Improving Communication in Collaborative and Team-Based Care

Laura M. Cascella, MA, CPHRM

Successful communication among healthcare providers has long been a critical element of patient safety, particularly now with the growing emphasis on collaborative and team-based care. As healthcare delivery has evolved and caring for the patient population has become more complicated, the paradigm of the solo practitioner has given way to more complex healthcare systems and multidisciplinary teams that involve clinical and nonclinical roles.

Collaborative and team-based care offer opportunities to improve access to healthcare, optimize patient outcomes and experience, reduce medical errors, improve healthcare safety and reliability, and create efficiencies for practitioners.¹ However, highly effective care teams require time and effort. “Physicians, clinicians, non-clinical staff and patients may have some difficulty adapting to team-based care models. . . Ongoing, structured communication and feedback are essential to optimize team performance and help to sustain teams over time.”²

Common sense dictates that when more providers are involved in patient care, the likelihood of communication lapses increases. Malpractice claims data support this notion. MedPro’s medical and surgical claims data from 2015 to 2024 show that communication was a contributing factor in 48 percent of cases — an increase of 7 percent from 2005 to 2014.³

Over the years, experts have developed various techniques 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 to improve communication among providers include call-out, check-back, I-PASS, and SBAR.

Call-Out

The call-out method is used to communicate important or critical information, and it helps to 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 repeat-back, 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 they understand it, and the sender either validates the information or provides a correction.⁵

I-PASS

This technique is based on evidence that using structured handoffs helps reduce medical errors and preventable adverse events.⁶ The technique involves 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 diagnosis and treatment plan.
• Action list: Develop a to-do list and establish timelines and ownership of tasks.
• Situation awareness and contingency plans: Be aware of what is going on and provide directions to follow in case the patient’s status changes.
• Synthesis by receiver: Offer an opportunity for the receiver to summarize key information, ask questions, and confirm the plan of care.⁷

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 (e.g., medical history, signs/symptoms, and test results).
• Assessment: Identify the potential condition or problem based on medical findings and clinical reasoning.
• Recommendation and request: State an initial recommendation, and propose next steps and actions needed.⁸

In Summary

The communication techniques discussed in this article 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 and liability exposure.

More information about these communication techniques 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.

Endnotes

¹ Bhatt, J., & Swick, M. (2017, March 15). Focusing on teamwork and communication to improve patient safety. American Hospital Association. Retrieved from www.aha.org/news/blog/2017-03-15-focusing-teamwork-and-communication-improve-patient-safety; Rotenstein, L., & Gitomer, R. (2023). Advancing team-based primary care: The importance and challenges in 2023. The American Journal of Accountable Care, 11(3), 33-35. doi: https://doi.org/10.37765/ajac.2023.89436

² American College of Physicians. (n.d.). Team-based care toolkit. Retrieved from www.acponline.org/practice-career/patient-and-interprofessional-education/team-based-care-toolkit

³ MedPro Group cases, closed 2015–2024 and 2005–2014.

⁴ Agency for Healthcare Research and Quality. (2013, December). TeamSTEPPS® 3.0: Pocket guide. Retrieved from www.ahrq.gov/teamstepps-program/resources/pocket-guide/index.html; Agency for Healthcare Research and Quality. (2023, May [last reviewed]). Tool: Call-out. Retrieved from www.ahrq.gov/teamstepps-program/curriculum/communication/tools/callout.html

⁵ Agency for Healthcare Research and Quality, TeamSTEPPS® 3.0: Pocket guide; Agency for Healthcare Research and Quality. (2023, July [last reviewed]). Tool: Check-back. Retrieved from www.ahrq.gov/teamstepps-program/curriculum/communication/tools/checkback.html

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; Starmer, A. J., Spector, N. D., O’Toole, J. K., Bismilla, Z., Calaman, S., Campos, M. L., . . . I-PASS SHM Mentored Implementation Study Group (2023). Implementation of the I-PASS handoff program in diverse clinical environments: A multicenter prospective effectiveness implementation study. Journal of Hospital Medicine, 18(1), 5–14. doi: https://doi.org/10.1002/jhm.12979

⁷ Agency for Healthcare Research and Quality. (2019, September 7). Patient safety primer: Handoffs. Retrieved from https://psnet.ahrq.gov/primer/handoffs; Agency for Healthcare Research and Quality, TeamSTEPPS® 3.0: Pocket guide.

⁸ Agency for Healthcare Research and Quality, Patient safety primer: Handoffs; Agency for Healthcare Research and Quality. (2019, November [last reviewed]). Tool: SBAR. Retrieved from www.ahrq.gov/teamstepps-program/curriculum/communication/tools/sbar.html

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