Breaking Down Communication Barriers in Collaborative and Team-Based Care

Laura M. Cascella, MA

Successful communication among healthcare providers has always been a critical element of patient safety. Yet, in recent years, the importance of good communication has become even more pivotal with the growing emphasis on collaborative and team-based care. As healthcare delivery has evolved, the paradigm of the solo practitioner has given way to more complex healthcare systems and multidisciplinary teams that include doctors, nurse practitioners, physician assistants, nurse anesthetists, surgeon assistants, clinical nurse specialists, and other clinical and nonclinical roles.

When executed effectively, collaborative and team-based care offer opportunities to improve access to healthcare, optimize patient flow, support chronic care management, improve healthcare safety and reliability, and create efficiencies for practitioners.¹ However, highly effective care teams require time and effort. “An effective clinical care team learns from regular practice to fine tune their skills, has shared goals, struggles with learning new approaches, has clear roles and responsibilities, and learns to rely on and trust their team members. The best teams also communicate effectively.”²

Common sense dictates that as more providers become involved in patient care, the more likely it is that communication lapses will occur, which helps explain why communication remains a persistent factor in malpractice allegations. In an analysis of more than 23,000 malpractice claims and lawsuits, CRICO Strategies identified communication failures as a risk factor in 30 percent of the cases. Further, 37 percent of the high-severity injury cases involved communication failures.³

Over the years, various techniques have been developed to help improve communication and teamwork in healthcare. As collaborative and team-based care continue to flourish, these communication techniques can help healthcare organizations and providers improve the quality and safety of patient care and potentially reduce liability exposure.

Notable techniques include:

• Call-out. This method is used to communicate critical information during emergencies, and it helps simultaneously inform all team members of the situation. Call-out might involve a question/response format between the team leader and other members of the team, or it might involve the team leader calling out important information (e.g., the patient’s vital signs) and directing team actions. Call-out allows members of the healthcare team to anticipate and prepare for next steps in patient care. An important aspect of call-out is clearly identifying the individual responsible for each task.⁴
• Check-back. This “closed-loop” communication technique, also called read-back or verify, is used to substantiate successful transfer of information and validate comprehension. In check-back, the sender initiates a message, the receiver confirms the message, and the sender validates that the message was understood. For example, the sender might initiate a message related to a specific medication order, including medication name, strength, dosage, administration route, timing, etc. The receiver repeats the information as he/she understands it, and the sender either validates the information or provides a correction.⁵
• IPASS. This technique is derived from a study that determined that using a standardized handoff bundle helped reduce preventable adverse events during patient signouts in the hospital setting.⁶ Part of the bundle included standardized oral and written information using the acronym “I-PASS,” which stands for:
  • Illness severity: Provide a one-word summary of patient acuity — “stable,” “watcher,” or “unstable.”
  • Patient summary: Offer a brief summary of the patient’s diagnoses and treatment plan.
  • Action list: Develop a to-do list of items that the clinician receiving signout should complete.
  • Situation awareness and contingency plans: Provide directions to follow in case of changes in the patient’s status, often in an “if‒then” format.
  • Synthesis by receiver: Offer an opportunity for the receiver to ask questions and confirm the plan of care.⁷
• I PASS THE BATON. This strategy, like IPASS, is designed to support the exchange of information during patient care handoffs. Breakdowns in the handoff process have been linked to adverse events in various care settings. I PASS THE BATON establishes a structured framework for transferring important information during the handoff process. The acronym stands for:
  • Introduction: Identify yourself and your role in the patient’s care.
  • Patient: Communicate key patient identifiers, such as name, sex, location, etc.
  • Assessment: Relay the patient’s chief complaint, vital signs, symptoms, and diagnosis.
  • Situation: Discuss the patient’s current status/circumstances, including code status, level of uncertainty, recent changes, and response to treatment.
  • Safety concerns: Review critical lab results, socioeconomic factors, allergies, and alerts (e.g., fall risk).
  — THE —
  • Background: Communicate the patient’s comorbidities, previous episodes, current medications, and family history.
  • Actions: Discuss what actions were taken or are required, including a brief rationale.
  • Timing: Identify the level of urgency and explicit timing and prioritization of actions.
  • Ownership: Identify who is responsible (provider/team), and include family responsibilities.
  • Next: Define what should happen next, any anticipated changes, and possible contingency plans.⁸
• SBAR. This technique is designed to communicate critical information about a patient’s condition and trigger immediate action. SBAR allows for concise and standardized communication. The acronym stands for:
  • Situation: Identify the patient’s current condition or problem.
  • Background: Establish the clinical background or context of the situation.
  • Assessment: Identify the potential condition or problem based on medical findings.
  • Recommendation and request: Initiate a specific, actionable response.⁹

These techniques can offer healthcare teams a structured approach to communication that will guide consistent transfer of essential information. Implementing these methods requires an investment of time and resources; however, in the long run, improvements in communication can support more efficient teamwork, contribute to better patient outcomes, and decrease the risk of errors.

More information about these communication techniques as well as strategies for effective teaching and implementation is available through the Agency for Healthcare Research and Quality’s TeamSTEPPS® program. Additionally, the Institute for Healthcare Improvement offers a SBAR Tool that includes guidelines and a worksheet for implementing the technique.

---

¹ Hupke, C. (2014, May 16). Team-based care: Optimizing primary care for patients and providers. The Institute for Healthcare Improvement. Retrieved from www.ihi.org/communities/blogs/team-based-care-optimizing-primary-care-for-patients-and-providers-

² Ibid.

³ CRICO Strategies. (2015). Malpractice risks in communication failures: 2015 annual benchmarking report. Retrieved from www.rmf.harvard.edu/Malpractice-Data/Annual-Benchmark-Reports/Risks-in-CommunicationFailures

⁴ Agency for Healthcare Research and Quality. (2013, December). Pocket Guide: TeamSTEPPS^®. Retrieved from www.ahrq.gov/teamstepps/instructor/essentials/pocketguide.html#callout

⁵ Ibid., retrieved from www.ahrq.gov/teamstepps/instructor/essentials/pocketguide.html#checkback

⁶ Starmer, A. J., Spector, N. D., Srivastava, R., West, D. C., Rosenbluth, G., Allen, A. D., et al. (2014). Changes in medical errors after implementation of a handoff program. New England Journal of Medicine, 371, 1803-1812. doi: 10.1056/NEJMsa1405556

⁷ The Agency for Healthcare Research and Quality. (2016, July). Patient safety primer: Handoffs and signouts. Retrieved from https://psnet.ahrq.gov/primers/primer/9/handoffs-and-signouts

⁸ Agency for Healthcare Research and Quality. (2013, December). Pocket Guide: TeamSTEPPS^®. Retrieved from www.ahrq.gov/teamstepps/instructor/essentials/pocketguide.html#passbaton

⁹ Ibid, retrieved from www.ahrq.gov/teamstepps/instructor/essentials/pocketguide.html#sbar

---

Prevention & Education Center home