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What is the medical staff's role in hospital patient safety training?

Patient Safety Quality Monthly, August 23, 2007

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As more hospitals train their staff members in specific safety tools and behaviors, the question usually raised is, "What is the role of the medical staff?" Hospitals often struggle with getting physician buy-in for patient safety processes, and it can be difficult to convince physicians to spend time undergoing training.

Using situation background assessment recommendation (SBAR) to communicate more efficiently is a good example of a technique hospitals may train nurses in - but not physicians. Hospitals may reason that, since it's nurses who actually use SBAR, why bother to train physicians?

However, I would argue that even if physicians are not responsible for originating a safety behavior, their responses to it  may promote or diminish those behaviors in staff members. To create a hospital culture of safety, physicians need to be engaged at some level.

For example, consider  how physicians can affect the use of SBAR. When a nurse calls a physician at night with a clinical issue, how might the physician respond? If the physician is aware that SBAR is being used and thanks the nurse for using it, the behavior is reinforced, and the nurse is more likely to use SBAR in the future. Or, if the nurse begins to present the information without using SBAR, the physician could politely stop the presentation and ask, "Would you mind using SBAR for that?" Even better, if the nurse is unsure, the physician could become a coach by saying, "Let's use SBAR: What is the situation?"

On the other hand, the physician could just as easily be a negative influence. If a SBAR presentation is interrupted by a gruff, "Don't bother with that, just tell me this," the nurse will be less inclined to use SBAR the next time. Or if the nurse doesn't use SBAR and the physician doesn't notice it, this sends a message that the tool is not really required.

So, what is the physician's role? I call it the three "Rs": Recognize, Respond, and Reinforce. Here's how the three Rs work:

 Recognize: Be aware of the safety tools that staff members have  learned and the likely situations for use with physicians
 Respond: Give an appropriate response to information presented or requested
 Reinforce: Provide positive reinforcement when staff members use safety tools correctly and coaching when they don't

Although training physicians in safety tools is ideal, it is difficult to do. A good first step is making them aware of the tools staff members have learned and how to perform the three Rs.

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