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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]