Society is mandating that health care providers (HC) become more effective interpersonal and systems-based communicators. Ineffective communication is a root cause of iatrogenic complications and even death among the patients we are entrusted to serve.
Globally and in the United States, patients die because of medical errors. According to Samantha Collier, MD, MBA, former Vice President of Medical Affairs at HealthGrades, "The equivalent of 390 jumbo jets full of people are dying each year due to likely preventable, in hospital medical errors, making this one of the leading killers in the United States."
Lessons learned in the airline sector related to safety, sentinel events, near-misses, and root causes are applicable to HC. An epic example of human error, based on ineffective critical elements of professional communication, resulted in the worst disaster in aviation history. On March 21, 1977, 2 jumbo 747's slammed into one another on a foggy runway in the Los Rodeos Airport at Tenerife, one of the Spanish Canary Islands, killing 587 people. There were no survivors on KLM Royal Dutch Airlines Flight 4805 from Amsterdam. A total of 51 passengers and 7 of the 16- member flight crew on Pan Am flight 1736, originating in Los Angeles, survived. The antecedent for these huge planes assembling at the Los Rodeos Airport was an act of terrorism at Las Palmas Airport in nearby Gran Canaria. A militant separatist group set off a bomb at the Las Palmas Airport, closing that field and shunting the air traffic. Los Rodeos Airport had only a single runway and 1 parallel taxiway. The diverted airplanes were actually parked on the long taxiway, a condition implemented by the control tower to essentially create 2-way traffic on a unidirectional runway. Once the planes were given permission to prepare for takeoff, a chain of communication errors ensued. Captain van Zanten, the senior pilot of KLM flight 4805, was KLM's most experienced 747 pilot. Although English is now the official language of all pilots and air traffic controllers, that particular day experienced a confluence of languages, dialects, and a variety of mixed aviation taxonomies, impeding safety, and, to make matters worse, a thick, dense fog was rolling over the runway reducing visibility. Moreover, according to the "black box," van Zanten thought he had clearance for takeoff when he was actually told only to "prepare for takeoff." The first officer questioned the order for takeoff but was ostensibly too intimidated to correct his captain (information from flight recorder). The plane then hurled down the runway gaining momentum, speed, and lift, but slammed over the top of Pan Am flight 1736, also taxiing the runway for final takeoff.
This tragic aviation example teaches the HC industry about ways to save more lives. After the Tenerife disaster, the airline industry developed a model called "Crew Resource Management (CRM)," which medicine has adopted. "CRM is about how human factors affect critical decision making factors-the effects of fatigue, expected or predictable perceptual errors, as well as the impact of different management styles and organizational cultures in high-stress, high-risk environments. CRM training develops communication skills, fosters a more cohesive environment among team members, and creates an atmosphere in which junior personnel will feel free to speak up when they think something is about to go wrong."
As medical educators, we must teach our students effective transdisciplinary communication. In the old model, senior physicians created a powerful aura of omnipotence, and junior faculty, students, and nurses were fearful to question them, especially in the operating room. Yet today, disciplines in HC tend to communicate in their respective silos, and physicians tend to talk at ancillary HC professionals rather than talk with them about critical HC decisions. Given the multiculturalization of the United States, and the influx of international practitioners, minimal competencies in communication should be established. Recently, the Institute of Medicine has underscored the need for effective communication for the sake of patient safety with these prevailing reasons:
* An estimated one-third of adverse events are attributed to human error and system errors.
* Research conducted from 1995 to 2005 has demonstrated that ineffective team communication is the root cause for nearly 66% of all medical errors during that time.
* Furthermore, medical error vulnerability is increased when HC team members are under stress, are in high-task situations, and when they are not communicating clearly or effectively.
Richard "Sal" Salcido, MD
Selected References