Academic journal article Creative Nursing

Interprofessional Communication and Teambuilding Using Applied Improvisational Exercises

Academic journal article Creative Nursing

Interprofessional Communication and Teambuilding Using Applied Improvisational Exercises

Article excerpt

According to The Joint Commission (TJC), the most frequently cited root cause of sentinel events is ineffective communication or miscommunication (TJC, 2002, 2012). The need to improve communication among health care professionals is a high priority because of the serious consequences of poor communication for everyone involved, on both personal and corporate levels. Applied improvisational exercises (AIEs) comprise a strategy for enhancing interprofessional communication (IPC). This article asks: What are the challenges inherent in IPC and teambuilding in the health care setting, and how can AIE help bridge the communication gap?

Keywords: miscommunication; sentinel event; interprofessional communication; applied improvisational exercises

Health care in the 21st century is quite different from 30 or 40 years ago; medi- cal, technological, and pharmaceutical advances have changed many areas of practice. Technology that allows patients to live with chronic diseases has the effect of increasing the average lifespan, but often necessitates provider treatment and escalates the cost of health care.

The National Practitioner Data Bank reported that annual medical malpractice payouts for communication breakdowns, including failing to share test results, more than quadrupled nationally between 1991 and 2010, to $91 million (Gale, Bissett-Siegel, Davidson, & Juran, 2011). According to the Institute of Medicine (IOM) and The Joint Commission (TJC), safety concerns around poor communica- tion and cooperation among clinicians is so great that the topic has been added to the National Patient Safety Goals since 2002 (IOM, 2001; TJC, 2002, 2013).


In fast-paced health care environments, the theory of complex adaptive systems (CAS) applies, as interprofessional teams comprising members who may have never met must quickly join to perform complex tasks. Studies in various high-risk envi- ronments demonstrate the applicability of Kahneman's concept of high communica- tion load (Kahneman, 1973) to various CASs, including health care. In Kahneman's work in aviation, high communication load is characterized by a combination of time pressure, workload stress, fatigue, distractions, interruptions, differences in training and professional experience, and social and cultural differences that af- fect one's ability to process information (Bruinsma, 2011; Loft, Sanderson, Neal, & Mooij, 2007). Any of these variables can lead to miscommunication.

In a review of theoretical research on human cognition, Bloom's revised Taxonomy of Learning Domains (Anderson & Krathwohl, 2001) asserted that the cognitive learning process is limited or enhanced depending on the pedagogy/ andragogy employed. Clinical research demonstrated that static lectures produce short-term learning outcomes, compared to higher knowledge acquisition and longer retention with an interactive learning model that uses visual, aural, and kinesthetic presentations (Anderson & Krathwohl, 2001).


Based on Kahneman's high communication load concept, the Crew Resource Management (CRM) model (Helmreich, Merritt, & Wilhelm, 1999; Loft et al., 2007) was adapted from aviation. CRM aims to mitigate, trap, and/or avoid error among teams and between individuals. In an exploration of the chronology of CRM, Helmreich et al. (1999) documented lessons learned, including the need for nonpunitive method for reporting near-misses, and focused reviews of sentinel events. These authors noted a similarity between pilots' and physicians' attitudes toward autonomy, and the resultant resistance to change as a particular impedi- ment to the inculcation of CRM outside the classroom.

Building on the CRM model, the literature identifies several health-care-specific interventions to improve communication, including team briefings (DeFontes & Surbida, 2004), situation/background/assessment/recommendation (SBAR; Marshall, Harrison, & Flanagan, 2009), surgical safety checklists (Haynes et al. …

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