Rafael Ortega 4
Hierarchical Communication in Health Care
Suggested Reading 1
Cloudberg A. Fateful Assumptions: The 1972 Chicago-O’Hare Runway Collision. Medium. https:// admiralcloudberg.medium.com/ fateful-assumptions-the-1972- chicago-ohare-runway-collision- 2d7032dde729. Published April 27, 2023. 2 Driskell JE. Crew Resource Management An Introductory Handbook. Published August 1, 1992. https://rosap.ntl.bts.gov/view/ dot/8636 3 El-Shafy IA, Delgado J, Akerman M, Bullaro F, Christopherson NAM, Prince JM. Closed-Loop Communication Improves Task Completion in Pediatric Trauma Resuscitation. J Surg Educ. 2018 Jan-Feb;75(1):58-64. doi: 10.1016/j. jsurg.2017.06.025. Epub 2017 Aug 2. PMID: 28780315. 4 Diaz MCG, Dawson K. Impact of Simulation-Based Closed-Loop Communication Training on Medical Errors in a Pediatric Emergency Department. Am J Med Qual. 2020 Dec;35(6):474-478. doi: 10.1177/1062860620912480. Epub 2020 Mar 23. PMID: 32204598. 5 Fang DZ, Patil T, Belitskaya-Levy I, Yeung M, Posley K, Allaudeen N. Use of a Hands Free, Instantaneous, Closed-Loop Communication Device Improves Perception of Communication and Workflow Integration in an Academic Teaching Hospital: A Pilot Study. J Med Syst. 2017 Nov 17;42(1):4. doi: 10.1007/s10916-017-0864-7. PMID: 29159555. 6 Quick Safety Issue 52: Advancing safety with closed-loop communication of test results. The Joint Commission. https://www. jointcommission.org/resources/ news-and-multimedia/newsletters/ newsletters/quick-safety/quick- safety-issue-52-advancing-safety- with-closed-loop-communication- of-test-results/#.ZGAb_0_MKHt
Learning Objectives 1. Synthesize the role of hierarchical communication in critical situations. 2. Understand how a clear chain of command improves patient safety. 3. Recognize the drawbacks of hierarchical communication, and work to mitigate the shortcomings associated with hierarchical communication.
Introduction In large hospitals, such as Boston Medical Center, hierarchical communication plays a critical role in ensuring efficient and consistent healthcare delivery. With a clear chain of command, authority rests with higher-ranking professionals, including physicians, nurse leaders, and administrators. This vertical communication structure helps streamline high-stakes communication to allow for the effective delegation of tasks and expectations. While the hierarchical structure provides a framework for effective communication, it is also important to create a culture that encourages open communication and input from all team members, fostering collaboration and innovation in patient care. Benefits of Hierarchical Communication One of the benefits of hierarchical communication is its potential to promote efficiency and consistency in healthcare settings. A clear chain of command and well-defined roles and responsibilities help streamline communication and decision-making processes, ensuring that tasks are delegated and executed efficiently. In critical situations, hierarchical communication is essential to facilitate rapid decision making and immediate action, as in emergency or trauma cases where concise communication is vital for patient survival. Extreme examples of this include
responding to mass casualty incidents (MCIs) in which a large volume of high acuity patients can present to hospital emergency departments. In a 2004 editorial in the journal Anesthesia & Analgesia examining the response effort to a terror event in an Israeli hospital, the authors examined how this chain of command helps to “control chaos”, with the senior triage surgeon, senior anesthesiologist, and senior orthopedic surgeon directing care and management of the most critical patients.
Establishing a clear chain of command can streamline communication, but it runs the risk of silencing the voices of individuals lower in the hierarchy. In patient safety, organized authority also plays a significant role in directing tasks and critical interventions to improve patient outcomes. Oftentimes, there are members of care teams from multiple specialties present during these situations in the clinical space, with differing levels of authority. Giving all team members the support of higher managers and
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HIERARCHICAL COMMUNICATION 33
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