Seems simple, but culture change can be difficult

While SBAR (Situation, Background, Assessment, and Recommendation) technique is a fairly straightforward concept, implementing the methodology can be more difficult than you might expect, says John Whittington, MD, patient safety officer and director of knowledge management at OSF Healthcare in Peoria, IL, which operates hospitals and medical groups in Illinois and Michigan.

"It's not enough to just explain the components of SBAR and then tell people to start doing it," he says. "It may look like just a checklist that people go down and convey certain information, but some of that involves changing the way people interact with each other, and that can be very ingrained. That's why we saw some hesitation when it came to nurses making a specific recommendation to the physician."

Overcoming that hesitation required time, Whittington says. The nurses had to see that the organization would support them speaking up and making suggestions. Plus, supervisors and other hospital leaders would periodically check on how nurses were using SBAR and would pay special attention to that step.

Measuring the success of SBAR can be a challenge, Whittington says, because no one measure of outcomes can be tied directly to the communication method. To see how well SBAR was being introduced in the OSF culture, Whittington and a colleague made spot checks by calling all the departments in every facility and asking to speak with a nurse. They would ask the nurse what SBAR stands for, and at first, many had no idea.

Over time, the recognition of SBAR improved. Whittington asked the nurses how much they used it. Early on, the nurses sometimes said they only used SBAR with physicians they liked. They felt uncomfortable using it with others.

"In the second year, we sent 'secret shoppers' who went out and had them interact with physicians and nurses, having the kind of conversation in which SBAR should be used," he says. "By then we found that people were using SBAR when it was appropriate, and when there was any shortcoming, it was usually with the recommendation."