Communication Failure: More Common Than You Think

By Marjorie Stiegler on February 16, 2015 in Communication, Leadership, Patient Safety and Quality, Teamwork

The single biggest problem with communication

Why is communication so pervasively difficult?  We see year after year that communication failures top the lists of root causes for sentinel events reviewed by The Joint Commission.   Few people would classify themselves as poor communicators, and yet, communication failures in healthcare are practically an epidemic in themselves.

most frequent root causes


Communication failures may be classified as flaws of:

1. Timing (too late to be actionable).  This speaks for itself, and highlights the importance of speaking up, which I’ve written about before.

2. Audience (person receiving information is not a core team member or  true decision maker).  This is all too common when attending physicians are not actively participating at critical times, such as the pre surgery “time out”.  Critical questions about patient position, anticipated blood loss, comorbid conditions and their impact on anesthetic options, and so on should not be guessed by junior members of the surgery and anesthesia teams.

3. Intent (what is the purpose, context, desired outcome?)   What do we want the other person to do with the information we’ve relayed?  Sometimes data is delivered, but a recommendation, order,  or request is not clearly linked.

4. Situation (competing distractions, music, conversations, inappropriate place or company).  The OR is a hotbed of alarms, music, conversations, and miscellaneous banging and clanging.  Use a “closed loop” technique to ensure you’ve been heard and that your information has registered with the intended recipient.

5. Content (insufficiently transparent, accurate, or relevant).  Medical specialties have languages all their own.  Certain constellations of signs and symptoms are self-explanatory among colleagues of the same discipline, but do not carry the same obvious significance to those in another domain.  Be sure you explain the “punchline” of the data you are conveying.


Communication failures clearly contribute to preventable patient harm.  What are the best strategies you’ve learned to tackle the failures listed above? 




1 Comment

  1. Java Doc February 17, 2015 Reply

    Communication is everything in anesthesia, with surgeons, staff and patient. One area I felt has always been overlooked is case turnover to another anesthesia providerm

    While the actual reported bad outcomes related to transfer of responsibility from one anesthesioligist to another is low, I believe the incidence is probably higher than we realize. I have always felt the lack of a checkist makes turning over complex cases dangerous. I created the ABC’s of case turnover in 2001 while a faculty member at MUSC. As a pilot it is critical to determine who has primary responsibility for flying and good Situational Awareness. The same applies to turning over a long complicated anesthetic.

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