Monday, February 2, 2009

We need to talk

I’ve been thinking about how important it is that we talk and listen to each other. This blog was designed in an attempt to open an alternative line of communication. It was my hope that not only two way conversation may occur, but perhaps an open forum of dialogue from a diverse set of perspectives might follow.

The importance of communication cannot be underestimated. In the United States the root cause of sentinel events that has been most frequently identified since 1995 (66% of reported sentinel events), is communication*. Could that mean that the majority of serious preventable harm in US hospitals is caused by communication failures within the system?

In reviewing the Institute of Medicine’s six “Aims for Improvement” what could this framework be communicating to us on behalf of the patients we serve?

Safe: Please don’t hurt me. Provide care for me with a health system that is safe.
Effective: Give me what I need based on the best known science.
Patient-Centered: Please respect me and all the things that make me uniquely who I am. Let me choose to be involved in my health care decisions in a way that I am comfortable.
Timely: Please don’t make me wait unnecessarily. Provide care to me at the right time.
Efficient: Please don’t waste my time or my care provider's time.
Equitable: Please give me an equal chance to be healthy. Please don’t leave me behind.

The importance of communication probably isn't a new concept to you. Communication is at the root of so much of what goes right and wrong for us in all aspects of our lives. We communicate for reasons beyond mere information exchange. We communicate for survival and companionship.

Last week, while at a meeting for the Integrated Nurse Leadership Program I learned about tap code , a method of communication that is commonly used by prisoners. In this case it was used by prisoners of war (POW) to communicate with each other. Letters are placed on a grid and by assigning a number to each letter; prisoners could communicate with one another by tapping on things such as a wall or pipes. It is simple in design yet very effective.

Newcomers can easily and quickly catch on. Information such as what questions interrogators were asking, to who needed help or extra food or supplies could be shared among the prisoners. POW Vice Admiral James Stockdale describes the code ,"Our tapping ceased to be just an exchange of letters and words; it became conversation. Elation, sadness, humor, sarcasm, excitement, depression -- all came through." Here is a link to a video of Stockdale speaking about the importance of the ability to communicate. In listening to him it's clear to me that this tool not only allowed for the exchange of information, but also the exchange of human spirit. He recalls that the men would communicate at any cost, "if you get caught and tortured for a while, that's just the do it anyway."

Failed communication isolates us from each other and all too often leads to misunderstanding; misunderstanding to misinformation; misinformation to complete chaos.

In the coming weeks, operations leaders will begin to seek input from you about how we can better communicate, how we can better listen. Our aim is to build an enduring system that promotes open and transparent communication. It’s not to say that we haven't done many things to promote better communication, because we have, but we can improve and we need to do more. Your participation will be essential. We are seeking the input of others from within our system that specialize in communication. Please join us as we seek your help to explore strategies that will strengthen our ability to connect with each other and those we here to serve.

More very soon...

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