Successful communication occurs when two people can exchange information and develop mutual understanding. Providing clinical feedback is affected by the sender, the medium and the receiver. There are technical and cultural issues within the medium that interfere with mutual understanding of a message.
In the June 13 edition of ACEP News, Doctor David Baehren expressed frustration in providing clinical feedback to EMS providers. In his column “Culture of Silence”, he wrote:
Along with this positive transformation (post 9/11 heroship), I also noticed that providing feedback to the EMS community became more difficult. Even writing what you are about to read is really sticking my neck out.
What I have found, over the past decade, is that people in the EMS system tend to bristle at negative feedback and even find ways to turn it back on the person who is trying to be helpful. Suddenly the person trying to be the good guy is the bad guy. 1
Skip Kirkwood, MS, JD, EMT-P, EFO, CEMSO is the past National EMS Management Association president and Director/Chief of Durham County (NC) Emergency Medical Services. Chief Kirkwood provided a generous response, relaying the challenges another North Carolina agency encountered after their medical director changed the backboard application protocol.2
Power and status differential
Greg Friese, MS, NREMT-P, is the Director of Education for Centrelearn. In the social media responses to Doctor Baehren’s article, Friese made a great observation.
“I think it is fairly common for just about anyone to bristle at negative feedback,” he said. “This is especially common in relationships with a significant power and status differential.”
Scarce resources, technology and reimbursement practices create an army of focused, specialized care providers that range from “patient care assistants” to narrowly-focused physician specialists. Paramedics are not the only health service provider struggling with effective delivery of care in an environment of significant power and status differential.
Interprofessionality
In 2011 the Interprofessional Education Collaborative provided the results of an expert panel. Core Competencies for Interprofessional Collaborative Practice3 referred to the 2005 concept of interprofessionality as “… the process by which professionals reflect on and develop ways of practicing that provides an integrated and cohesive answer to the needs of the client/family/population... [I]It involves continuous interaction and knowledge sharing between professionals, organized to solve or explore a variety of education and care issues all while seeking to optimize the patient’s participation... Interprofessionality requires a paradigm shift, since interprofessional practice has unique characteristics in terms of values, codes of conduct, and ways of working. These characteristics must be elucidated” (p. 9)4.
Four Interprofessional Collaborative Practice Competency Domains:
The expert panel identified four domains to facilitate an interprofessional relationship:
- Values/ethics for interprofessional practice
- Roles/responsibilities
- Interprofessional communication
- Teams and teamwork
In discussing Interprofessional Communications, the panel made this observation:
Using professional jargon creates a barrier to effective interprofessional care. A common language for team communication is a core aspect of the TeamSTEPPS team training program5, which endorses practices such as Situation-Background-Assessment-Recommendation (SBAR), call-out, and check-back, whose aim is communication that is clearly understood.”
“An important part of language is literacy, both general reading literacy and health literacy. Both play a part in teamwork and patient-centered care. Presenting information that other team members and patients/families can understand contributes to safe and effective interprofessional care.4
Step one in breaking the Culture of Silence
Paramedics are intelligent providers capable of responding to dynamic emergency situations. We have the innate ability to be creative problem solvers. Doctor Baehren’s article started a much-needed discussion.
Our response should focus on patient safety. TeamSTEPPS®: Strategies and Tools to Enhance Performance and Patient Safety, offered through the Agency for Healthcare Research and Quality, provides an interprofessional approach to improving EMS-to-hospital communication.
TeamSTEPPS is an evidence-based teamwork system aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals. It includes a comprehensive set of ready-to-use materials and a training curriculum to successfully integrate teamwork principles into any health care system.6
The key to success for interprofessional communication is that providers from multiple disciplines within the health care community participate in the master trainer program. That would mean that EMS and the emergency department would identify TeamSTEPPS master training candidates.
Those selected will be the implementation team for the process. They will teach those within their community and function as advocates for the TeamSTEPPS program.
Appreciate that starting this conversation will be difficult. Focusing on patient safety, appropriate clinical care delivery and patient satisfaction are three significant drivers in hospital clinical care. The alternative is to remain silent and snarky.
References
1. Baehren, D. (2013 June 13) Culture of Silence. ACEP News. Retrieved June 30, 2013, from http://www.acepnews.com/views/in-the-arena/blog/culture-of-silence/e18e4c0b72818e1a04b31f55e21eb772.html
2. Ward, M. (2013 June 23). Skip Kirkwood responds to ACEP physician issue with EMS feedback. Firegeezer. Retrieved June 30, 2013, from http://firegeezer.com/2013/06/23/skip-kirkwood-responds-to-acep-physician-issue-with-ems-feedback/ .
3. Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative. Accessed June 30, 2013 at: https://www.aamc.org/download/186750/data/
4. D’Amour, D. & Oandasan, I. (2005) Interprofessionality as the field of interprofessional practice and interprofessional education: An emerging concept. Journal of Interprofessional Care, 19 (Supplement 1), 8-20
5. Agency for Healthcare Research and Quality. (no date). TeamSTEPPS National Implementation. TeamSTEPPS curriculum tools and materials. Rockville, MD: US Department of Health & Human Services. Retrieved June 30, 2013 from http://teamstepps.ahrq.gov/abouttoolsmaterials.htm
6. Agency for Healthcare Research and Quality (no date). About the National Implementation Plan. Rockville, MD: US Department of Health & Human Services. Retrieved July 1, 2013 from http://teamstepps.ahrq.gov/aboutnationalIP.htm
