“The single biggest problem in communication is the illusion that it has taken place.”
―George Bernard Shaw
On January 13th, 1982, an Air Florida passenger jet crashed into the 14th Street Bridge after takeoff from Washington National Airport, killing 74 passengers on the plane and 4 people in their vehicles on the bridge. After reviewing the flight data recorder, it was discovered that the first officer had repeatedly told the captain that something wasn’t right at takeoff and was rebuffed. Instead of assertively repeating his concerns, the first officer finally agreed with the captain that everything was normal.
The airline industry used this tragedy to implement what became known as Crew Resource Management. Although the scope of CRM is complex, the main change was in how crew members communicated with each other. A group of psychologists helped develop the program with an emphasis on group dynamics, interpersonal communications and decision-making. What was the result of this training? In the February of 2000, the BMJ (formerly the British Medical Journal) published a study that, among other things, asked a sample of airline pilots and surgeons whether they agreed with the statement: Junior staff members should not question the decisions made by senior staff members. While 97% of pilots disagreed with the statement, only 55% of surgeons did.
We have all heard stories of overbearing doctors screaming at nurses, but nonverbal communication can be just as damaging. A doctor, nurse manager or hospital administrator may simply ignore issues brought up by junior staff members which not only increases the risk of the ignored issue causing problems, it makes it more likely that the ignored person will not bother to speak up the next time. Note: the problem is not simply the orthopedic surgeon who screams at anyone who questions his order of the latest wide spectrum “gorillacillin” for pre-op use or the timid pharmacist who decides not to suggest a narrower spectrum cephalosporin in it’s place, but rather the environment in which two health care professionals find it difficult to relate to one another.
How do we create an environment that facilitates teamwork? One answer is detailed in General Stanley McChrystal’s book, “Team of Teams: New Rules of Engagement in a Complex World”. In this book, General McChrystal explains how he had to flatten the rigid structure of the military to combat a terror cell based enemy that didn’t follow rigid rules of engagement. This was accomplished by disseminating information to as many stakeholders as possible and making sure that each member knew what his role was within the system. For example, Navy SEALS trained with intelligence analysts and learned the importance of rapidly sharing intelligence so that it could be followed up and facilitate the capture of the bad guys in a timely manner.
Following a similar strategy in healthcare will help to create the team environment necessary to encourage the communication needed for collaboration. Maintaining the old system of staying in tribes of professional silos will only increase the risk of communication failures in the future, as healthcare gets more complex.
Bio:
Jeff Harris is a Pharmacist with over 25 years of leadership experience in hospital, retail, and home health environments. Due to a spinal cord injury, he is currently on long term disability. Jeff is passionate about patient safety, risk management and cybersecurity issues in healthcare. He continues to research and write about improving healthcare on a pro-bono basis.