COMMUNICATION IN
HEALTH CARE
SBAR Tool
Learning Objectives
1. To identify the nature and causes of
communication breakdown in health care.
2. To understand the SBAR tool and its
effectiveness in preventing communication
breakdown and promoting patient safety.
3. To develop skill in using SBAR.
4. To identify strategies for implementing
SBAR.
5. To understand how SBAR should be
used.
Patient Safety Primary Purpose
Improved communication among health
care providers and patient/caregivers
will improve the quality and safety of the
care the patient receives.
National Patient Safety Goal
focused on improving the
effectiveness of communication
among caregivers.
The Joint Commission Sentinel
event stats found that
communication issues were the root
cause of about 65% of the sentinel
events reported between 19952004. Many of these events
resulted in patient death.
Enablers/Barriers
• Team Work to include,
• Resources to include,
trust and respect,
staffing, equipment
communication,
and supplies,
leadership,
environment.
inclusiveness.
• Responsibility to
• Culture to include,
include, Organizational
leadership, hierarchical (e.g. structures and
structures,
systems, managing
communications and
change, corporate and
systems approach
individual program,
staff safety, individual.
Communication Errors Contributing
Factors
Human Performance Limitations
Interpersonal Dynamics
Hierarchical structures
Cultural Differences
Gender Differences
Disciplinary Differences
Individual differences and Filters
Team Functioning and the Clinical
Environment
situational awareness
learning environment
communication processes/structures
Team Functioning and the clinical environment
• Situational Awareness
• Ineffective
• Multiple information
Communication
Structures
• Hand-offs and
transitions
• Team rounds
• Limited Time
• Ineffective response to
errors
sources with multiple
players
• Incomplete information
• Rapid changes with
clinical scenarios
Consider the impact of:
limited memory capacity
stress
fatigue
multi-tasking
Consider also:
1. “pecking order” may prevent sharing
2. individuals not confident in own
observations and recommendations
3. What does it mean to “question”
4. Culture & Gender influence
communication content and style
Communication between Disciplines
Additional Dynamics between providers to
consider:
1. Medicine/Nursing Brief details vs.
narrative or descriptive
2. OT-PT Order vs. Flexibility, Judgers vs.
perceivers
3. Pharmacy focuses on observable data
We bring different filters to work. It is
important to identify these
differences and develop a shared
structure to support effective
communication
Communication errors are a
team and system approach
SBAR APPROACH
We need to create a culture that
examines errors in light of
interpersonal dynamics and
communication structures
WHAT IS SBAR?
The SBAR model will be used to
facilitate accurate and thorough
patient handoff communication
between care providers. This will
include a focused process in
communication with Physicians in
relation to clinical situations.
SBAR
Always identify yourself and the patient at the
beginning of an SBAR
S=Situation… the problem or
concern
B=Background the relevant clinical
data
A=Assessment relay your findings
R=Recommendations action or
request needed
Human Factor response concepts
Appropriate Assertion
Critical Language
Situational Awareness: What are the red
flags
Create the learning environment
including debriefing
A COMMON DEBRIEF MODEL IS
SBAR
Assertion:
individuals speak up, and state their
information with appropriate
persistence until there is clear
resolution
Assertion Barriers:
Power Differences
Lack of common mental model
Don’t want to look stupid
Not sure when you are right
Others??
Overcoming Barriers:
Get the person’s attention
Express Concern
State the Problem
Propose an Action
Reach Decision
Critical Language
We have a serious problem, stop and
listen to me
C=I’m Concerned
U=I’m Uncomfortable
S=This is Unsafe
Situational Awareness
Maintain the Big Picture
Quality of Care
Safety
Think ahead and plan
Discuss contingencies
Tune into Red Flags
RED FLAGS
• Ambiguity
• Doesn’t feel right
• Poor communication
• Boredom
• Confusion
• Task saturation
• Doing something new
• Being rushed
under pressure
• Verbal Violence
• Deviating from
established norms
Create a learning environment:
DEBRIEFING
After the event/situation ask:
What did the team do well?
What were the challenges?
What will we do differently next time?
SBAR EXAMPLES
Case SCENARIOS
SEE HANDOUTS
Successful SBAR Implementation
Support from Leadership
Teamwork Training
Use of Standardized/structured tools
Errors are not considered clinical
incompetence
Team members respond to requests
in positive collaborative manner
When to use SBAR
Time sensitive or critical situations
Treatment decisions requiring “same
page” collaboration
Phone call to MD’s/team members
Hand-offs/transitions in care
When you need clarity
Reminders:
Think out loud/sounding board
Close the Loop with an action and
accountability
Be prepared with needed info before
making a phone call
Expect a response to your request for
help
USE critical language
Support each other using SBAR
NEXT STEPS
1. Take this information back to
your facility
2. Share this information with the
clinical staff
3. Determine the best way to
implement SBAR in your facility
4. Share feedback at the April 8th
Focus Group meeting
5. Be prepared to fully implement
SBAR with your staff by the 28th of
April
6. Call for assistance if additional
information or education is needed
for your facility.
QUESTIONS??
CONTACT
Michelle Nelson
Robin Moreno
If additional information or assistance
with education is needed.
THANK YOU