Communication breakdowns in healthcare are often the leading cause of serious mistakes reported to the Joint Commission’s Sentinel Event Root Cause Database. The Joint Commission defines ‘communication’ as that which is “oral, written, electronic, among staff, with/among physicians, with administration, with patient or family.” In nursing, if a message is not clear or perceived inaccurately, patient care can suffer.
So I ask, what methods have hospitals found most successful to communicate new information, policies or procedures to large numbers of staff? Staff in the hundreds or thousands -- specific to a department or hospital wide, often on several campuses, working day shift, night shift, per diem, and/or are travelers -- creates many obstacles for effective communication.
The Joint Commission’s 2012, National Patient Safety Goals, addresses improved staff communication. Staff must be informed at a pace that keeps up with the abundance of information. The most frequent form of communication between nurses occurs at shift change when patient reports are given. The outgoing nurse is exhausted, has multi-tasked all day, but need to give an accurate summary of her patient’s history and care. If not, treatments, medications, and more may be missed. Another example of poor patient reporting that I often see in the ER setting occurs when a patient arrives from a nursing home and appears confused. It is vital to know how cognitive impaired versus mildly confused versus demented a patient is at baseline so that the next nurse does not over-react. ‘Over-reacting’ often exposes a patient to more, unnecessary tests, radiation and needle sticks.
Of course communication does not just occur between nurses. The purpose of this blog is to go beyond nurse-to-nurse communication and tackle the gulf between administrators, physicians, nursing staff and patients. Policy changes, new documentation requirements, budget issues, changes in products supplied, a practice revision or staffing updates all originate from offices that do not frequently communicate with nurses. These types of changes often need to be filtered through to the nursing staff at a fast pace; they can require on-site training and frequent conversations that extend well past an hour staff meeting. However, these employer-specific changes and updates do not often cause poor patient outcomes or fatalities. For example, if a nurse hasn't been oriented to a new computer documentation system or new form, she/he can still take care of the patient. The documentation may suffer and the nurse may eventually need to go back in the chart, with the help of a peer, after the patient has been cared for, and make edits. Although the patient outcome should not be affected, employers seek compliance to changes and ultimately any breakdown in communication needs to be avoided.
At my employer, we face this dilemma: As the first quarter of 2012 nears, many new projects are being launched. A new documentation requirement for stroke and STEMI (S-T elevation Myocardial Infarctions, aka a specific type of heart attack that is critically unstable and often fatal) patients in the Emergency department, Joint Commission updates, a hospital wide launch of a new computerized documentation system and a new tele-neuro system (a television-like computer that helps specialists treat critically ill patients from an off-site location) all need to be addressed. In addition, our Emergency Department is beginning construction of a new mental health patient care area, and policies are currently under revision to improve care for this population. Although this project may seem very focused, it is a huge endeavor that will require full team participation and strong communication.
Workplace satisfaction surveys also support the idea that staff want better communication, not only for improved patient care but for more greater happiness at work. Nurses want to know what is going on, especially if it affects how they do their job, how they will be evaluated and if it touches on their salary or benefits. The economy is affecting hospital budgets severely. A once “safe” job is not immune from budget and staffing cuts. If employers do not speak honestly about these issues, staff can respond defensively.
Forms of communication include everything from small focused meetings to mandatory staff/hospital meetings to emails, on-site training, phone calls and even the dreaded mailbox method and sign in sheets. A combination of several methods is usually most preferred and most effective. I want to know what creative methods of communication are working and hold staff accountable for the information and training. Are staff paid for their time if training requires extra hours on-site? Do they get overtime for that? Please pass on your ideas as 2012 starts off with a bang! Cheers!