How Communication Breakdowns Lead to Safety Failures | Vistelar

Poor communication doesn't just cause confusion—it creates risk. In healthcare settings, communication breakdowns contribute to approximately 70% of sentinel events, according to The Joint Commission. Yet despite this clear connection, many organizations still treat communication and safety as separate domains, addressing them through different training programs and departmental responsibilities.

As we observe National Safety Month this June, it's time to recognize and strengthen the critical link between structured communication and safety outcomes. When we improve how we communicate, we directly enhance the safety of our patients, our colleagues, and ourselves.

Communication as a Safety Tool

Communication serves as more than a means to exchange information—it's a powerful safety tool that can prevent incidents, reduce errors, and protect both patients and staff. Consider these scenarios:

• An emergency department nurse uses a structured communication technique to de-escalate a frustrated family member, preventing a potentially violent confrontation
• A physician employs clear handoff protocols when transferring care, ensuring critical patient information isn't lost
• A security officer uses non-escalation techniques when approaching an agitated visitor, maintaining everyone's safety

In each case, structured verbal interactions serve as preventive measures against potential harm. Just as we provide staff with personal protective equipment to guard against physical hazards, we must equip them with communication protocols that protect against verbal and interpersonal risks.

The High Cost of Communication Failures

When communication breaks down, the consequences can be severe:

In Patient Care:

• Medication errors due to unclear instructions
• Missed critical information during shift changes
• Delayed responses to deteriorating conditions
• Procedural mistakes from ambiguous directions

In Staff Safety:

• Escalation of potentially violent situations
• Increased workplace stress and burnout
• Strained professional relationships
• Higher turnover and absenteeism

In Organizational Performance:

• Reduced patient satisfaction
• Increased liability exposure
• Inefficient resource utilization
• Damaged reputation and trust

Building Structured Verbal Interactions

At Vistelar, we've developed and refined communication frameworks that enhance safety across various high-stakes environments. These structured verbal interactions provide predictable, effective ways to handle challenging situations. Key elements include:

1. The Universal Greeting

Beginning interactions with a consistent greeting framework establishes professionalism and sets a positive tone. The Universal Greeting includes:

• A proper greeting
• An introduction with name and role
• Statement of purpose
• Relevant question that gives the other person a voice

Example: “Hello, my name is Melissa and I’m an RN from oncology. I’m here to take your vitals and otherwise help you get ready for your treatment. Do you have any questions before we start?” 

This simple structure reduces uncertainty, demonstrates respect, and reduces suspicion, thereby creating psychologically safe interactions from the first moment of contact.

2. Beyond Active Listening

Active listening has long been recognized as important, but in high-stress situations, basic listening techniques often fall short. Enhanced listening approaches include:

• Clarifying to ensure understanding
• Paraphrasing to demonstrate comprehension
• Reflecting feelings to acknowledge emotions
• Advocating to ensure good intentions 

Summarizing to ensure understanding and agreement These techniques do more than gather information—they demonstrate respect and reduce the likelihood of conflict escalation.

3. Redirections

When conversations begin to derail, structured redirection techniques help maintain focus and prevent escalation:

• Acknowledging concerns without reinforcing or dismissing them, before redirecting
• Using "however” and “and” statements to pivot conversations
• Offering explanations that build understanding
• Modeling appropriate tone and body language

4. The Persuasion Sequence

When seeking cooperation, a structured approach maximizes effectiveness:

• Asking, instead of “telling” by making clear, specific requests
• Explaining why cooperation matters for them
• Presenting options positively and clearly
• Giving opportunities to reconsider

Implementing Communication as Safety Infrastructure

To truly integrate communication into your safety culture, consider these implementation strategies:

1. Train communication skills as safety skills

Include structured verbal interaction training alongside other safety training. Practice scenarios should incorporate both physical safety procedures and communication protocols.

2. Create communication standards for high-risk interactions

Develop specific verbal protocols for situations with heightened safety concerns, such as:

• Delivering bad news to patients/families
• Addressing non-compliance with safety procedures
• Responding to escalating behaviors
• Intervening when witnessing unsafe practices

3. Incorporate communication metrics into safety audits

When evaluating safety performance, include measures of communication effectiveness:

• Adherence to communication protocols
• Quality of handoffs and information transfers
• Staff confidence in handling difficult conversations
• Frequency of communication-related incident reports

4. Provide communication tools and reference materials

Just as we post reminders about hand hygiene and fall prevention, provide visual cues for effective communication:

• Pocket cards with key phrases and techniques
• Posters outlining communication frameworks
• Checklists for critical conversations
• Decision trees for responding to escalating situations

Closing the Gap

The divide between communication training and safety training represents a significant missed opportunity in most organizations. By explicitly connecting these domains, we create a more comprehensive approach to preventing harm and promoting well-being.

This National Safety Month, consider how your organization might strengthen the link between communication and safety. Investing in structured verbal interactions isn't just about improving information exchange—it's about creating fundamental safety infrastructure that protects everyone involved in care delivery.