Communication strategies among healthcare team members

.....communication strategies used in my current setting are based on years of institutional protocol and practice. Although the organizational codes of ethics have been updated recently to address issues like harassment, the communications protocols have changed little, leading to some problems like those identified by both Halm (2013) and Dufault, Duquette, Ehman et all (2010). Dufault, Duquette, Ehman et al. (2010) point out the need for a "standardized, evidence-based, patient-centered approach," particularly when it comes to shift-change handoffs (p. 59). While our organization does have handoff protocols, those protocols are based not on empirical research or on a patient-centric approach but on ingrained habits supported by senior staff members. Communication strategies remain relatively consistent, and are not unevenly applied to different team members. Halm (2013) notes the importance of standardization in patient handoffs. While we do have some standardization methods, they are not effectively implemented due to the lack of strong leadership. Therefore, the pros of our current communication strategies are that they are consistent and standardized but they do not empower nurses and nor do they empower patients.

In a systematic review of barriers to communication during patient handoffs, Halm (2013) found that there were both sender-related and receiver-related problems in communication. Likewise, organizational culture issues were somewhat to blame for communications faults. Sender-related issues include offering too much or too little patient information during the handoff procedure. With higher quality and accuracy of information, the transitional periods would be more effective and patient-centric. Nurses on our team often demonstrate attentiveness problems because they are not encouraged to offer critical patient information that is not part of typical protocol. This occurs because the senior staff deems such information as extraneous or irrelevant and their training and sense of power permits them to make snap judgments instead of taking into account cultural diversity.

Based on the readings, I do believe that a different communication strategy that is more patient-centric would be more effective in the long run for the organization. The new strategy would include teamwork, disallowing the strict organizational hierarchies that have become too entrenched. Junior nurses often work directly with patients in ways that the staff leaders do not, and those nurses do have critical information about patient needs that need to be communicated systematically to successive staff members during handoff. Evidence does show that when handoffs are patient-centered, they are more efficient and effective (Dufault, Duquette, Ehmann, et al., 2010; Halm, 2013). The resources needed to create organizational change would require cooperation from senior administrators at the healthcare organization. Unfortunately, the administration does not listen to junior nursing staff because of the organizational culture. Changing the organizational culture would be ideal, but until that time, junior nurses do need to work together and empower themselves by speaking up during handoffs. Asking important questions and offering pertinent information even when beyond protocol would help to change the ways nurses communicate during these critical periods.

Communication is important for maintaining high standards and patient outcomes. When communication deteriorates, nurses can even be prone to avoidable errors. Lack of leadership and a resistance of staff members to participate in the team building process are major problems that need to be addressed through changes to the organizational culture. These changes should not be haphazard, but systematically implemented based on evidence. Improving the quality of nurse training, reducing nurse fatigue through improved scheduling and human resources management, and enhancing communication through empowerment are the key solutions to the problem.

References

Dufault, M., Duquette, C.E., Ehmann, J., et al. (2010). Translating and evidence-based protocol for nurse-to-nurse shift handoffs. Worldviews on Evidence-Based Nursing 2010, p. 59.

Halm, M.A. (2013). Nursing handoffs: Ensuring safe passage for patients. American Journal of Critical Care 22(2): 158.