The Society of Hospital Medicine (SHM) is a medical society comprised of hospitalists that exists to promote exceptional care for hospitalized patients.
Adverse events must be managed by a careful, multi-step review and response. However, adverse events can also be prevented by analysis of safety risks and prospective interventions. Teamwork and communication are crucial processes for adverse event prevention because no care is given in hospital medicine by single providers or even one type of provider. Communication breakdown is a major source of error and adverse events (Kohn, To Err is Human1) and patients receiving care from poorly functioning teams experience more complications and death (Mazzocco 20092).
Many training methodologies and tools have been proven to be effective in improving communication, teamwork, teambuilding, and rapport between team members. Of these, using training based on principles (CRM/TeamSTEPPS/I-PASS) or simulation may be most likely to improve outcomes (Buljac-Samardzic 20203). Some of these strategies have been shown to improve mortality (Neily 20104, Riley 20115) and other patient-related outcomes (Mayer 20116, Pan 20177, Gittell 20008).
Fostering a culture that promotes speaking up about safety concerns is critical to reducing adverse events. Strategies for speaking up include CUS (I’m Concerned; I’m Uncomfortable; this is a Safety issue), ARCC (Ask a question, Request a change, state a Concern, go up the Chain of Command), and Validate and Verify (question and double-check key communications). Health systems can use strategies like flattening hierarchies or tools like Lean Daily Management to promote safety and empower providers to report safety events and latent risks.
For a more detailed look at Teamwork and Communication issues, tools, and resources for healthcare settings, read this Executive Summary.