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Miscommunication in the OR: A tipping point

Publish Date: 6/12/2013
Communication is a serious challenge in the perioperative environment—this is old news.

There are pockets of perioperative teams getting communication right—nurses are empowered to speak up, surgeons are engaged with the team, briefings and debriefings occur around every case—but this is too rare.

Many operating rooms across the country are still plagued by a shortage of empowered perioperative professionals able to communicate well together, according to Lisa Spruce, DNP, RN, ACNS, ACNP, ANP, CNOR, AORN director of evidence-based perioperative practice.

“We see this reality in the data,” Spruce notes, citing a recent report from The Joint Commission in which 60% of sentinel events in 2012 were tied to miscommunication. She also says communication, human factors and leadership remain the most frequently identified root causes of sentinel events reviewed by The Joint Commission.

“Miscommunication in the OR is hurting our patients—this is an issue we must address,” she stresses.

Targeting the trickiest conversations
Spruce says miscommunication is an equally challenging problem among peers, and between leaders and those they lead in the perioperative workplace.

“The biggest problem is that people do not feel empowered to speak up and share their concerns directly,” she explains as she looks back to her previous role as perioperative clinical nurse specialist at Valley Health System in Las Vegas. “No one likes confrontation. It’s difficult to candidly approach someone and be empowered to have a dialogue about your concerns.”
Spruce suggests several ways to break down the barriers preventing healthy communication in the periop setting:

1. Empower yourself and your team to be excellent communicators
Leaders have a responsibility to bring good communications skills to teams through specific training. Simulation is a good way to practice these skills in a safe environment. Doing team training in the OR makes sense for so many reasons—this needs to be encouraged and even expected.

2. Build communication time into care processes
Making time for preoperative briefing and postoperative debriefing is an important way to foster team communication and be better prepared for any patient complications that can be on the radar early on. Using a checklist and taking a Time Out is helping foster better preoperative communication, but we need to work on debriefing.

3. Practice communicating in emergent situations
Scenario training is a great way to practice communication skills in high-stakes situations, such as when the surgery becomes an emergency and everything is fast paced. People react differently in stressful situations, tensions run high and communication breaks down. For example, the surgeon may take on a more dominant communication approach to take charge of the situation, which can intimidate members of the team.

4. Speak up!
Unsafe miscommunication patterns can be hard to break. Maybe you are dealing with a physician who has intimidated you in the past, so you don’t speak up and the patient is harmed. Having the courage (and the skills) to speak up and confront the physician to address the problem can be powerful. Think of yourself as giving the patient words, your voice is the only voice a patient has—use it.

5. Survey your culture to find the communication obstacles
For leaders encountering the same communication issues over and over again, survey your teams to find the most common communication situations you need to confront. Then shape these situations into scenarios that can be discussed openly. This can help team members feel more comfortable speaking up.

6. Reflect on yourself, find the tools to improve
Help yourself and your staff consider how to self reflect. Ask, “am I allowing this person to speak to me this way? Why?” This is also a good starting point to look for gaps in communication skills. Many of us were not taught good communication skills in nursing school. We must be proactive and seek out resources to become better communicators.

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