Communication Breakdowns Undercut the Effectiveness of Safety Tools, Impact Patient Outcomes

Healthcare professionals make calculated decisions daily to not alert their colleagues when a safety tool signals potential harm to a patient, according to a new study of 6,500 nurses and nurse managers released March 22 during a national briefing in at AORN Congress being held this week in Philadelphia.

Over the past decade, the healthcare community has developed safety tools to prevent communication errors and breakdowns, such as handoff protocols, checklists, computerized order entry systems and automated medication-dispensing systems.

According to the national study, The Silent Treatment: Why Safety Tools and Checklists Arent Enough to Save Lives, 85 percent of health care workers reported a safety tool warned them of a problem that otherwise might have been missed and could have harmed a patient. And yet, more than half (58 percent) of the participants said while they got the warning, they failed to effectively speak up and solve the problem.

These results indicate that while safety tools are an essential part of the formula for preventing avoidable medical errors caused by poor communication, cultures of silence in U.S. hospitals undermine their effectiveness.

The Silent Treatment research focuses on an especially dangerous kind of communication breakdown: known risks that are left undiscussed.

More than four of five study participants expressed particular concerns about three undiscussable issues: dangerous shortcuts, incompetence and disrespect. Many have witnessed these undiscussables lead to near misses or cause actual harm to patients.

Two of the nations largest specialty nursing associations American Association of Critical-Care Nurses (AACN) and Association of periOperative Registered Nurses (AORN) partnered with VitalSmarts, an innovator in evidence-based corporate training and organizational performance, on The Silent Treatment study to identify communication barriers that contribute to avoidable medical errors. Additionally, all three organizations focused attention on identifying and providing solutions to improve patient outcomes.

The report confirms that tools dont create safety; people do. Safety tools will never compensate for communication failures in the hospital, says David Maxfield, vice president of research at VitalSmarts and lead researcher of The Silent Treatment.

Among the studys key findings:

- More than 4 out of 5 nurses have concerns about dangerous shortcuts, incompetence and disrespect demonstrated by their colleagues.

- More than one-half say shortcuts led to near misses or harm, and only 17 percent of those nurses shared their concerns with colleagues.

- More than one-third say incompetence led to near misses or harm, and only 11 percent spoke to the colleague considered incompetent.

- More than one-half say disrespect prevented them from getting others to listen to them or respect their professional opinion, and only 16 percent confronted their disrespectful colleague.

AORN executive director and CEO Linda Groah, RN, MSN, CNOR, CNAA, FAAN, speaks to the implications these findings have on nurses in the operating room.

Safety tools such as protocols and checklists guard against honest mistakes, Groah says. However, this study tells us there is more work needed in the OR to support the surgical teams ability to establish a culture of safety where all members can openly discuss errors, process improvements or system issues without fear of reprisal.

AACN president Kristine Peterson, RN, MS, CCRN, CCNS, cardiac clinical nurse specialist at Aspirus Wausau Hospital in Wisconsin, notes the tremendous progress made by the healthcare community.

Compared with what we learned in 2005, nurses now speak up at much better rates and are now nearly three times more likely to have spoken directly to the person and shared their full concerns, Peterson says. This increased focus on creating cultures of safety needs to continue until every health professional feels empowered to speak up to reduce errors and improve quality of care.

The Silent Treatment builds on findings from research conducted in 2005 by AACN and VitalSmarts as documented in the study Silence Kills: The Seven Crucial Conversations for Health Care.