Better staff communication helps patient safety effort

JCAHO looking for staff development

Most health care professionals would agree that patient safety continues to be a high priority for the Joint Commission on Accreditation of Health Care Organizations in Oakbrook Terrace, IL.

Patient safety initiatives are pretty common, right? What about teaching staff how to communicate with one another as a way to improve patient safety? If your facility is like most, that’s a Joint Commission standard that’s not as clear cut.

"This is one of those standards that kind of leaves you scratching your head," says Dorothy Ruzicki, PhD, RN, director, department of educational services for Sacred Heart Medical Center in Spokane, WA.

She reports that her facility includes communication and teambuilding activities as part of all new employee orientation, as well as ongoing training on a departmental basis, and adds that while communication training is important, it can be a gray area for facilities that often is difficult to measure and track.

According to the Joint Commission, the employee teamwork and communication standard is a logical part of the bigger patient safety picture.

"When we survey a facility, we’re looking at medical records, policies, procedures, performance improvement initiatives and results, and human resource efforts," says a Joint Commission spokesperson. "Departments within an organization do not function in isolation. The teambuilding and [communications] efforts are important. All of it is tied together for increased patient safety."

Joint Commission Standard LD.3.2 says facilities must "foster communication and coordination among individuals and departments." The intent is for a health care facility’s leaders to "develop a culture that emphasizes cooperation and communication. An open communication system facilitates an interdisciplinary approach to providing patient care."

The intent of this standard also involves leaders promoting communication among services, individual staff members, and quality improvement teams. The leadership role is called coaching.

While this standard went into effect in July 2001, its intent is in line with the most recent set of patient safety goals, including the second objective, which is to improve communication among caregivers.

Delivering the message

Bob Weigand, director of management training and development for St. Luke’s Hospital and Health Network in Bethlehem, PA, says there are creative ways to bring this kind of education to units in a health care facility. His network is comprised of four hospitals and a visiting nurses association. Weigand says that while most facilities turn to on-line and video content, St. Luke’s is moving forward with more interactive forms of education.

His department created a game that incorporates most of the training pieces involved in its staff education program. Now in its fourth year, the game’s format has been copyrighted. It’s called PCRAFT Pursuit, a takeoff on the popular Trivial Pursuit board game. PCRAFT stands for pride, caring, respect, accountability, flexibility, and teamwork, which are the areas of staff education on which the program focuses.

Staff take different modules (game pieces) toward the required staff education goals for the year. The bottom line, Weigand explains, is to deliver relevant material in an appealing and effective manner. He says most of his staff, when surveyed informally, admitted to infrequently reading nursing journals. Fewer than 10% at a recent group meeting said they read nursing journals on a regular basis for information and education.

"We want our people to understand the value of the training and how it translates into quality patient care, which is a challenge for any modern health care facility. [The game] is a creative and educational way to emphasize the hospital’s patient care philosophy. We just don’t mean respect and accountability with patients, but it means staff interactions as well," Weigand says.

"How do you relate to people [other employees] here? How do you interact with staff from other departments? If these working relationships aren’t strong, it translates into patient care," he answers. The goal is to teach staff how everyone is part of the same process.

Cathy Stouffer, customer service and patient safety officer for Freeport (IL) Health Network, says her department’s education begins with a team culture philosophy.

"We use team-based training. Our staff, including registration, MDs, and nursing, work as one component for quality patient care," she reports.

A teambuilding initiative, Stouffer says, will not survive if management is not involved. "Some people look at me crazy when I say that, but it is true. Management is only one part of the process."

Staff in different areas are organized into teams with a leader selected by the group. This team drives the education process and helps motivate other employees and solve disputes when they arise. Individualized skills building involves 40 hours of learning on an annual basis.

As the facility’s education moved toward a teambuilding culture, learning in isolation was reduced. "We’ve moved toward inservices for staff and limited our video watching. It wasn’t meeting our needs," Stouffer says.

The seven components that make up Freeport’s hands-on direct education efforts include:

  • active listening;
  • constructive feedback;
  • dealing with difficult customers/patients;
  • service recovery (making sure patients stay within the Freeport system);
  • time management;
  • leadership;
  • change modules (dealing with change, positive attitudes).

"We have zero tolerance for poor performance," Stouffer says. "The team culture means we all work together toward patient safety and quality care goals."