Safety-critical communication

Abstract

In Chapter 1 we highlighted an example of failed handover in a tragic case report. This example underscores the difficulty that doctors, as a craft group, often have when we try to talk about communication problems. When trying to explain why an adverse event has occurred, we frequently invoke ‘poor communication’ as a contributing factor. Deeper discussion, however, often proves to be a woollier beast, and we often retreat to the comforting realm of the technical, where the landscape is reassuringly familiar and the outlines are, for us, more clearly defined. Unfortunately the mammoth in the room cannot be ignored; under systematic scrutiny, ‘communication failure’ consistently represents one of the lead contributors to serious adverse events. Most recently, analysis of AIMS report data in an Australian area health service revealed that communication problems were the largest single contributing factor to severe and/or life-threatening clinical incidents over a 2-year period (2007–2009). Perhaps if we develop a better vocabulary of the types of communication errors that occur commonly in the workplace, we can be more articulate about them and develop more focused strategies to overcome them. Communication can be defined as the transfer of meaning from one person to another. For the purposes of developing practical communication tools, communication can be broken down into a package of signals sent from one person—the transmitter— to another—the receiver. These signals are both verbal and non-verbal. It is essential to realize that as social beings we are all constantly ‘transmitting’ signals—not just in the content of our words, but the types of words we use, the tone of our voice, our facial expressions, our body language, our physical proximity to others, the way we dress, the material possessions we display, etc. At any one time most of us are only partly conscious of the total package of what we are ‘saying’ to others. At the same time we are constantly receiving signals and, to a greater or lesser extent, trying to read meaning into and ‘make sense’ of these perceptions. Again often we are only partly conscious of the meaning of the ‘vibes’ we receive; yet they can have a profound impact on what we hear from others.