Situation-Background-Assessment-Recommendation: A Practitioner's Communication Tool.
Nico Pronk, Ph.D., FACSM, FAWHP, is executive director of the Health Behavior Group and vice president of Health and Disease Management at HealthPartners health system, which provides health promotion, disease prevention, and disease management services for worksites and health plans around the country. Dr. Pronk has published extensively in the health-related scientific literature and is currently an associate editor for ACSM's Health & Fitness Journal® and an Editorial Board member of Center for Disease Control and Prevention's Preventing Chronic Disease e-journal. Among other public services activities, he currently serves on the Task Force on Community Preventive Services supported by Center for Disease Control and Prevention and the Interest Group on Worksite Health Promotion at ACSM. Dr. Pronk received Fellow status from ACSM and the former Association for Worksite Health Promotion.
Excellent communication among members of the worksite health promotion (WHP) team is an absolute necessity for a program to be implemented in an efficient, effective, and well-coordinated manner. However, communications are often at the center of many problems, misunderstandings, errors, misconceptions, incorrect assumptions, or failures of any sort. To be able to communicate effectively among team members, WHP practitioners would benefit from a formal process to do so. A formal process would include a defined, broadly understood, and consistently implemented method.
WHAT IS EFFECTIVE COMMUNICATION?
Keeping it simple, effective communication occurs when the person to whom you are communicating understands your message-it is particularly effective when this occurs in a two-way manner. It is not sufficient to explain a particular situation in a short, incomplete, and sketchy way and assume that the other person will understand the level of importance and urgency. This "hint" and "hope" approach does not generate good results. For example, a site coordinator may mention to the program manager, in passing that the online health risk appraisal (HRA) response rate seems to be stabilizing during the HRA rollout and that some people have called about problems logging into the Web site. However, this does not provide a clear picture of the situation when, in reality, the Web site is down, no employees can log in, and the problem might take two days to fix!
Effective communication requires some degree of structure, assertion that allows for a direct message to be sent, directness to get at the salient issues, and emotional safety to allow for communication without fear of retaliation. The results should include clear action or resolution of issues. Such an approach to communication will allow any member of the WHP team to use the communications method that is agreed upon and send a clear, complete, concise, and consistent message, while feeling safe in doing so and expecting a clear and timely response.
BARRIERS TO COMMUNICATION
It is not that people are purposely trying to withhold information by using poor methods of communication. Many barriers may contribute to the difficulties in communication among team members. Examples of communication barriers may include the following:
* no agreed-upon structure for communications
* uncertainty about initiation of communications
* uncertainty about when to initiate communications-"Is this message important enough?"
* hierarchy-related issues-"Should I wait to talk to my direct supervisor, or is it okay to go straight to the director?"
* sex-specific or cultural assumptions
* differences in communication styles among various team members
* fatigue or stress that lead to poor listening
Despite an understanding of potential barriers to communications, solutions to get around such barriers are paramount. One such solution is the Situation-Background-Assessment-Recommendation(SBAR) technique.
The SBAR technique provides a framework for communication between members of the WHP team. Situation-Background-Assessment-Recommendation is an easy-to-remember concrete mechanism useful for framing any conversation, especially critical ones, requiring a WHP team member's immediate attention and action. It allows for an easy and focused way to set expectations for what will be communicated and how it will be communicated among members of the team, which is essential for developing teamwork and fostering a culture of effective communications.
The SBAR technique was developed by Michael Leonard, M.D., and his colleagues at Kaiser Permanente of Colorado in an effort to improve patient safety through a method of collaborative communication (1). This SBAR technique allowed his team to be systematic in their approach and resolve poor communication, miscommunication, and/or lack of communication within the team and do so in a concise, straightforward, consistent, and complete manner. The nature of the tool ensures that all staff have a means to say what they think is happening and make a recommendation while providing sufficient contextual information to allow for others to understand their rationale and overall assessment of the situation.
The Figure presents the SBAR tool as a print-based form. This form can be used by any team member to report on a given circumstance that requires action. To avoid using the SBAR tool in a cumbersome way, limit yourself to a single page. This forces everyone to take some time to reflect on the situation, identify the important issues to be communicated, and propose or recommend next steps. To support the use of the tool, consider the following at each step (2):
S = Situation
* quick and to the point
* delivers the punch line
* provides context of the issue
* captures the attention
B = Background
* describes pertinent history
* describes how we got to this point
* draws a picture for the listener(s)
A = Assessment
* provides a point of view of what you think is happening
* describes your position based on the background provided
* provides clarity of the issue for the listener(s)
* lists key questions
* engages everyone
R = Recommendation
* what you want from others-what actions are you asking for?
* contains time frames and deadlines
* is specific and clear
SBAR-A FORMAL METHOD TO SUPPORT TEAM COMMUNICATIONS
Whereas SBAR was designed in a clinical care delivery setting, its applications may be easily adopted by WHP practitioners. At the end of the day, it is all about generating clarity of understanding about issues and interactions among team members and improving the overall outcomes of the work we all do together. Using the SBAR tool will provide a means for a team to ensure that all can speak freely, all are encouraged to accept others' ideas and concerns, and all recognize the value of others' ideas and thoughts, and the method allows for conflicts to be resolved and decisions to be made and supported based on input from all team members. If nothing else, SBAR will allow for a collaborative approach to communications and is a great example of a tool designed to bridge gaps in communications as well as bring team members closer together.