Communication Techniques for Healthcare Teams

"The greatest problem with communication is the illusion that it has been accomplished."
baton is a strategy to assist timely and accurate handoff.

First letter	Strategy	Description
I	Introduction	Introduce yourself, your role and job, and the name of the patient.
P	Patient	Gather name, identifiers, age, sex, location.
A	Assessment	Present chief complaint, vital signs, symptoms, and diagnosis.
S	Situation	Record current status or circumstances, including code status, level of (un)certainty, recent changes, and response to treatment.
S	Safety concerns	Know about critical lab values or reports, socioeconomic factors, allergies, and alerts (falls, isolation, and so on).
The
B	Background	Learn about co-morbidities, previous episodes, current medications, and family history.
A	Actions	Share what actions were taken or are required. Provide brief rationale.
T	Timing	Determine level of urgency and explicit timing and prioritization of actions.
O	Ownership	Determine who is responsible (person or team), including patient or family.
N	Next	Ask What will happen next? Anticipated changes? What is the plan? Are there contingency plans?

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3. Resolving Disagreement and Conflict

It is important for all members of the team to feel they can speak up when they see something they feel will impact the safety of the patient. The following protocols have been developed to help members of a team express their concerns in a graded manner.

3a. Two-Challenge Rule

The two-challenge rule is designed to empower all team members to “stop” an activity if they sense or discover an essential safety breach. Sometimes someone will make an approach to a team member but be ignored or dismissed without consideration. This will require a person to voice his or her concerns by stating their concerns at least twice if the initial assertion is ignored (thus the name “two-challenge rule”). These two attempts may come from the same person or two different team members.

With the two-challenge rule, it is important to note the following:

• The first challenge should be in the form of a question.
• The second challenge should provide some support for the team members’ concern.
• Remember this is about advocating for the patient—the “two-challenge” tactic ensures that an expressed concern has been heard, understood, and acknowledged.
• The team member being challenged must acknowledge the concerns.
• If this does not result in a change or is still unacceptable, then the person with the concern should take stronger action by talking to a supervisor or the next person up the chain of command.

3b. CUS

CUS is shorthand for a three-step process in assisting people in stopping an activity.

Step	Description
1	I am Concerned.
2	I am Uncomfortable.
3	This is a Safety issue.

3c. DESC Script

DESC describes a constructive process for resolving conflicts.

• Describe the specific situation or behavior and provide concrete evidence or data.
  
• Express how the situation makes you feel and what your concerns are.
  
• Suggest alternative actions and seek agreement.
  
• Consequences should be stated in terms of impact on established team goals or patient safety. The goal is to reach consensus.

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Authored by Cindy Ebner, MSN, RN, CPHRM, FASHRM