Intended for healthcare professionals

Editor's Choice

Good communication is key to good care

BMJ 2018; 361 doi: (Published 19 April 2018) Cite this as: BMJ 2018;361:k1704

Communicating effectively by lamenting the issues correctly

Dear Editors

I am responding to Dr Yeung's rapid response in which he comments, "articles lament the lack of direct verbal communication between colleagues in the NHS nowadays"

The response also 'laments' about being "often interrupted when attempting proper SBAR (situation, background, assessment, recommendation) handover"

The simple reason to this observation is also actually given in his same response, that "the referrers give too much irrelevant information during busy handover" although I am unsure if the author is conscious about this.

While there is no real time limit on the concept of SBAR, we must remember the presentation of SBAR is the referrer talking about a case without even the listener asking the questions and formulating a management plan as yet.

Practically, even for a complex case, if the referrer cannot communicate SBAR effectively to give a sense of where this handover is going within 1-2 minutes, then there is a problem in communication.

Often this is a result of lack of preparation for the task by the referrer and shows little consideration/respect for the listener who has many other priorities to consider; this kind of attitude (reflected by referrers) is a phenomenon particularly common even in handover between doctors of similar grades.

People claiming to be using the SBAR technique must understand that writing it down on paper (as described in the original technique) help prioritise the order of information and organise what is important and what is ancillary.

If a referrer just take 2 minutes to do the SBAR communication, and the listener takes 3 minutes to ask questions and give instructions/advice, how many cases can you handover within 30 minutes in a busy clinical unit?

Hence we should aim for communication to be far more effective and succinct if we are truly using SBAR technique properly as intended. SBAR is actually designed to be used by all grades and type of health care professionals and hence intended to be simple, and yet is often poorly executed by all.

And before someone wants to get side-tracked by calling this "victim-blaming", I shall pre-emptive this line of argument by asking this:

"Who is the victim here?

The referrer who did not do SBAR properly as taught

The listener who by receiving the poorly-performed SBAR, now has to bear the burden of the responsibility of the care of the patient from here-on

The patient who has complex problems, but probably really only has 1-2 urgent issues to address right now, but this may not be even identified properly by the referrer."

Hint: There may be more than one victim, but only one person is doing the SBAR.

Competing interests: No competing interests

25 April 2018
Shyan Goh
Orthopaedic Surgeon
Sydney, Australia