1. How does poor communication impact on patient safety?
Poor communication can have extensive impacts on patient safety, and as seen by the Elaine Bromiley case stated within the article, it can be the difference between whether a patient survives or dies as a result of a group of medical professionals’ communication and collaboration with one another. Gluyas states that “teamwork requires co-operation, co-ordination and communication … to achieve desired outcomes”. Healthcare professionals are part of an industry that involves high-risk situations on a regular basis. As a result there is an increased need for effective communication within various teams in the industry so as to ensure that all work carried out is safe. This safety is crucial for both the patient and the professionals involved and should be prioritised alongside efficiency as well**. When teams of healthcare professionals have poor communication they increase their risk of making mistakes, such as errors of communication during handover procedures. If a member of the team receives the wrong information or doesn’t receive all vital information about a patient during handover, this can cause a significant increase in risk factors for patient safety and ultimately puts them in danger of possibly receiving the wrong treatment, medication or management of their current health needs.
The following cited article supports Gluyas article by agreeing that poor communication between nurses and doctors can cause an impact on patient safety:
Manojlovich, M. (n.d). Reframing Communication With Physicians As Sensemaking Moving the Conversation Along. Journal Of Nursing Care Quality, 28(4), 295-303.
2. What barriers to effective communication are described?
Gluyas’ article discusses a variety of barriers that can inhibit communication within a healthcare group, suggesting that there is a naturally occurring hierarchy between junior and senior level staff members. The article goes on to reference the idea that if a healthcare professional, of a lower authority, suspected that a patient was at a form of risk; they are less likely to voice their concerns due to their inferiority and their lower place in the hierarchy. Whereas, it is more likely for a senior member of staff to voice their concerns to their fellow team members confidently, as they hold a position of greater authority. This idea also goes on to argue that the hierarchy between nurses and doctors can often affect nurses’ level of comfort when it comes to challenging doctors’ practice techniques and decisions within the workplace. Statistics have supported that healthcare professionals will occasionally choose not to speak up even when there is the possibility of severe risk, justifying their choices due to history of a lack of respect received from the other medical professionals in which they were working alongside. Gluyas describes this reoccurring “authority gradient” as a defining impediment in communication between the various levels of healthcare professionals, due to its ability to make staff feel a lack of respect and growth in inferiority between them and their leaders. Another distinct barrier Gluyas defines is the significant differences in communication techniques between doctors and nurses; he credits this mostly to implicit differences between the two groups varying levels of education and the underlying values that they have been taught. Gluyas explores the idea that doctors and nurses have been educated to value varying aspects of the patient care, and this has resulted in differences in communication methods. Doctors are more likely to stick to the evidence behind the health risk and focus on achieving a cure for the patient, whereas nurses are generally considered to be more centered on caring for the patient in a way that still works towards achieving a solution for the health problem but at the same time also focuses on their health including mental and social health and not merely their specific health concern. When this variance in attention to detail occurs it can become a barrier in communication between the two groups, as nurses tend to communicate in a story telling like fashion, whereas doctors tend to be briefer in conversation and focus purely on factual evidence in terms of science.
The following cited article supports Gluyas’ views on barriers within communication:
Pettit, A. M., & Duffy, J. J. (2015). Patient Safety: Creating a Culture Change to Support Communication and Teamwork. Journal Of Legal Nurse Consulting, 26(4), 23-26.
3. Which skills and behaviours are described as necessary for good teamwork?
There are many different skills and behaviours that are important for a good team to function to it’s full potential, Gluyas focuses on four key skills that are crucial to an effective team; leadership, mutual support, situation monitoring, and communication. In order for a team to cooperate successfully each member needs to focus on being self aware of their role in the process of working towards the group goal, while also being mindful of their team members and their roles and how each role works together with one another to reach the team’s objective. In regards to leadership, this skill is essential for successful teamwork because it allows a group member, or a small number of group members, to control and encourage communication within the group and to use their leadership to help create an effective plan and allocate each group member their role and tasks accordingly. This role is crucial in reminding the team of their responsibilities in their roles and making sure that everyone has a solid understanding of the task at hand and the goal that is to be completed. Mutual support is another skill that Gluyas believes strengthens teamwork, as it allows room for a sense of trust to grow among the members of the group which creates a judgment free space intended to boost morale so that the team is more effective as a whole and also as individuals. Situational monitoring is crucial for successful teamwork as it allows for moments of regrouping with fellow team members to keep each other in check and make sure that everyone is still on the same page and still has the same goal in sight. Situational monitoring also allows for there to be an awareness of what stage the team is at in the process of reaching the goal. It can also be a great way to alter the way in which tasks are being carried out if something isn’t working as successfully as the team members had hoped. Finally communication is an imperative skill for good teamwork, it is a way for a group of medical professionals to share their knowledge with one another so that they can strengthen their general knowledge not only as individuals, but as a group as well. Teams that work well are able to communicate with each other in effective and structurally efficient ways that vary based on their healthcare situation. Another great communication skill to have is being able to confirm with your team members that everyone has interpreted knowledge correctly, this is also known as closed loop communication.
The following cited study strengthens Gluyas’ opinion that leadership plays a significant role in teamwork:
Weng, S., Kim, S., & Wu, C. (2017). Underlying influence of perception of management leadership on patient safety climate in healthcare organizations – A mediation analysis approach. International Journal For Quality In Health Care: Journal Of The International Society For Quality In Health Care, 29(1), 111-116.
4. What strategies are proposed to improve teamwork and communication?
Gluyas’ article states that there are many ways for a team to improve communication and break down barriers that were touched on in the previous question. When trying to eliminate authority gradients, the use of team briefings and debriefings allows for all members of the team to agree on their target goal and refresh each other on every individual’s specific role and how they work towards the goal. This may also be a constructive way to notify people of significant information about the goal or anything that may be out of the ordinary when completely tasks. When debriefing the team is encouraged to talk about the rises and falls of the system and if there are any ways they can improve on carrying out that same system if given the opportunity again. Gluyas also encourages the use of structured communication tools that aim to challenge authority gradients and lower variation in professional communication styles between group members, allowing for more effective communication. Finally Gluyas also touches on the effectiveness of checklist and read-back protocols, these are both used in an aim to strengthen communication within a group. Read-back protocols can be put in place to reduce the risk of communication failures when sharing important information. Checklists are used to hold everyone accountable to the tasks they have and have not completed.
The following cited paper supports Gluyas’ proposed strategies, in particular the positive effects of briefing and debriefing:
Severson, M. m., Maxson, P. M., Wrobleski, D. S., & Dozois, E. J. (2014). Simulation-Based Team Training and Debriefing to Enhance Nursing and Physician Collaboration. Journal Of Continuing Education In Nursing, 45(7), 297-305.