Download (Microsoft PowerPoint - 2013 06 13 Haag SBAR [Kompatibilitetsl

Communication gaps in patient safety
EFFECTIVE COMMUNICATION IN
A HIGH RISK ORGANIZATION:
SBAR
Carl-Johan Wallin, MD, DEAA, PhD
WHAT IS OUR MISSION?
To cure, care and comfort patients without harm
Hippocrates
c. 460 bc – c. 370 bc
Meet patients needs
Health, relief and
and problems
value for patients
SOME HIGH RISK ACTIVITIES ARE SAFER
THAN OTHERS
Professor Rene Amalberti
Haute Autorité de Santé
10-7
•
Amalberti R, Auroy Y, Berwick D, Barach P. Five System Barriers to Achieving Ultrasafe Health Care. Ann Intern Med.
2005;142:756-764.
WHAT KIND OF OCCUPATION IS MEDICINE AND
HEALTH CARE?
COMPLEX ADAPTIVE SYSTEM?
”Medicine used to be simple, ineffective, and relatively safe.
Now it is complex, effective, and potentially dangerous.”
Chantler C. The Lancet 1999;353:1178-81
THE FUNCTIONAL UNIT (“CELL”) IN HEALTH CARE
A team of experts (20th century)
An expert team (21st century)
A DIRECT ASSOCIATION BETWEEN TEAMWORK
BEHAVIOURS AND MORBIDITY / MORTALITY
Teamwork behaviours: information sharing and briefings
Mazzocco K, Petitti DB, Fong KT, et al. Am J Surg. 2009;197(5):678-85. doi: 10.1016/j.amjsurg.2008.03.002.
A DIRECT ASSOCIATION BETWEEN COMMUNICATION AND
MORBIDITY
Davenport D, Henderson WG, Mosca CL, et al. J Am Coll Surg 2007;205:778–784.
WHAT IS THE NATURE OF COMMUNICATION
BREAKDOWN?
Information was never transmitted
49 %
Information was communicated but inaccurately received
44 %
Information transmitted but never received
7%
Greenberg CC, Regenbogen SE, Studdert DM, et al.. J Am Coll Surg 2007;204: 533–540. doi: 10.1016/j.jamcollsurg.2007.01.010,
WHAT IS THE AIM OF COMMUNICATION IN HEALTH CARE?
• To create interpersonal relations
• To transfer information
• Contribute to a common understanding of the present situation
”situational awareness”
”shared mental model”
”sit in the same boat”
”watch the same movie”
”updated”
”read on the same page”
EFFECTIVE COMUNICATION RESULTS IN
• A shared understanding of the present situation
• A base for decision making
• A base for effecitve task execution
PREREQUISITES FOR EFFECTIVE COMMUNICATION
• Presence
Physical
Mental
• Eye contact
• Avoid distraction
A STRATEGY FOR EFFECTIVE COMMUNICATION:
CLASSIC RHETORIC
• A discovery - not an invention
• A structure for communication, which makes the receiver
understand what the sender wants the receiver to do.
CLASSIC RETHORIC IN IT´S SIMPLIEST FORM
Dispositio
Exordium
Narratio
Argumentatio
Peroratio
SBAR
Structure
S
Situation
B
Background
A
Assessment
R
Recommendation
1. SITUATION:
A CONSISE STATEMENT OF THE PROBLEM
• Presentation of the problem initiating the contact
• Patient safety concerns are always reason for contact and
should be clearly stated
2. BACKGROUND
A PERTINENT AND BRIEF INFORMATION
RELATED TO THE SITUATION
• Allows the receiver to understand the context
• Appeals to the receivers' values
• Gives the receiver motivation to listen and act
3. ASSESSMENT
ANALYSIS AND CONSIDERATIONS OF THE
OPTIONS — WHAT YOU FOUND/THINK
• A summary of the most important facts together with a
reasonable interpretation of the situation
4. RECOMMENDATION
ACTION REQUESTED – WHAT THE SENDER WANTS
• A pertinent request for what the sender want the receiver to
– Know
– Understand
– Discuss
– Do
– and an invitation for dialogue
Thanks for your Attention!
Carl-Johan Wallin, MD, DEAA, PhD
Strategic Services Development
Karolinska University Hospital
[email protected]