Medical Malpractice

If you could reduce the number of serious mistakes in your life with a solution that costs nothing, would you do it? Many hospitals are reducing deaths and injuries from mistakes. Their solution is not more technical training for surgeons, or fancy new equipment. The remedy is much simpler - teaching people to talk to each other in a clear, concise way.

"Poor communication in medical practice is one of the most common causes of medical errors," said Richard M. Frankel, Ph.D., professor of medicine at the Indiana University School of Medicine, and a research scientist at the Health Services Research and Development Center on Implementing Evidence-Based Practice.

Indeed, 60 percent of death-and-injury events are the direct result of communication errors, according to the Joint Commission on Accreditation of Healthcare Organizations

The most crucial situation is where a patient or task is handed from one person to another. A simple misunderstanding can lead to a patient getting the wrong medicine, or worse.

Now think about your job, and your family. How often are mistakes the result of some miscommunication? If you analyze it, you'll find that a great many mistakes in life come from two or more people suffering a simple "failure to communicate."

One solution is the use of a "communication model." Dr. Frankel said that many health professionals are adopting a very simple conversation technique first developed in the military and aviation, where fast-but-accurate briefings can mean the difference between life and death not just for one person, but for hundreds or thousands. The day I spoke with him (Friday, June 30), Dr. Frankel was getting on a plane to Kenya, where he is lending his expertise to help administrators who operate a large AIDS treatment center.

There are different models. Most involve a structured way to have a multi-step conversation in just a minute or two. "It's not rocket science," Dr. Frankel said. One example is the S-B-A-R model:

S - Situation. Describe the problem in a simple sentence.

B - Background. Anticipate the listener's questions about the situation and provide those answers.

A - Assessment. Summarize your observations about the situation.

R - Recommendation. Provide a specific recommendation for solving the problem.

The use of such a formula forces both the speaker and the listener to move through a discussion in a predictable, logical flow. It cuts through hierarchy. It allows people with differing communication styles to "get on the same page." It puts more weight on the conversation. It causes the listener to react to the speaker's recommendation, rather than passively taking in the information. And it saves time by cutting through extraneous detail. A SBAR briefing can be done in as little as 60 seconds or less.

A major Illinois hospital implemented the SBAR approach and reduced cases of harm to patients by more than half in the first year, according to The Wall Street Journal.

This technique was created in the aviation field, where NASA and other agencies recognized that hierarchy interferes with communication in a crisis, Dr. Frankel said. Surgeons, ship captains and others at the top of a hierarchy often don't receive critical information because underlings are unable or unwilling to speak up in a clear and assertive way. "In medicine we see that certain surgeons who intimidate others have a much higher complication rate, because their style breaks down the communication loop," Dr. Frankel said. The SBAR model provides a tool to overcome hierarchical barriers that can end up killing people.

Just as a conversation model like SBAR can help doctors and nurses reduce deaths, injuries and malpractice claims, improving interpersonal communication can help all of us save money, enhance relationships, and reduce mishaps in our own lives.

"Any kind of manufacturing process, personal service or service organization has tremendous potential to benefit" from the use of SBAR, Dr. Frankel said.

Try the SBAR approach in your work, or even at home. Once you get used to it, it becomes second-nature, and your day-to-day interactions will become much more productive.