Hospital Development

SBAR (Situation – Background – Assessment – Recommendation), is a model of communication commonly used in healthcare today. SBAR was originally developed by the U.S. Navy as a communication technique that could be used on nuclear submarines. In the late 1990s, Safer Healthcare, an organization that focuses on the delivery of specialized products and services supporting the development and sustainability of high reliability organizations (HRO) within the healthcare industry, helped bring this communication model into the healthcare setting. Since that time, SBAR has been adopted by hospitals and care facilities around the world as a simple yet effective way to standardize communication between care givers.

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To bring context to SBAR, users should consider the following framework:

Situation                         Take 5-10 Seconds to Explain

Background                    Provide Context and Data

Assessment                    Describe the Specific Problem/Situation

Recommendation           Explain What You Want to Do About it and When

If you’re asking yourself, “Why SBAR?” I offer the following:

  1. It’s the Joint Commission’s stated industry best practice for standardized communication (primarily spoken) in healthcare for effortlessly structuring critical information;
  1. It promotes quality, patient safety and high reliability because it helps individuals communicate with each other with a shared set of expectations;
  1. Staff and physicians use SBAR to share patient information in a clear, complete, concise and structured format, improving communication efficiency and accuracy.

How Does SBAR Translate to Organ Procurement Organization (OPO) Professionals?

It can be used in a “Team Huddle” scenario (spoken by the OPO Transplant Coordinator).

Situation “The patient has satisfied death by neurologic criteria and has been pronounced dead by Dr. Smith. The patient is medically suitable to donate organs and tissues.”
Background “This patient was a victim of an MVC. Upon meeting clinical triggers, Sue, the bedside RN, referred this patient as a potential donor. The family has now gathered at the bedside to say their good-byes.”
Assessment “Since it appears that the family understands their loved one has died, we now need to formulate a plan for providing the family with their donation opportunity.”
Recommendation “I suggest that we determine which member of the care team has established a trusting relationship with the family and encourage him or her to introduce me and remain present to support the family during the donation conversation. How does this sound?”

It can be used in a Physician Meeting (spoken by the OPO Hospital Development Coordinator).

Situation “We were called to evaluate one of your patients last week as a potential organ donor. The patient’s heart, lungs, liver and kidneys were all successfully transplanted.  I wanted to thank you for all that you did to help make this happen.”
Background “It sounds like the family initially really struggled to understand that their loved one had died. Two of your residents spent an extensive amount of time with them.”
Assessment “After talking with your residents about their experience, I think that they are uncomfortable talking to families about death by neurologic criteria.”
Recommendation “I’d like to provide all of your residents with training on how to explain death by neurologic criteria to families. We can customize it to meet whatever time constraints may exist. What do you think?”

When the organ donation process goes well, it is usually due to collaboration and communication. Similarly, when it doesn’t go well, it’s largely due to breakdowns in these two areas. In hospitals and critical care areas in particular, optimizing our communication is essential. Getting and keeping members of the care team engaged also requires us to evaluate how we are communicating.

If they appear to have time for a more lengthy conversation then, by all means, take full advantage of that and enjoy the interaction! If they’re not, SBAR is probably the way to go. I strongly recommend that you incorporate this communication model into your approach just once and see how it works.

For additional SBAR information and resources, please visit:

http://www.ihi.org/resources/Pages/Tools/sbartoolkit.aspx

Gweneth D. O’Shaughnessy is Vice President, Hospital Services at Gift of Life Donor Program in Philadelphia, PA

As with most things related to relationship building, listening is key. When attempting to engage a physician, you’ll need to listen carefully to his or her language and learn to convey your donation information with that language in mind. In other words, speak the physician’s language.

Taking it to the next level, you’ll also need to discern the implications behind the physician’s language. What priorities does the physician’s language convey? It’s a fairly safe bet that those priorities include patient outcomes, family care, and process efficiencies.

It’s also important to consider any barriers to language that may result from your personal communication habits or OPO jargon. Specifically, what do you say and what does your hospital partner hear?

For example, you’ve probably used the term “early referral” when discussing donation. However, the physician could easily hear this as “too early.” Additionally, the physician could begin to use this terminology with colleagues who are less informed about donation. Instead, use the term “timely referral.”

Understand Their Perspective

It’s imperative when engaging physicians to put yourself in their shoes. Consider the following OPO terms and what they mean to us.

Now, consider what each means to the physician. His or her perspective of terms may carry very different, and often sensitive, meanings.

OPO Term                                          What it May Mean to Physician 

Organ referral Failure and loss
On-site; early linkage Family betrayal
Optimize organ function Caring for a patient with no hope of recovery
Brain death pronouncement Time, resources; futile care
Collaborative request Loss of control
Compliance Dictated practice

Use your knowledge of the physician’s language and potential perspectives on donation terminology to understand where the physician is coming from. Then use the understanding of those perspectives to align goals or to be on the same page.

Remember, the most likely common ground that exists between you and the physician is the patient. Expand that probable common ground to include the patient’s family and efficiencies and you have a strong foundation for conversation. Donation best practice and policy implementation should center around the benefits of your partnership to this common ground.

Be Transparent

As an OPO professional, it’s your role to serve both the potential donor patient and the potential transplant recipient. This role as dual advocate is an undeniably important one and bears acknowledgement. Transparency in that role is necessary to achieve credibility as a partner and to ensure the best hospital development outcomes. From that foundation—and using language focused on common ground—it’s appropriate to discuss areas that may otherwise be sensitive ones for physicians.

One such area—critical to both maximizing and optimizing donation opportunities—is end-of-life clinical management. How a patient is managed clinically at end-of-life has profound implications on whether—and to what extent—donation is possible. While this area is exhaustive unto itself, it’s a great example of one that can benefit significantly from transparency in your role as dual advocate. The physician may perceive the OPO as “only out to get the organs.” He or she may feel you are asking physicians to perform inappropriate clinical interventions, draw resources away from other patients, or to go against the wishes of a patient or family.

Even though you may feel you are pushing very hard when meeting with a physician, it’s okay that you’re advocating for both potential donors and recipients. These people count on you to do so. But it is also okay that the physician has discomfort or differing opinions. His or her concerns are as real to the physician as your motivation for addressing the topic is to you. Neither should be disregarded.

Examine your use of language, try to speak the physician’s language, and acknowledge your different perspectives. Then use your common ground—usually the patient—to openly discuss your hospital development initiatives with transparency. In the end, this will often equate to full engagement of the physician as a partner.

Elizabeth Spencer has been working in the OPO community since 2002. She was with Washington Regional Transplant Community (WRTC) for nine years, serving as both Director of Hospital Services & Professional Education, and in the clinical division as a Senior Clinical Recovery Coordinator. As Director of Hospital Services & Professional Education, Elizabeth was responsible for oversight of partnerships with area hospitals regarding the implementation of donation best practices, donation educational programs for various hospital staff, hospital data analysis and reporting, hospital donation strategic planning, and hospital policies related to organ and tissue donation.

Many years working on the front lines of family care have enabled me to recognize the importance of the collaborative approach to comprehensive end-of-life care, which, in many cases, includes donation. Because the ultimate goal is a supportive environment when making end-of-life decisions, a shared commitment works best for all stake holders involved in the care of patients and their grieving families.

As a former Manager of Family Services, I’ve heard many OPO colleagues discuss the challenges often encountered during donation cases. Many hospital partners also shared with me the challenges they were presented with during a potential donor case. After comparing the two group’s perceptions, it became evident that there was ample opportunity for stronger and clearer collaboration between both sides, and that the challenges both groups expressed were most often the result of communications breakdowns.

huddle

A good starting point for consistent collaboration should be an effective huddle between the OPO and hospital team as soon as the patient meets clinical triggers, repeated as often as needed to assure that all parties are on the same page. The huddle should be comprised of those involved in the care of the patient, including the physician, nurse, chaplain, social worker and members of the palliative care team. Showing discipline to this best practice can provide our hospital partners with a clearer picture of our activities and limit confusion on potential donor cases which leads to optimal care for the family.

By removing the old mindset of working in silos, we can foster stronger relationships that will benefit everyone. We will also create an environment that will allow us to make full use of our hospital partner’s expertise while building trust so they will do the same in return.                        

Stacey Photo

Stacey Caruthers has spent the last 20+ years of her professional career helping to advance organ and tissue donation. She was most recently with Indiana Donor Network (formerly Indiana Organ Procurement), serving as both Manager of Family Services and as a Family Services Coordinator.

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