Issue link: https://beckershealthcare.uberflip.com/i/683043
31 PATIENT SAFETY lectures, research or memorizing scientific information. An intellectual approach, such as a video on "how to listen" or a poster that shows the guidelines for giving and receiving constructive feedback, will not effectively get at the underlying human growth that must occur to practice the skills, according to Ms. Boynton. "We don't see communication as a serious enough problem, and so we find we don't have time in schools to have courses on communication. We don't have time in our workdays to manage conflict. ose things do take time and we have to make it a priori- ty to do it right," she adds. e chaotic hospital environment also makes effective communication difficult, which is why it is important to be cogni- zant, clear and concise about what pieces of vital patient information can be com- partmentalized, and what pieces should be prioritized, Ms. Moore says. Doing that, though, takes certain skills and that takes organizational direction to help people understand the need, Ms. Moore says. It also takes energy, and it takes energy of the individual practitioners to be aware. Medical improv at's where training, such as medical im- prov, comes in. Medical improv, taught by Ms. Boynton, is a specific form of applied theater improvisation that uses experiential learning activities to teach healthcare professionals communication and interpersonal skills. ere are a few principles and many activ- ities that promote emotional intelligence, communication, teamwork and leadership. Activities can easily be framed around important organizational initiatives like cre- ating a culture of safety, promoting employee engagement, developing communication skills or improving patient experience. Ms. Boynton develops workshops based on specific organizational initiatives and group composition. A group of nurses might ben- efit from a focus on assertiveness whereas a group of physicians may learn more from listening activities. A mixed group could focus on both with experiences lending to collaborative work. ere are many activities that can be adopted for various groups. For instance, one activity involves synchro- nized storytelling, where two people try to tell the same story at the same time. "In pairs, one person tells a story while the other watches the person and tries to tell it at the same time. So if I say, 'Once upon a time,' the idea is that my partner is going to say that at the same time that I am. It's a little slow at first, and what happens is the person following the storyteller becomes intently focused on that person. It is one of the most effective ways to teach listening that I know of," Ms. Boynton says. Medical improv and other training resourc- es can help provide healthcare professionals with the proper tools and skills to improve communication, but it is up to health- care workers to practice these skills when talking to colleagues, all in the name of patient safety. Ms. Moore recalls a pediatric trauma case in which the patient's initial exam showed no underlying complications, but members of the care team felt there was an issue. e team communicated that to the surgeon, who stated he disagreed, but the team persisted. e child was taken for a CT scan and clinicians found a subdural hematoma, which resulted in immediate surgery. is case could have had a very different outcome if the team had not communicated their concerns, Ms. Moore says. e hos- pital had worked hard to create an atmo- sphere of mutual respect through commu- nication skill building. is allowed the care team to not defer to perceived status and power of the surgeon. Prioritizing the patient To improve communication, hospitals and health systems must also make it clear the patient is the first priority, according to Ms. Moore. ere are certain high-risk tasks that require very clear and concise commu- nication. Hospital staff need to define what high- risk procedures are and what type of communication should be occurring when actions are taken, she says. Hospitals and health systems "should have visual cuing or nonverbal communication that says, 'In this area of concentration, safety is first, do not interrupt,'" she says. "It's really having the passion about patient safety that you're really infusing commu- nication standards around it. Not only is it teaching people how to have really hard, tough conversations, but skill sets such as active listening and seeking out informa- tion also helps people to respect what is high-risk." Additionally, hospital leaders must be com- mitted to developing strategies and contin- uously train staff to help them perform at their highest level. n Care Quality and Clinical Outcomes Vary Considerably for Colonoscopies By Shannon Barnet R esearch from Yale University in New Haven, Conn., revealed the quality of colonoscopies varies con- siderably among outpatient procedures, with many resulting in unplanned hospitalizations. The findings were published in the journal Gastroenterology. Study authors examined data from 2010 medical outpatient colonoscopy claims to estimate rates of unplanned hospi- tal visits within seven days of the patients' procedures. The study found roughly 16 out of every 1,000 outpatient colo- noscopies resulted in an unplanned hospital visit among Medicare beneficiaries. That said, the rates varied across outpatient facilities, indicating a disparity in care quality. The most common reasons for unplanned hospital visits were hemorrhaging, abdominal pain and perforation. Patients with a history of fluid and electrolyte imbalances or psychiatric disorders, as well as those over the age of 65, were more likely to end up in the hospital within a week of having a colonoscopy. "We calculated a risk-adjusted measure of outpatient colo- noscopy quality, which shows important variation in quality among outpatient facilities," concluded the authors. "This measure can make transparent the extent to which patients require follow-up hospital care, help inform patient choices, and assist in quality-improvement efforts." n