Monthly Archives: August 2018

Our Stories: Improving Communication

‘The art of communication is the language of leadership’ -James Humes

Communication: a simple word that is anything but simple. It is the basis of everything we do. We communicate with our coworkers, team members, patients’ families, and patients continuously. In fact, most of us spend 70 to 80 percent of our waking hours in some form of communication. (Lee, Dick & Hatesohl, Delmar. 2018). Without effective communication, a message can turn into error, misunderstanding, frustration, or even disaster.  Excellent communication, on the other hand, is the foundation for great teams.

At UI Health Care, we have multiple ways to communicate: meetings, landlines, Voalte One (hospital hand-held devices), Voalte Me (app for your personal cell phone), email, pagers, Spok Mobile app, and Smart Web. Though having multiple ways to communicate can be convenient, it can present a unique set of challenges: incompatible platforms, dropped calls, undelivered messages, dead batteries, full inboxes, and frankly, just too many messages. This is why it is critical to ensure that your device(s) are on, batteries are charged, and when you are not available, designate another team member to return messages in a timely fashion.  Also, be sure to choose your preferred method of communication in your Smart Web profile          (Smart Web User Guide: Device Management, page 2).

‘The single biggest problem in communication is the illusion that it has taken place.’             – George Bernard Shaw

Excellent communication is vital to fostering a culture of safety.  The Patient Safety Net entries with an underlying issue of communication are entered daily, and the Clinical Quality, Safety and Performance Improvement Office evaluates each PSN report. Occasionally, a root cause analysis, or RCA, is necessary to determine how and why events occur. This process aids in the identification and implementation of systems-based improvements. Since July 2017, 85 percent of RCAs completed had communication issues as a contributing factor. Those errors may be as simple as a misunderstanding of what was said or not closing the communication loop fully. It is no wonder we ask our patients how well our providers explained things and listened, how nurses kept them informed and educated, and how well teams worked together. It is also why we ask you, our staff, how you feel team members do with communication. As a leader, it is part of my job to help teams communicate more effectively and understand where the gaps may lie.

There are several beneficial tools and strategies to help with team communication.  TeamSTEPPS has been rolled out in many areas throughout UIHC.  With this program and tools such as SBAR, (Situation, Background, Assessment, and Recommendation), we can more create consistencies of what each of us can expect when we communicate.  Read back and verify/Check-Back uses closed-loop communication, or repeating what was said, to ensure that the information conveyed by the sender is understood by the receiver. And I PASS THE BATON is just one example of a handoff tool designed to enhance information exchange during shift change or transitions of care.

(AHRQ Pub. No. 14-0001-2, Revised December 2013)

A more recent tool developed by a large workgroup at UI Hospitals and Clinics is clinical messaging templates built within Smart Web and Voalte. With these templates, the sender enters all required information into the message so the receiver can act on a request or simply be well informed of a patient’s status. Use of these templates should help decrease the number of pages to providers as well as improve the overall communication among clinical teams. By standardizing the messages, there are clear expectations of what must be included in each message sent and a timeframe expectancy on the action requested. STAT: Need at Bedside should be an immediate response.  Any Routine messages should be acted upon within 10 minutes.  And any Urgent messages should be addressed more quickly or within less than 10 minutes, but truly rare occurrences. If they do occur, the sender may page again sooner due to urgency, as actions requested may directly affect patient care. The sender should escalate to a senior resident or attending when there have been two messaging attempts with no response.

 ‘Communication and communication strategy is not just a part of the game- it is the game.’ – Oscar Munoz

Given the importance of communication in the development of our safety culture, I have decided to add a section highlighting communication and ways to enhance it in Quest, our monthly newsletter. This section will cover updates in communication platforms in addition to sharing stories about communication, both successes and areas that need improvement. I want to share best practices and any learning opportunities with you.

As always, I encourage you to share any story you may have with my office, and I challenge you to continue to improve communication in your area. Hopefully, you find some of the tools and strategies mentioned helpful.

If you would personally like to learn more about improving communication, I strongly encourage you to attend an Effective Communication course offered by the University of Iowa’s Learning and Development Office. Sign up through “My Training” in Employee Self Service.

‘Communication is a skill that you can learn. It’s like riding a bicycle or typing.  If you’re willing to work at it, you can rapidly improve the quality of every part of your life.’                  – Brian Tracy

In an effort to promote optimal communication I want to be sure that you know that I thank you for all your hard work and dedication to our patients and families, and to our team!

—Theresa Brennan, MD, Chief Medical Officer