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WP3 Effective Communication

Identify basic elements for effective communication

Workpackage leader - University Medical Centre Utrecht (UMCU), The Netherlands

 

Objectives

The objectives of this workpackage are:

  • to determine how variations in handoff processes lead to “near misses” and adverse out-comes,
  • to identify standardized elements for communication, that can be used as a general tool in handoff processes throughout Europe.

The idea of developing a single approach for all handoffs is not likely to be possible due to the diversity and complexity of healthcare. HANDOVER will therefore aim at providing basic elements for efficient communication that can be tailored to meet individual, institutional and/or regional requirements.

 

Description of work and role of participants

Activities
The workpackage comprises the following activities:

  • Analyses of data: We will analyze focus group and interview data to identify barriers and facilitators to effective communication.
  • Identifying standardized elements for communication: Using described data, we will construct a cause and effect model using the Ishikawa method, specifically exploring the roles of the place, procedures, people, and policies as barriers or facilitators to effective communication.
  • Defining roles and responsibilities.
  • Process analyses: We will also conduct a process analysis of the maps with a focus on improvement with the aim of identifying inefficiencies, removing obvious redundancies or complexities, and facilitating and aligning goals.


In order to capture demonstrably effective tools and processes common data needs to be recorded in different settings on: the standard time for a handoff, the location(s) in the work area where the handoff is conducted, the participants in the handoff communication, the length of time taken for a handoff, whether a common instruction of set of rules are employed, the minimum information transferred (clarity, brevity and level of filtering required), what is excluded from the handoff, the functionality of tools used and what type of durable record is used and how is it accessed by the care team?

Methods
Two tools will be assessed in the development of a general model for communication:
I-SBAR 
I-SBAR (Introduction, Situation, Background, Assessment and Recommendation) .is a tool for increasing structure, standardization and accuracy in handoff processes. I-SBAR is an expanded version of SBAR (Department of Defence, 2005). The model was introduced to help clinicians to have a shared mental model for the patient’s clinical condition. The tool is based on naval nuclear training, with particular focus on telephonic nurse-doctor communication and to improve dysfunctional communication which can lead to misunderstanding, poor decision-making and medical error. SBAR is a tool that can enhance consistency, it is to the point and it promotes critical thinking. It can help overcome differing communication styles, such as giving a long report or just the headlines. The I-SBAR is currently being tested in several hospitals as a format for structured handovers. The study by Haig, Sutton and Whittington found that implementation of the SBAR lead to a gain of effective medication use and a reduction of adverse events. The use of SBAR in situations that a nurse reports to a physician on the phone, has improved patient safety by providing clear, accurate feedback of information between caregivers. There have been fewer incidents of missed information during handovers since SBAR was introduced. SBAR is currently being tested in shift changes and transfers to other departments.

5P’s
The Five-Ps is another tool for handovers and was developed by Gary Yates and Shannon Sayles (Department of Defence, 2005). Important essences are attention to details, questioning, checking and coaching. The five P’s stand for Patient, Processes, Purpose, Patterns and Physician assigned to coordinate. The 5Ps are a reminder of the essential elements of well functioning care systems (microsystems) and the interrelatedness of those elements in meeting the needs of the patient. The 5Ps form an answer to the following questions:

  • Purpose: What is the purpose of the clinical microsystem and how does that purpose fit within the overall vision?
  • Patients: Who are the people served by the microsystem?
  • Professionals: Who are the staff who work together in the microsystem?
  • Processes: What are the care giving and support processes the microsystem uses to provide
  • Patterns: What are the patterns that characterize microsystem functioning?


Transfer of information
The Rapid Response System process (a process for change management) upon which the model will be built is depicted below. This model allows us to model the dissemination process of the projects deliverables.

In the model best practices on how relevant information can be transferred will be described. A standardized approach to handoff communication involves gaining an understanding of the following elements: identification of the specific type of handoff situation to which it applies, who is, or should be involved in communication, what information should be communicated (for instance: diagnostic and current condition of the patient, recent changes in condition or treatment, anticipated changes in condition or treatment, what to watch for in the next interval of care etc.),opportunity to ask and respond to questions, when to use certain communication techniques (such as I-SBAR, repeat-back etc.) and how information should be available (print, electronic, other).

The model for handoffs should be based on the following operating principles:

Patients: The need for involvement of the patient at all stages of the handoff should be considered;
Task and Technology: The handoff should be structured as such that information is practical and accessible;
Individual clinical staff: Clear lines for accountability and responsibility should be established;
Clinical teams: Handoffs should include all members of the team.
Work environment: Handoffs procedures should be adaptable to the local clinical setting.
Organisation and management: There must be system commitment at all levels;
Institutional context: All staff should be aware about privacy provisions.





Rapid Response System implementation process

In the model best practices on how relevant information can be transferred will be described. A standardized approach to handoff communication involves gaining an understanding of the following elements: identification of the specific type of handoff situation to which it applies, who is, or should be involved in communication, what information should be communicated (for instance: diagnostic and current condition of the patient, recent changes in condition or treatment, anticipated changes in condition or treatment, what to watch for in the next interval of care etc.),opportunity to ask and respond to questions, when to use certain communication techniques (such as I-SBAR, repeat-back etc.) and how information should be available (print, electronic, other).

The model for handoffs should be based on the following operating principles:
Patients: The need for involvement of the patient at all stages of the handoff should be considered;
Task and Technology: The handoff should be structured as such that information is practical and accessible;
Individual clinical staff: Clear lines for accountability and responsibility should be established;
Clinical teams: Handoffs should include all members of the team.
Work environment: Handoffs procedures should be adaptable to the local clinical setting.

Organisation and management: There must be system commitment at all levels;Institutional context: All staff should be aware about privacy provisions.

 

Deliverables

D5 Report on how variations in handoff processes lead to “near misses” and adverse outcomes