According to Maxfield, D., (2005), et al, Silence Kills, The Seven Crucial Conversations for Healthcare, past studies have indicated that more than 60 percent of medication errors are caused by mistakes in interpersonal communication (JCAHO). A second research study; Crossing the Quality Chasm: A New Health System for the 21st Century a Report (2001}, analysis of communication difficulties experienced by health care personnel in health care organizations revealed, “a paradigm shift from provider failure to system failure” (Girouard, 2017). All too often, well-intentioned people in healthcare institutions choose not to speak up, this can create what is called a “quality gap” in the delivery of quality care. The silence of interpersonal communication is one of the major issues concerned with the “quality gap” is communication difficulties experienced by health care personnel in health care organizations.
In David Maxfield’s (2005), et al article, Silence Kills, the ability of professionals to discuss risky topics in health care like patient safety, quality of care, micromanagement, disrespect, lack of support, broken rules, may continue to contribute to mistakes in interprofessional communications and effect avoidable errors and other chronic problems in health care. The estimated percentage of my colleagues who had (some) the seven categories of conversation that are especially difficult from Silence Kills was 50 percent, no individual in my 12 person group delineated all seven categories of conversation difficult to discuss.
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Within the group, the three most popular categories difficult to discuss were, micromanagement, lack of support, disrespect and broken rules. Within this group, the general consensus was, among themselves (registered nurses), there is support to discuss “the seven categories of conversation”, but not with or to nursing management, physicians, or the hierarchy. The entire group of 12 colleagues stated (at one time or another) they had witnessed a percentage of their colleagues, break the rules, fail to support, disrespect them, show poor teamwork, only one stated incompetence, but remained silent.
Operationalize one of the rules to better guide patient-clinical relationships.
The rule that I would put into operation and put to use to better guide patient-clinical relationships would be rule 10 “cooperation among clinician”. The “operationalizing” for me would begin at the top. The use of the rule to better guide patient-clinical relationships requires the attention and involvement of stakeholder; the health care professional health care policy makers, consumer advocates and purchasers of care.
Quality improvement in any system must begin with “cooperation among clinician” and must begin with systemic changes and not placing the blame. I choose this rule because in many systems, care is taken to protect professional prerogatives (privilege restricted to an individual’s rank or discipline) and separate roles, and the hierarchy and management and basically overlook concerns According my group this happened a lot in many areas of our organization, and is a systemic concern, and does not contribute to enhancing patient and clinician communication. The act of working together among clinicians is a priority; clinicians and institutions should actively collaborate and communicate to ensure an appropriate exchange of information and coordination of care with each other.
For example, one colleague (in my 12 person group) explained ; “a PCP explained to a patient that the test he [patient] was insisting on having done, was not a necessary test to be done and not related to his diagnosis, the patient then call the Chief of medicine complaining that his PCP was refusing to order the test he (patient) wanted, The chief of medicine, then call the PCP, and said “let it go, let’s give him whatever he wants, to avoid complaints to the head office, I’m going to order the test”, and he did”. When a patient seeks inappropriate health care services, the challenge for clinicians (chief of medicine) is to find ways of reducing this conflict and, to the extent possible, resolving it, guided always by efforts to understand and respond to patient needs, not overriding another clinician (PCP).
In conclusion, the rule I chose “cooperation among clinician” (a new rule), is more important than professional prerogatives and rank or role. This new rule Operationalize, emphasizes a focus on good communication among members of a team using all the expertise and knowledge of team members, where appropriate (all departments), meeting all patient’s needs. The new rule “cooperation among clinician”, means patient expectations of health care, is the rule to better guide patient-clinical relationships. Experts and studies have shown that the new expectations are consistent with the kind of quality care most clinicians strives to provide daily.
Crossing the Quality Chasm: A New Health System for the 21st Century a Report (2017), National Academy of Sciences Engineering Medicine, Health and Medicine Division, Retrieved from Web, March 19, 2017, http://www.nationalacademies.org/hmd/Reports/2001/Crossing-the-Quality-Chasm-A-New-Health-System-for-the-21st-Century.aspx
Evans, M., (2017), An Illustrated Look at Quality
Improvement in Health Care, Video, Institute for Healthcare Improvement, Health and Healthcare Worldwide, Retrieved from NU 300 Professional Transitions Week 8 – Outcomes, Readings & Activities, Silence Kills, Crossing the Quality Chasm, and To Err is Human, Online Course, Saint Joseph’s College Maine, March 19, 2017, http://www.ihi.org/resources/Pages/AudioandVideo/MikeEvansVideoQIHealthCare.aspx
Girouard, T., (2017), NU 300 Professional Transitions, Week 8, Outcomes, Readings & Activities, Objectives, Online course, Saint Joseph’s College Maine, Retrieved from Website, March 19, 2017,
Kelley J. M., (2014), et al. The Influence of the Patient-Clinician Relationship on Healthcare Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS ONE 9(4): e94207
doi:10.1371/journal.pone.0094207, Retrieved from Web, March 19, 2017.
Maxfield, D., (2005), et al, Silence Kills, The Seven Crucial Conversations for HealthCare, The American Association of Critical-Care Nurses (AACN), VitalSmarts, Retrieved from Web, March 19, 2017, https://www.aacn.org/~/media/aacn-website/nursing-excellence/healthy-work-environment/silencekills.pdf?la=en
The Silent Treatment – Silent Treatment Study (2005), a download, Retrieved from NU 300 Professional Transitions Week 8 – Outcomes, Readings & Activities, Silence Kills, Crossing the Quality Chasm, and To Err is Human, Online Course, Saint Joseph’s College Maine, March 19, 2017, https://www.silenttreatmentstudy.com/Silent%20Treatment%20Executive%20Summar…
Maxfield, D., (2005), et al, The Silent Treatment, Why Safety Tools and Checklists Aren’t Enough to Save Lives, The American Association of Critical-Care Nurses (AACN), VitalSmarts, Retrieved from Web, March 19, 2017, https://www.aacn.org/~/media/aacn-website/nursing-excellence/healthy-work-environment/silenttreatmentexecutivesummary.pdf?la=en
Wojcieszak, D., (2005), Standards, Audits, and Saying I’m Sorry: An Engineer’s Family Proposes Solutions, Retrieved from NU 300 Professional Transitions Week 8 – Outcomes, Readings & Activities, Silence Kills, Crossing the Quality Chasm, and To Err is Human, Online Course, Saint Joseph’s College Maine, March 19, 2017,
Maxfield, D., (2005), et al, Silence Kills, The Seven Crucial Conversations in Healthcare, VitalSmarts,
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