"Just doing my job"

For the past few days, we have had a consultant from the Institute of Healthcare Improvement (IHI) working with us to help achieve our clinical quality goals, particularly around reducing caesarean section rates and reducing fetal distress and morbidity.

Given the hierarchy that exists in healthcare in India (and really, everywhere in the world), his training this morning to our nurses on speaking up is remarkably important. His examples related to aviation (he is a pilot, besides being an obstetrician) are particularly sobering. He gave the example of one carrier in the US about twenty years ago: the role of the co-pilot then included reading off how much gas is left in the tank at set times. So that's what he did. Countdown at pre-defined times - 5. 4. 3. 2. 1... all the way down to zero. The plane crashed, but the co-pilot "did his job."

Statistically speaking, flying in airlines is much much safer than checking into a hospital. We've all heard of surgeons operating on the wrong leg. A sobering stat: "Ineffective communication is a root cause for nearly 70% of all patient deaths reported in US hospitals" (Sentinel event statistics, 1995-2003). Really incredible and downright scary: 7 out of 10 deaths are preventable with better communication.

Most helpful was the framework for communication that IHI provides, especially around hand-off, when information is particularly apt for getting lost: SBAR - Situation, Background, Assessment, Recommendation. Really important, considering that doctors and nurses are trained to communicate differently, right from school.

On a lighter note, even when you think you're helping, unless both people properly communicate their goals and play back to one another, catastrophe can occur, as seen in this hysterical video.