Quality Update

In a Manner of Speaking
Adopting communication skill training from aviation to improve teamwork among medical staff is gaining altitude.

Bill Taggart, the aviation industy’s ace on communication skill training, explains to an ICU staff how briefings and teamwork reduce errors.

In another busy ICU, a medical student told a fellow in passing about an abnormal laboratory result affecting a patient’s condition. But the seriousness of the situation didn’t register with the senior house staff officer, who was consumed with helping another critically ill person. Two hours later, when the situation finally became apparent to the fellow, he appropriately treated the patient.

Examples of communication failures like these fall into Bill Taggart’s lap all the time. He gathers similar anecdotes like others collects research data. Taggart is a well-known expert in interpersonal communication skills and teamwork training within the aviation field, and now he’s brought his forte to the health care industry. His four-hour training session has become the backbone of a joint program by Hopkins Hospital’s patient safety committee and Hopkins Medicine’s Center for Innovation in Quality Patient Care to teach front-line medical staff how to improve such skills as assertiveness, listening and group decision-making.

Communication breakdowns among health care professionals are one of the leading causes of patient harm. “If we can get our care teams to improve their communication,” asserts Peter Pronovost, a nationally recognized patient safety expert and Hopkins anesthesiologist, “it will take us miles toward eliminating medical errors.”

Hopkins borrowed its idea for interpersonal communication training from the aviation industry because of its success record in reducing communication-related causes of plane crashes. During its investigations, the National Transportation Safety Board discovered that many plane accidents might have been avoided had pilots not ignored warnings from copilots. This led the industry to conduct training aimed at breaking down the hierarchal barriers among the flight crew.

Taggart believes the leap from aviation to health care isn’t so unconventional. Both industries have common elements: highly skilled teams, high-stakes services, highly regulated safety environments and a traditionally hierarchical structure.

Medicine’s complexity, however, does present its own obstacles to breaking down communication barriers, Taggart concedes. “The challenge,” he says, “is to get the physicians, nurses, residents, pharmacists and others in the same room for the training. Otherwise, it’s meaningless.”

Using flip charts, video segments and PowerPoint, Taggart takes staff through the basic principles of effective communication: briefings, assertiveness, situational awareness and team decision-making. A study at Orange County (Calif.) Hospital showed, for example, that checklists and daily briefings reduced wrong-site surgeries by 200 percent, cut the nursing turnover rate to zero and increased morale for all of the surgical teams. “Briefings,” Taggart notes, “put everyone on the same page.”