Improving Communications Yields Positive Results
Beth Ulrich, EdD, RN, CHE, FAAN, Editor

The 38th ANNA National Symposium in Dallas this year was a great place to see what communication can accomplish.  If you were there, you saw it.  If not, picture this.  Walking through the exhibit hall, two nurses debate the virtues of a dialysis machine.  In a hallway, during a break between meetings, four nurses discuss the pros and cons of vascular access methods.  In our Nephrology Nursing Journal session on writing for publication, the energy and the passion are palpable as nurses talk about topics they care enough about to want to share with others.  You couldn’t walk 5 feet without hearing nurses talking to each other, sharing ideas and experiences, and figuring out better ways of doing things. 

This is communication at its best – sharing knowledge, debating solutions, and moving the discussion forward.  It’s easier done, to be sure, in a stress-free setting such as a national association meeting where there are no alarm bells ringing, no patients waiting to be put on dialysis, no finicky vascular accesses that require undivided attention, and no need to get three things accomplished at once. But it’s also something that we need to do routinely in our day-to-day communication.

Communication, from a process perspective, is easy. You open a conversation, you listen, you respond. In the best case scenario, all participants respect and value each other and each other’s opinions and the actions and words during the communication reflect that respect. In reality, communication often doesn’t go that well.

Results of Communication
Though research has long shown the positive relationship between communication/collaboration and patient outcomes and nursing job satisfaction, poor communication continues to be a major problem. Year after year, communication is the root cause of over 60% of the sentinel events reported to the Joint Commission (2007). Disruptive behavior, which has a negative effect on many things, including communication, has been linked to adverse patient outcomes, including mortality (Institute for Same Medication Practices [ISMP], 2004; Rosenstein & O’Daniel, 2006).

Beginning the Communication
Beginning the communication about certain issues is often the hardest part. A study by the American Association of Critical-Care Nurses (AACN) and Vital Smarts identified seven categories of what they term crucial conversations— conversations that are especially difficult but also especially essential: broken rules, mistakes, lack of support, incompetence, poor teamwork, disrespect, and micromanagement (Maxfield, Grenny, McMillan, & Patterson, 2005).  More than 50% of the participants said they had witnessed events in these categories (many persisting for a year or more), but most felt that it wasn’t possible to call attention to the issue, nor was it their responsibility even though they had often seen injurious consequences (thus, the title of the study “Silence Kills”). The answer to why they didn’t start the crucial conversations may rest in the researchers’ finding that only about 10% of the participants (nurses, physicians, clinical care staff, administrators) were confident in their ability to initiate these crucial conversations.  

Improving Communication
The problem and the answer is three-fold: (a) to identify communications that need to occur; (b) to instill nurses and other healthcare providers with the confidence and professional integrity to initiate the conversations; and (c) to create work environments in which having these communications is valued and encouraged. One strategy would be to include crucial conversation topics as a part of every staff meeting. Another would be to offer interdisciplinary sessions on improving communication and/or mentors to work with individuals. It would also be helpful to have discussions about why people don’t start these critical conversations so that those barriers can be addressed and removed.

Conclusion
When effective communication occurs, positive results follow. We learn. We grow. We improve.  Our patients have better outcomes. It is important to both us as individuals and to our patients that we initiate and engage in crucial conversations and that we encourage our colleagues to do the same. Improving our own communication skills and creating environments that encourage these conversations increases the odds that important issues will get discussed and resolved.

Beth Ulrich, EdD, RN, CHE, FAAN
Editor
E-mail: BethUlrich@aol.com

References
Institute for Safe Medication Practices (ISMP). (2004).  Intimidation: Practitioners speak up about this unresolved problem.  Huntingdon Valley, PA: Author.

Maxfield, D., Grenny, J., McMillan, R, & Patterson, K.  (2005).  Silence kills: The seven crucial conversations for healthcare. Provo, UT: Vital Smarts. Retrieved May 25, 2007 from http://www.silencekills.com/Download.aspx.

Rosenstein, A., & O’Danial, M. (2006). Impact and implications of disruptive behavior in the perioperative area.  Journal of the American College of Surgeons, 203(1), 96-105.

The Joint Commission. (2007). Sentinel event statistics – December 31, 2006. Retrieved May 25, 2007 from http://www.jointcommission.org/SentinelEvents/Statistics/.