Although many things factored into the crash, the way the crew of one of the aircraft communicated was critical. In those days, the captain was considered all-powerful, and the other members of the crew couldn’t question his judgment without losing face. In this case, the captain of the KLM was dreadfully wrong about the situation on the runway, but no one in the cockpit could tell him so.
Sometimes, patient care is like a giant airplane. There are many systems to manage and many orders to carry out, with a lot of “cooks in the kitchen” trying to keep a patient alive and healthy. Some of those “cooks” have more experience, higher degrees, and more seniority than others. It’s natural for those individuals to feel like their ideas are more important and influential, just as it’s natural for individuals without those qualities to feel like their views don’t matter.
That’s what happened in 1977, and it had disastrous results.
Communication is essential in patient care, and it must occur among all team members at all times. However, speaking assertively and directly to your boss or someone with experience than you can be a challenge.
To start, all pharmacy personnel need to understand the concept of mitigation, meaning the sender of the message deliberately changes the way it’s communicated to avoid discomfort. In other words, we choose to “soften” the message because we’re afraid the receiver might get upset with us or ridicule us for speaking.
For example, instead of saying, “I think the prescription you just completed is wrong,” someone might say, “Maybe we should double-check that one?” This mitigated message (and its sender) can be easily dismissed.
Here are some things your team can do to reduce mitigation and communicate more clearly and directly:
1. Reduce power distances between team members
Pharmacists have more education and experience than technicians, on average, but that doesn’t mean they’ll always make the correct decision or complete a task correctly. If your technicians think their role is to “,” they’ll be very hesitant to speak out when needed.
Pharmacists should actively communicate to their team members that when it comes to patient safety, degrees and experience don’t matter; everyone’s perceptions and ideas are important.
2. Build trust among team members so communicators know no one will take messages personally
This can be done most effectively by setting aside some time periodically to hold team-building meetings that emphasize interpersonal relationships and opportunities to practice hearing and reacting to difficult messages. Emphasize joint accountability (“We,” not “you”) and make it clear to all team members that their personal and professional reputation isn’t at stake.
3. Make the message “observable” instead of “inferential”
Your message should only include content concerning what anyone in the room could’ve seen, not statements about why. For example, if a pharmacist misinterpreted a physician’s order and the technician notices, it’s not useful to say, “Why aren’t you paying more attention?” or “How could you be so careless?”
Instead, consider the SBAR method:
- Describe the Situation
- Provide a brief Background for how we got here
- Give a brief Assessment of the problem
- Offer a Recommendation for a remedy
When you finish your message with a recommendation, remember to ask the receiver for agreement on it (“I think we should do X. Do you agree with that?”). Avoid asking for agreement in a leading way (“Don’t you agree?”) and don’t be defensive if the answer is “no.” Don’t become too fond of your own recommendation; besides, this isn’t a competition.
In the aviation industry, this enhanced communication model has revolutionized cockpit dynamics and improved safety tremendously. In health care, its elements can be found in surgical training methods, but I believe pharmacies can also benefit.
Kraig Schell, PhD
Kraig Schell, PhD, is a Professor of Psychology and Director of the Consultation and Research Institute at Angelo State University in Texas, and also Affiliate Professor of Pharmaceutical Outcomes and Policy at the University of Florida School of Pharmacy. He has taught, consulted, and authored dozens of continuing education articles for pharmacists on patient safety and engagement, as well as the application of psychological principles to safer and more effective care.