Communication Is What Makes a Team Strong

Objective: Learn about communication tactics to help multidisciplinary teams

understand one another better and improve patient and family care.

Communicating with Physicians

Nikole Neidlinger MD FACS

Chief Medical Officer Donor Network West Transplant Surgeon

California Pacific Medical Center

Why this conversation?

Concerns from Physicians regarding donation:

More involvement of the doctor earlier Communication, especially after a case, needs

improving Need to focus on the patient, not just the

organs More balance between family, OPO, doctor Better updates. Ongoing status Education in the moment when a case is

happening

Concerns from Nursing staff

Number 1 Challenge to MD communication: 60% of you said finding time, limited

availability, and holding their attention 20% said helping physicians see the importance of

donation 20% cited not sounding like an idiot and

intimidation

Objectives

Understanding Physician Training and Culture How do Physicians communicate? How do I communicate effectively as part of a

health care team? Difficult conversations and hospital

hierarchy?

Objective 1 Understanding Physician Training

Physician Training 4 years undergrad 4 years medical school 3-10 years residency

As PGY 10, $12.50/hour Average debt $419,738 50% regret the decision 28% received recent pay cut 30% of time spent administrative tasks More work does not equal more reward, so you have

to appeal to their emotions/commitment to patient care.

Culture taught to Physicians

Trust no one, do it yourself (not great at being team members)

Eat and sleep when you can (take care of patients before yourself)

You are responsible for everything, whether you know about it or not, whether you were present or not (dislike for handoffs, shifts)

Characteristics of Physicians

Decisive Self-Reliant Distance themselves from any non-physician Fiercely Independent Courageous (see one, do one, teach one) Expert Problem Solvers Terrible negotiators

Beckers Hospital Review

Expectations on Physicians

Responsible for everything Typically managing 5-30 patients

simultaneously Availability: never turn off pager/cell phone Be evidence based, current, cost and quality

focused Frustrated with familiarity with hospital

business (MDs can do the admin job) yet administrators cant do the clinical job

Objective 2 How do physicians communicate?

How do Physicians Communicate?

Fast Paced, Task Oriented Problem Solvers Value headlines and critical thinking Typically poor negotiators Responsible for everything Will not read an email addressed to >6

people

The 4 Personality Types Task-oriented People-oriented

Dire

ct,

fast

pac

ed

Indi

rect

, sl

ow p

aced

Get it Done!

Get Appreciated!

Get it Right!

Get Along!

Differences in Communication Styles in the hospital

Nurses and midlevel providers complain that physicians: Do not view them as professionals See them as purveyors of tasks Do not know nurses scope of practice or

autonomy Are inattentive, especially at night Unwilling to discuss goals of care Felt a list of signs/symptoms had to be provided

rather than the nurses evaluation Dixon Et al. AACN advanced critical care 17(4):376

Differences in Communication Styles in the hospital

Physicians complain that nurses: Are too narrative Present with disorganization of information,

illogical flow of content, lack of preparation for questions

Include extraneous or irrelevant information Are too descriptive, say too much Dont get to the point Do not clearly delineate the problem/request

Dixon Et al. AACN advanced critical care 17(4):376

Objective 3 How do I communicate as part of a health

care team?

SBAR-Situational Briefing Model Used in the nuclear submarine service for

concise and accurate communication Situation the punch line, give it in 5-10

seconds Background the context, objective data, the

numbers, how did we get here Assessment what is the problem Recommendation what do we need to do and

when?

SBAR in OB

S Dr.X, Im worried about Ms. Klein, I think she is going to rupture her uterus

B She is a VBAC; she has a dense epidural, but she is having persistent breakthrough pain; she is complete and ready to push

A Im concerned something is wrong I dont want her to push

R I think we need to think about a C-Section. Please come in and see her as soon as you can.

Situation

I see youre busy, can I get 5 minutes before you leave the unit regarding.

Are you taking care of pt X? I wanted to discuss the brain death notes on

__

Background

Synopsis of treatment/procedures and date Current vitals, and other pertinent hemodynamic data He appears to be having clinical instability with

hypotension, tachycardia, and diabetes insipitus the family has been asking whats next and seems to

understand the prognosis I saw the brain death note on the chart, but am not

sure whether the patient was normothermic when examined

Assessment Give your conclusions about the present

situation It seems to me this would be a good time to

speak with the family about options. Im worried that the brain death notes leave

the team at risk Im concerned that we dont have the IV

access for appropriate resuscitation

Recommendation I think we should include the possibility of

donation as they consider EOL decisions I think we should re-document the brain

death exam now that the patient is warm Can we address perfusion and oxygenation so

that the family can make an informed decision?

SBAR key points

5 second blurb about why youre calling, and what you hope to achieve

Use critical thinking to determine what is relevant beforehand

Make sure you have the correct person Being brief and succinct does not mean you

arent thorough What do you want and by when?

Objective 4: Difficult Conversations

Handling the difficult conversation

Asserting concerns is NOT

Accusatory (if you dont provide pressors ) Disrespectful (these brain death notes dont

adhere to policy) Bullying (if you refuse to help)

Its not personal! Change the focus: providing high quality patient

care and service for the grieving family

Handling the difficult conversation

Asserting concerns IS Patient and family focused Succinct, crisp, and shows critical thinking Uses questions (help me understand? How can I

help? How can we make this easier?) Uses phrases I am concerned that and I am

worried that and I want to help provide quality care..

What do physicians want regarding the donation process?

To be included as key players your patient/family Included in communication Clear expectations

Constant but Clear Communication Even when they seem disinterested. Daily. Never too often! SBAR style

Follow-Up Immediate. Day after the recovery. Again within 2-3

days of the transplant Debrief case. What happened?

Communicating donation Focus on benefit of

donation for donor families

Hospital having primary responsibility and ownership

No discussions with family unless with attending first

Written in medical record and conveyed verbally to correct person

Teach with tact Follow-up

Questions?

A hero is within each of us. An everyday hero.

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Slide Number 1Communication Is What Makes a Team StrongCommunicating with PhysiciansWhy this conversation?Concerns from Physicians regarding donation:Concerns from Nursing staffObjectivesObjective 1Physician TrainingCulture taught to PhysiciansCharacteristics of PhysiciansExpectations on PhysiciansObjective 2How do Physicians Communicate?The 4 Personality TypesDifferences in Communication Styles in the hospitalDifferences in Communication Styles in the hospitalObjective 3Slide Number 19SBAR-Situational Briefing ModelSBAR in OB SituationBackgroundAssessmentRecommendationSBAR key pointsSlide Number 27Objective 4:Handling the difficult conversationHandling the difficult conversationWhat do physicians want regarding the donation process?Communicating donationQuestions?A hero is within each of us.An everyday hero.