Jump-start SBAR:
With the Secret Ingredient!
by Beth Boynton, RN, MS*
In healthcare circles we've been hearing more and more
about the connection between communication and medical
errors. The Joint Commission, (TJC) investigates sentinel
events. These occurrences include unexpected death,
serious injury or process variations which could lead to
same. Typically they are of such a serious nature that they
must be addressed immediately. Statistics from these
investigations have repeatedly shown that the leading root
cause of sentinel events, is communication failure!
Further, communication issues have been implicated in almost 100% of medication errors
and a recent Institute of Medicine report stated that the cost of medication errors every year
is 3.5 billion dollars!
SBAR (Situation, Background, Assessment and Recommendation) is a model that is making
its way into facilities as a result of TJC's requirement for structured communication. It has its
origins in the military and attempts to standardize and clarify communication efforts when
critical information is being transmitted.
SBAR is a great start, but missing a critical component which nurses have a huge
potential to illuminate.
SBAR focuses on how and what information is transferred. This means it addresses 2 out
of 3 integral aspects of communication, the message and the sender. What it fails to do is
provide a format for the LISTENING component of transmitting critical information.
Here is a vital question that nurses at all levels can ask: What do I/we need in order to feel
supported and therefore optimize my/our effectiveness in communicating critical information?
Asking this question is a way for nurses to reflect on what kind of support we need in order
to optimize our role in relaying crucial messages.
GRRRR, (greeting, respectful listening, review, recommend or request more info, reward) is
a model I created which will help illustrate my point. I encourage you to use it and modify in
a way that reflects your needs and those of your workplace.
GRRRR for Great Communication
Greeting: Recipients can set the tone for a professional dialogue with a kind ‘Hello’ and
use of the caller’s name. “Hi Beth, this is Nursing Supervisor Jones or Dr. Smith, how can I
help?” This is a simple, quick and respectful way to begin a stressful conversation.
Respectful listening: Allowing clinicians to finish sentences without interruptions,
occasional acknowledgments such as, “O.K.’ or ‘Hmmmm.” A brief pause between pieces of
information can decrease anxiety and allow the reporting professional an opportunity to
think and transmit critical information. If in person, eye contact and nodding with receptive
body language can promote a calm rapport even in the middle of an emergency. When a
supervisor or physician is receiving a hand-off from a clinician with lesser power, it may be
helpful to realize that there may be some anxiety about bringing a concern up the ladder.
Yet, this is exactly what clinicians are supposed to do.
Review: A quick summary of the information can clarify the reporter’s concerns and allow
for additional thoughts without being intimidating or humiliating. In addition to getting the
message straight, there is enormous value in validating. A few seconds here can lead to
clinicians feeling heard, respected and ultimately understood. This can be a challenging
process, as it requires listeners to separate their perspective and response from receiving
the clinician’s report. The ability to do this effectively can be influenced by an array of
variables such as time, stress, tradition, skill, training, mood and even the weather! Doesn’t
it seem prudent to establish an organizational norm rather than try to work around all of
these variables?
Recommend or Request more info: At this stage in the communication the responder
has enough information to either initiate an order or gather more information. This may
involve agreeing or disagreeing with the clinician’s recommendation, but a team approach to
the communication process is still important. Listeners should avoid put-downs. “A chest
tube is a reasonable suggestion and the objective information you’ve provided is great. This
patient has some CHF too and that could be part of the problem. Let’s do a CXR and
ABGs stat. Take a minute and get those tests ordered, then let’s review her med list."
Leaders, at all levels, have opportunities here to teach and build relationships when
presenting this aspect of the GRRRR model. As they do this, they can help communication
recipients learn to steer away from difficult dynamics and shift towards collaboration.
Reward: “Thank you for your attention to this patient’s needs", "I appreciate your call” or
"call me if problems persist", can help the reporter, feel like a respected team player. Inviting
further discussion, if needed, is an empowering communication strategy. It reduces any
reluctance to call in the future and contributes to a collaborative problem-solving
environment.
Effective listening is sometimes simple, and sometimes complex—but always
essential.
Let me know if this article has been helpful or how you might add to this advice.
bbbboynton@verizon.net
*The author wishes to thank William Owens, PhD., for his contributions in developing and
editing this work.
**As I am writing this article, current stats are being updated. When released, you will find
them posted along with related information on their website: http://www.jointcommission.
org/SentinelEvents/Statistics/ .\
© Beth Boynton, RN, MS