Team Communication

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Poor communication skills in healthcare environments can lead to medical errors, fragmented care, poor team coordination, and incivility. Most problems that occur in teams are traceable back to challenges with communication. So consider the following stories that leaders and friends (not in healthcare) have told me during the last six weeks:

I signed myself out of the hospital against medical advice. I found the hospital experience scary – the lack of communication between healthcare staff with each other is shocking. I could not get any straight answers about what was happening with my treatment. I feel safer at home.

Our charge nurse asked me if she could force nurses to stay and give the end-of-shift report. My mouth dropped when she told me new nurses were clocking out because “their shift is up.”  I was flabbergasted to learn of this unsafe professional behavior. We have bedside shift rounds as a role expectation. They told the charge nurse that if the end-of-shift report was part of the work – they should have a 30-minute overlap to do it. Talking to some of these younger staff who said they had personal things to do after work and needed to leave on time every day – I was struck by how many treated the job like they were working at a Mcdonald’s. 

I had my pre-op visit for hip surgery today with the PA of the Surgeon – it was evident they had not discussed the case. He asked me who was picking me up from outpatient surgery. The surgeon indicated in our last visit I would be hospitalized for at least one night because of bone issues with the hip. Nothing written about that he tells me – you are going home. I asked him about the possibility of a rehab center because I live alone and he told me he knew nothing about that. He asked if I had a walker and cane at home – I said no. I later look at his entry in MyChart; he checks the pre-op checklist as complete, and the patient has a cane and wheelchair at home. I emailed the surgeon but have second thoughts about using this team – no confidence in them.

These stories are not isolated. Nurse leaders now struggle with complaints about communication in a health system that has grown increasingly fragmented. A nurse leader asked me on a recent program – Whatever happened to TEAMSTEPPS?  She raised a great point – in the pre-COVID environment, every health system used it because it is a strong evidence-based team communication model.

Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) is an evidence-based communication model developed for clinical practice with funding from the Agency for Healthcare Research and Quality. These tools were developed for team members to communicate effectively and build safer patient care environments. Tools in the model include SBAR, the Two-Challenge Rule, Call-Outs, and Check-Backs. The content is free – the only cost is staff training time.

TeamSTEPPS® has fallen into disuse like so many things in the past three years. We now have a new generation of nurses (and other disciplines) who need the training. I would contend that it is time to bring it back as a high priority for all clinical disciplines in healthcare.