Implementation of an organization-wide standardized communication initiative

Abstract

Background/objectives

Leadership at all levels of a large children's hospital embraced the implementation of a standardized communication process, including techniques of assertion, closed-loop communication, and a situation briefing model organization-wide.

Implementation/methods

Key administrative and clinical leaders underwent training in the techniques of the ‘Clarity in Communication’ initiative. The initiative was piloted in targeted areas of the organization over 6 months. The final model for training staff and evaluation of the initiative occurred hospital-wide over an additional 18 months. Evaluation focused on the use of a standardized communication strategy across the organization, including direct observation and survey techniques.

Results

From October 2006 to January 2008, more than 6500 interdisciplinary staff received training. Four hundred and fifty-six observations of the standardized communication processes were recorded, with 68% of the observations occurring during patient rounds and handoffs. Sustained improvements in all 16 elements were observed across the organization. Survey responses revealed significant improvements in all domains, with the highest change perceived by staff in the authority gradient (P < 0.002).

Conclusions

Implementation of a standardized communication strategy among interdisciplinary staff across an organization was found to be feasible, successful, and sustainable. Future work will focus on the impact of the initiative on patient outcomes.

Keywords:

• Communication techniques
• Patient safety
• Employee assertion
• Close-loop process
• Situation briefing model

Additional information

Notes on contributors

Patricia Hickey

Drs Hickey, Blum, and Ms. Brostoff chair the steering committee for Clarity in Communication and led the organization-wide implementation at Children's Hospital Boston. Each author is actively engaged in improving patient safety and quality for pediatric patients and families. Children's Hospital Boston is a large free-standing pediatric hospital and consistently ranks among the top two children's hospitals in the United States.

Patricia Hickey, PhD, RN, FAAN is Vice President of Cardiovascular and Critical Care Services at Children's Hospital Boston. Nationally, she serves on the American Academy of Nursing's Expert Panel, Magnet Advancement and American College of Cardiology's Pediatric Quality Metric Steering Committee. She holds faculty positions at Harvard University, Northeastern University, and UMass Boston.

Jean Anne Connor

Jean Anne Connor, DNSc, RN, CPNP is Director of Nursing Research for the Cardiovascular/Critical Care Programs, Faculty Program Patient Safety & Quality (PPSQ) at Children's Hospital Boston, and Clinical Instructor of Pediatrics, School of Medicine, Harvard, Boston, MA.

Bethany Trainor

Bethany P. Trainor, BSN, RN is a Clinical Research Nurse with 20 years of nursing experience in Pediatric Cardiology and 5 years of experience as Clinical Research Nurse at Children's Hospital Boston.

Marcie Brostoff

Marcie Brostoff, MS, RN is the Director of Nursing Education/Staff Development at Children's Hospital, Boston. She is a visiting scholar for Boston College and the executive liaison to 31 schools of nursing. She has co-authored a successfully awarded proposal to secure funding for a Nursing Career Lattice Program at CHB.

Richard Blum

Richard H. Blum, MD, MSE, FAAP is Assistant Professor of Anesthesia at Harvard Medical School, Senior Associate in Anesthesia and Medical Director of the PACU at Children's Hospital Boston. His interests include simulation-based competency assessment, patient safety, communication and team training. Dr Blum is Board Certified in Anesthesia and Pediatrics.

Kathy Jenkins

Kathy J. Jenkins, MD, MPH has served as Director of the Program for Patient and Quality since 2004, and as Senior Vice President, Chief Safety and Quality Officer since 2008, both at Children's Hospital Boston. She is also a Professor of Pediatrics at Harvard Medical School.

Eileen Stuart-Shor

Eileen Stuart-Shor, PhD, ANP, FAHA, FAAN is an Assistant Professor of Nursing, University of Massachusetts Boston and a Nurse Practitioner in Anesthesia/Critical Care at Beth Israel Deaconess Medical Center in Boston. Her interests include disparities in cardiovascular outcomes for racial/ethnic minorities, global health and effective cross-cultural patient-provider communication.