked to adverse events and medical errors.

THIS
1. Identify challenges to effective communication in health-care
settings
2. Discuss the characteristics of assertive communication
3. Describe three effective communication strategies – the
SBARQ, CUS and the Two-challenge Rule

 Affects the entire team’s functioning
Numerous endorsements (hand-overs) – level of care, 24/7
environments, shifts
Shared Responsibilities – M.D.s, R.N.s, Therapies,
Consults, Ancillary services, etc.
Establish diagnosis and plan procedures and therapy
 Patient outcomes depend on accurate transfer of
information from one care-provider to another in the right
manner and at the right time in the right context.

Effective communication is
challenged by the co-existence
of intra-personal, inter-personal
and organisational
dynamics.

 Disposition – positive, negative
 Cognitive load – too much to think about
Competence – Are you knowledgeable and are you able to
apply that knowledge?
Confidence – Your level of confidence can either be
inspiring to others or dampen their enthusiasm
 Stress – Can be internal, or due to external factors
(financial, matrimonial, familial, etc.)

Past experience with the sender of the message
Conflict between the two – sender and recipient
Language and cultural differences between two
health providers or between the provider and the
patient
Gender issues
Hierarchy issues
Misinterpreting non-verbal communication

 Production pressures
 Resources to do your work effectively – human resources, supplies,
equipment, etc.
 Diffusion of responsibility – too many of us are responsible for health-care
and this can create problems in the flow of work if clear guidance
is not available
 Authority gradient – can either be a boon or a bane, depending on
where you are in relation to the hierarchy
 Interruptions, distractions, etc. can hamper effective communication
and even prevent smooth transfer of information, putting the safety of
the patient and/or provider at risk.

1.ADVOCATE for the patient or the health colleague
2.ASSERT for your point of view
3.RESPECTFULLY CHALLENGE
4.RESOLVE CONFLICT within the
framework of the guidance provided by the hospital

Structured
Communication
Strategies

 S: RN identifies self, patient and states purpose of the call and
informs the physician of the deterioration of the patient
 B: RN gives the background of the patient
 A: RN describes the change in the patient’s assessment
 R: RN recommends what he/she thinks should be done
 Q: She listens to the physician and then asks question on any doubts
that he/she may have
 Note: Repeating the instructions of the physician BACK is
extremely important in ensuring that the communication was error-free
and effective

 C: I am CONCERNED
 U: I am UNCOMFORTABLE
 S: I do not think the current situation is SAFE
The CUS is a SIGNAL PHRASE. It is like a red light that asks the person opposite
to stop and listen, and act accordingly
If the recipient of the CUS signal IGNORES or DISREGARDS the signal, it is
DISRUPTIVE BEHAVIOUR or IRRESPONSIBLE BEHAVIOUR and then you need
to evoke the next technique of conflict resolution.
Let us listen to an audio for demonstration purposes.

 If you believe that the patient’s health is being compromised
and
 You have been assertive in your communication
and
 You have failed to get the provider’s attention or he is acted in a
disruptive manner,
Then
 Let the provider know you are going up the CHAIN OF COMMAND
 And will STOP ONLY WHEN YOUR CONCERN IS RESOLVED.

NORMAL
The provider must listen attentively to the CUS
He/she must acknowledge the concerns mounted by the
communicator
 Both the parties should maintain a mutually respectful
demeanour
 If there is disagreement, the provider must provide a clear
explanation or rationale for disregarding the other
person’s concern or for not changing the line of thinking or
treatment

 We have discussed what communication means
 What are the challenges to effective communication
 What are the ways to communicate effectively – Assertive communication and the
SBARQ
 What are the methods to resolve conflict – the CUS and the Two challenge Rule
Remember: Effective Communication is the Human Connection; it is
the KEY to your personal and career success. In the field of
Healthcare, which is a very complex system, it can prevent
disruptions, medical errors and even save lives.

Effective communication in patient safety and healthcare

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