Caring Communication is Key to High Reliability Health Care

I was talking with a change coach from a hospital system and she talked about her organization’s focus on becoming a High Reliability Organization.  She is spearheading a culture change strategy focused on communicating with caring.  And she wanted my thoughts on how a focus on caring communication connects with a High Reliability strategy.  First of all, this struck me as a very constructive question, because it reveals that she and her organization’s leaders are intent on integrating their different initiatives—connecting the dots, so that their focus is clear and all activities support their focus—which is high reliability.

High Reliability — Consistent performance in a complex, unpredictable environment at high levels of safety over long periods of time.

How does a focus on caring communication help?

1. Mindfulness on everyone’s part (collective mindfulness) is critical. Everyone needs to fully experience what’s happening and pay attention to what is and isn’t working. Everyone on the staff needs to tune in to patients, families and each other. Only by fully tuning in and not multi-tasking will people pick up cues and concerns.
2. Processes must be clear. To achieve high reliability, we need to specify how things should work, adhere to the designed process and thereby reduce variation and risk. The same is true for how people communicate. The standard communication process needs to include communication of caring, since caring communication impacts the quality of care. It also earns trust and encourages people to speak up about their concerns without fear of retribution and to partner with us to ensure the best, safest, most compassionate care.
3. Human factors affect safety, and caring communication affects human factors. Communication within and across our teams needs to be caring—exuding an atmosphere of harmony and respect, so that people feel energized, engaged and inclined to give their all. Communicating to create a “shared mental model” is important so that all members of the healthcare team understand what’s expected and can anticipate next steps.
4. Team members need clear expectations, standardized training and skill sets in common. To achieve consistent performance, we need to thoughtfully design and commit to adherence to defined processes. The message: This is how we do things here. We need explicit expectations about communicating with caring, not only explicit expectations about technical processes. Caring communication helps us clarify how we engage patients and how we work together as a team. Expectations about communicating this way should be standardized, not optional, and hardwired into job descriptions, performance review, and ongoing performance management. And the concept of zero-tolerance should apply when staff members don’t communicate with empathy and compassion.
5. High reliability organizations have high-trust cultures. When people communicate with empathy and caring, they earn trust; minimize defensiveness, and breed openness and candid conversation. High reliability organizations rely on people speaking up, feeling free to do so, without repercussions. In short, leaders hear concerns, problems, the reporting of errors as well-meaning expressions of people’s commitment to the organization and its patients.
6. High reliability organizations pride themselves on transparency and feedback. Everyone can see the data and talk about it—patient survey data, point-of-service feedback to physicians, infection rates, falls, pressure ulcers. This helps everyone take responsibility and engage in improvement.
7. Frontline people are the real experts with the power to make or break outcomes. Frontline employees are THERE in the midst of the action. They are at the “sharp end” and in close touch with what is. They have great ideas. They have active eyes and ears that inform high reliability.
8. Perseverance: Like other strategies and expectations, skills in communicating with caring need to be pursued, mastered and reinforced relentlessly to assure sustainability and consistency.

A focus on collective mindfulness, astute engagement, alertness in the moment and a commitment to leave no stone unturned ensure optimal quality and safety for patients, families and each other and are essential to achieving high reliability.

I welcome your comments and questions below.