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Medical Errors Could Be Reduced with Improved Workplace Communication

According to a study released in January, Silence Kills: The Seven Crucial Conversations for Healthcare, the culture of poor communication and collaboration that prevails among health professionals contributes significantly to continued medical errors and staff turnover. The national study of more than 1,700 nurses, physicians, clinical care staff and administrators found that fewer than 10 percent address colleague behavior that routinely includes problems with following directions, poor clinical judgment or taking dangerous shortcuts. The report was co-sponsored by the American Association of Critical-Care Nurses and VitalSmarts, a research firm that focuses on leadership training and organizational performance. Among the study’s key findings:

  • 84 percent of physicians and 62 percent of nurses and other clinical care providers have seen co-workers taking shortcuts that could be dangerous to patients.
  • 88 percent of physicians and 48 percent of nurses and other providers work with people who, in their opinion, show poor clinical judgment.
  • Fewer than 10 percent of physicians, nurses and other clinical staff directly confront their colleagues about their concerns. The 10 percent of health care workers who do raise these crucial concerns observe better patient outcomes, work harder, are more satisfied and are more committed to staying in their jobs.

To "drive" the cultural transformation needed to improve environments, the AACN has developed a set of national standards. These guidelines for establishing and sustaining healthy work environments are:

  • Skilled Communication. Nurses must be as proficient in communication skills as they are in clinical skills.
  • True Collaboration. Nurses must be relentless in pursuing and fostering collaboration among colleagues.
  • Effective Decision Making. Nurses must be valued and committed partners in making policy, directing and evaluating clinical care, and leading organizational operations.
  • Appropriate Staffing. Staffing needs to ensure the effective match between patient needs and nurse competencies.
  • Meaningful Recognition. Nurses must be recognized and must recognize others for the value each brings to the work of the organization.
  • Authentic Leadership. Nurse leaders must fully embrace the imperative of a healthy work environment, authentically live it and engage others in its achievement.

In a related study on errors reported by hospital nurses ("The Prevalence and Nature of Errors and Near Errors Reported by Hospital Staff Nurses," Applied Nursing Research, November 2004), nurses frequently reported that communication among health care providers was a contributing factor in both the cause and prevention of errors and near errors. Other findings suggest a number of recurring factors may precipitate or contribute to errors. Variation from standards of practice and protocols, interruptions and distractions, pre-occupations and attention slips, and inadequate staffing were cited as "areas to address." 

Silence Kills: The Seven Crucial Conversations for Healthcare is available online.

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