Episode 17: Communication

Author: Eoghan Colgan    @eoghan_colgan
Special Guest: Stephen Hearns @StephenHearns1

11/07/18


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Guest Bios

Stephen Hearns

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Stephen is a Consultant in Emergency Medicine based at the Royal Alexandra Hospital in Paisley and lead consultant for the Emergency Medicine Retrieval Service (EMRS) in Scotland. His main interest lies in the care of seriously ill patients in remote environments. He has been an active member of Arrochar mountain rescue team for 18 years and holds the Mountain Leader Award. Stephen acted as medical officer on seven international expeditions before establishing the first expedition medicine course in the UK. He has previously been an instructor on ATLS, ALS and PALS courses. Stephen finished his training with the London Helicopter Emergency Medical Service.  Over the past ten years he has led the establishment of the EMRS in Scotland. Stephen has published a number of papers and book chapters related to these subjects. He also led the team establishing the Diploma in retrieval and transfer medicine for the Royal College of Surgeons and contributes to the organisation of the annual UK retrieval conference.  He is attracted to the challenges of retrieval medicine in demanding remote environments with limited resources.

He is married to Kerry and has three sons. Stephen enjoys mountains, road cycling and mountain biking.


Show Notes

Eoghan and Stephen discuss communication in high-pressured situations – why it matters, why it is often sub-optimal and how we can improve.


Take Home Points

Why is communication important

  • Essential in high-pressure situations when there is a lot of information to be processed
  • Information being passed needs to be accurate, well-structured and communicated clearly (process accurately and suppprt decision-making appropriately)
  • Video-replays of high-pressure scenarios reveal poor communication

Bad communication can lead to

  • erroneous decision-making
  • procedures being carried out incorrectly
  • suboptimal patient care

Why is communication often suboptimal:

  • Time limitations
    • In pressured situations there is limited time for communication so messages can be rushed and information not clarified by the listener
    • Need to plan what to say before you communicate
    • Keep it structured (SBAR etc)
  • Limited cognitive capacity
    • There is a limited cognitive bandwith
    • We can only concentrate on a certain amount of information
    • Actively listening becomes more difficult
  • Cognitive appraisal
    • In high-pressured situations we can become stressed and ‘frazzled’ as well as task-fixated or easily distracted. 
    • Information receiving is compromised

How to improve:

  • Take a moment to prepare what you will say before passing information
    • Accurate, comprehensive and concise
  • Identify the right moment for communication
    • For example during natural lulls in activity or changes in tempo
  • Ensure the receiver is prepared to receive
    • Ask are they ready to receive
    • use first name, eye contact and hand on shoulder to get their attention
  • Closed-loop communication
    • Receiver should repeat the information back to the giver to ensure it has been understood
  • Communication:
    • Repeat important numbers – “16 mg, 1, 6, mg”
    • Don’t use abbreviations like ‘isn’t’ – instead say ‘is not’
    • Jargon/keywords can be useful in high-functioning, well-rehearsed teams but can be confusing in ‘flash’ teams (don’t know each other well or often work together)

Non-Verbal Communication

  • Can be extremely powerful if done well
    • Displaying control and calm will communicate a sense of optimism and confidence
    • The team is likely to work more effectively in this scenario
  • Can be very negative
    • Your facial expressions and behavior can reveal your stress and loss-of-control that can be damaging for the team
    • The team is likely to lose confidence in the leader and less likely to listen and follow-instructions
    • Their stress will rise which will impact their contribution
  • It’s important to think about your non-verbal communication when training/simulating

Three phases to improvement

  1. Awareness of the techniques
    • Formal training (written or face-to-face) on the skills of communication/leadership
    • Develop your communication toolbox
  2. Development of techniques in simulation
    • Simulation under increasingly pressured situations and practicing/developing these skills
  3. Personal reflection and continuous improvement
    • Debrief after every significant event
    • Ask your colleagues to comment on communication skills
    • Live filming if possible

Resources for learning/developing communication skills in healthcare

  • Scott Weingart
  • Mike Lauria


Links

 Emergency Medice Retrieval Service

Emergency Medice Retrieval Service

 Angela Lewis from PSA Ltd provides human factors training to the EMRS team. We can highly recommend the quality and content of the training she provides for the team

Angela Lewis from PSA Ltd provides human factors training to the EMRS team. We can highly recommend the quality and content of the training she provides for the team

Excellent website with a huge amount of information about communication challenges and solutions - https://www.communicationtheory.org

Hannah BellComment