On this blog we have thoroughly established the existence of communications breakdowns within and among care teams. We’ve also pointed out the cost of these deficits in terms of patient well-being, dollars, and legal activity. All of that begs the question of how these problems arise in the first place. Glad you asked.
In general, there are two main drivers of communication errors. One is simple lack of a care team collaboration strategy, the other is a lack of appropriate tools. The problems are extensive and related to issues described earlier. As Michelle O’Daniel and Alan Rosenstein put it in the introduction to their book chapter “Professional Communication and Team Collaboration,”
“When health care professionals are not communicating effectively, patient safety is at risk for several reasons: lack of critical information, misinterpretation of information, unclear orders over the telephone, and overlooked changes in status.”
And the corollary:
“[A] review of the literature also shows that effective communication can lead to the following positive outcomes: improved information flow, more effective interventions, improved safety, enhanced employee morale, increased patient and family satisfaction, and decreased lengths of stay.”
Research has pinpointed several factors that contribute to deficient communication within care teams. These include:
Some of these - gender, culture, training - can be summarized as differences in perception and, to some extent, communications style. The others - hierarchies and professional identity - take on a different tone. We all take pride in our chosen careers. Everyone undergoes specialized training that includes both physical skills and intellectual processes unique to their particular field. Simply, we know things others don’t, or we approach things in ways others don’t. When combined with ingrained human wiring, this training naturally leads us to prioritize our angle over others’.
These issues can be managed through a collaboration strategy, but problems will only multiply in the absence of a clear plan.
Another result of a poorly formed or missing communication strategy is a lack of consistency. Jessica Geissberger is a nurse with HonorHealth in Arizona. When asked about developing a strategy, she said,
[I]t definitely stems back to consistency. [T]rying to unify policies, procedures, communication tools, all kinds of things. […] I feel that there's so many variables that it creates the lack of communication and it creates a lot of confusion when a company has so many different extracurricular adopted ways.
[I]n healthcare, time is everything. Especially when a patient's ill, every minute wasted is unnecessary. [A hospital system] should have some ability to create continuity in their nursing practice and their physician practice because to me it's [currently] so disheveled.
Without an SOP, people will create their own systems to fill the vacuum. Eventually, within a given practice or unit or hospital, two or more of those different, improvised collaboration strategies will bump into each other and potentially cause conflict. As Geissberger notes, that’s when more time is wasted and critical decisions delayed.
The second driver of communication errors is outdated technology, or a lack of appropriate tools.
The Joint Commission has noted that communication and information management are inextricably linked, and it’s not hard to understand why. In in the healthcare industry, because clear communication is necessary for effective care, stakeholders have worked for millennia (yes, really) to develop and implement technology to assist in this effort. We’re not going to get into it here, but if you’re interested in more check out “A Brief History of Medical Communications Technology”.
Even as we worked to develop this blog post, we heard (and experienced) stories about medical practices calling patients back to refund overcharges due to errors in paperwork, or to rerun payments that didn’t go through on the office credit card machine. Of course, every person who has visited a medical office - everyone in the US, basically - knows the difficulty of getting a call through to the appropriate provider to follow up on lab work, a prescription, etc.
And then there’s the almost unbelievable fact that those dinosaurs of communications technology - fax machines - still hold a prominent place on the desks at medical offices across the country. Elsewhere, too. In a head-scratching and hilarious, but ultimately harmless mishap (harmless for everyone but the agent who was immediately fired), a bad fax machine led to one of the top defensive players in the NFL being accidentally released by the Denver Broncos. It’s an absurd story that we can use to lightheartedly highlight the problems caused by outdated technology. One of the articles published at the time said, “this […] fiasco leaves us wondering why 1980s technology is still the communication method of choice in 2013.” Four years later and we couldn’t have said it any better.
Anyway, inefficiencies abound, and it’s a lot more serious in the life-and-death business of healthcare. Traditional “technologies” only compound these inefficiencies. Simply paging a physician can cause problems, according to Geissberger:
[A]s a nurse the most frustrating thing to me when it comes to communication is paging a physician. […] we have such a weird, eclectic group of patients as it is, but because we're observing [on med-surg], they can crash really fast because we don't really know what's wrong and things turn bad.
With paging a cardiologist I have to call and I have to first listen to every option because you can't pick your option ahead of time, so I'm listening to 10 options, and then I'm finally picking that I'm a provider or facility, and then I'm going through another set of options, and then I'm finally talking to somebody on the board who can barely hear me, yet alone put the patient's name in. And then asking the name, the age, the date of birth, where are they at, what unit, what do you need, and then it's another 10-15 minutes before the physician even calls me back.
Any secure tool to help reduce the time it takes to get a physician engaged in a critical situation is worth considering. Geissberger noted the disconnect:
We can spend millions of dollars on these beds that are smart that tell us if a patient's moved, but we can't figure out how to make communicating with nurse-to-physician simpler. It blows my mind that we haven't figured that out yet.
BeckonCall is built to do exactly that, while also providing a paper trail for documentation purposes. We can’t make team members get along, or put aside professional differences, but we can make interactions between them simpler.
Topics: Care team communication