About 98,000 deaths occur annually because of breakdowns in communication, says SIOP member Alex Alonso, according to a 1999 report. Alonso’s work is helping to prevent communication errors before they can hurt patients.
Alonso, who has been a senior research scientist at the American Institutes for Research for the last 6 years, is the most recent recipient of APA’s Innovative Practice Award citation for his work to build team training and cultural competencies in healthcare.
“When you look at some of the big mistakes that occur in the medical field, there are medication errors, failures to acknowledge allergies, and many are caused by a lack of communication,” Alonso explained. “We are trying to prevent that.”
SIOP member Rich Cober
nominated Alonso for the Innovative Practice award, which will be featured in an upcoming story in the APA Monitor
Alonso’s work is an offshoot of TeamSTEPPS™, a training curriculum developed by SIOP member David Baker
and his colleagues at AIR. TeamSTEPPS™ is the national standard for team training in healthcare, and Baker also received an APA Innovative Practice Award citation earlier this year for the work (to read more about Baker, click here
“My work focuses solely on one aspect of the TeamSTEPPS™ training: communication,” Alonso explained. “This focuses on information exchange, known as information exchange coaching.”
Over the last 2 years, Alonso, along with his team of close to 60 people, including coaches, designers and implementers of the training, and others, have taught a staff of close to 500 in a large midwestern health system. The team helped the system design their communications intervention and is currently helping them evaluate it.
“One of the things we do is support the emergency department with improving information exchange between patients and healthcare providers,” Alonso said. “We have been working on building a model whereby nurses and doctors work together to glean more information and higher quality information from the patient.”
Alonso said poor communication can affect many aspects of patient care.
“If you are not getting the best quality information from your patients, you are not going to catch some errors,” Alonso explained. “For example, if a person is allergic to penicillin, and they are given a penicillin-based medicine down the road, that can cause other problems. So an initial lack of communication can lead to big problems. The idea here is collecting as much information as possible and ensuring that the information is quality.”
Alonso said his work focuses on communication during triage, the first point of contact between patients and medical staff.
“The quality of the information at that point can affect every treatment decision down the road,” he said.
Traditionally one nurse would work in triage, a second nurse would do an assessment of the patient, then later on when the patient was taken to a hospital room, the doctor would speak with the patient, Alonso explained.
“The issue is that the patient is being treated up until that point where both nurses and the doctor have all spoken with him or her, so things that shouldn’t happen have the potential to happen, such as medication errors,” he added. “With this new system we have a nurse at triage then a nurse and physician come in together to follow the initial nurse, so the patient has the opportunity to speak with them at the same time.”
Alonso said there are numerous benefits to allowing the patient to communicate with all three medical professionals at the beginning.
“Having two people in the room at the same time ensures the patient doesn’t have to repeat themselves,” he said. “You have two people in the same room so it also allows for less misunderstanding and helps reduce cultural barriers because there are two people to interpret what the patient says.”
Another benefit is that it can allow the patient to communicate more freely, he said.
“A patient who is embarrassed to say something to a nurse because it is a man rather than a woman or vice versa might prevent them from saying something important,” he said. “So if you have a group there together, the patient is more likely to share the information.”
Another benefit is that having two practitioners speak with the patient at once reduces the chances that misinterpreted information will be passed on.
“If a patient shares information with the nurse and the nurse assumes something about the communications and then passes it down to the doctor, that nurse has passed down an assumption, information that may not be a fact,” Alonso explained.
Using this model, however, a patient may have a nurse who assumed one thing and a doctor that heard something different, and they compare their reactions to get to the truth.
Alonso and his team are currently evaluating their system, which he says has been a success.
“It’s been quite effective,” he said. “Patient satisfaction scores are way up; the complaints are way down in terms of any kind of communication errors, whether it be culturally based and other communication, and folks are finding that the length of stay in hospitals is shorter.”
Alonso said the goal is to expand within the current healthcare system in which they began their practice and then take it elsewhere.
In addition to Alonso and Baker, SIOP member Cristina Banks was also recognized by APA this year for her research and practice on applying job analysis to develop scientifically sound methodology that companies could use to classify jobs as exempt or non-exempt.