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Beyond communication: The role of standardized protocols in a changing health care environment

Vardaman, James M.; Cornell, Paul; Gondo, Maria B.; Amis, John M.; Townsend-Gervis, Mary; Thetford, Carol

doi: 10.1097/HMR.0b013e31821fa503

Background: Communication errors have grave consequences in health care settings. The situation–background–assessment–recommendation (SBAR) protocol has been theorized to improve communication by creating a common language between nurses and physicians in acute care situations. This practice is gaining acceptance across the health care field. However, as yet, there has been little investigation of the ways in which SBAR may have an impact on how health care professionals operate beyond the creation of a common language.

Purpose: The purposes of the study were to explore the implementation of the SBAR protocol and investigate the potential impact of SBAR on the day-to-day experiences of nurses.

Methods: We performed a qualitative case study of 2 hospitals that were implementing the SBAR protocol. We collected data from 80 semistructured interviews with nurses, nurse manager, and physicians; observation of nursing and other hospital activities; and documents that pertained to the implementation of the SBAR protocol. Data were analyzed using a thematic approach.

Findings: Our analysis revealed 4 dimensions of impact that SBAR has beyond its use as a communication tool: schema formation, development of legitimacy, development of social capital, and reinforcement of dominant logics.

Practice Implications: The results indicate that SBAR may function as more than a tool to standardize communication among nurses and physicians. Rather, the findings indicate that SBAR may aid in schema development that allows rapid decision making by nurses, provide social capital and legitimacy for less-tenured nurses, and reinforce a move toward standardization in the nursing profession. Our findings further suggest that standardized protocols such as SBAR may be a cost-effective method for hospital managers and administrators to accelerate the socialization of nurses, particularly new hires.

James M. Vardaman, PhD, is Assistant Professor of Management, Mississippi State University, PO Box 9581, Mississippi State. E-mail:

Paul Cornell, PhD, is President, Healthcare Practice Transformation, Dallas, TX.

Maria B. Gondo, PhD, is Assistant Professor of Management, University of New Mexico, Albuquerque.

John M. Amis, PhD, is Associate Professor of Management, University of Memphis, TN.

Mary Townsend-Gervis, MSA, BSA, BSN, RN, is Chief Nursing Officer, Baptist Memorial Hospital, Southaven, MS.

Carol Thetford, BS, RN, is Chief Nursing Officer, Baptist Memorial Women’s Hospital, Memphis, TN.

No funding was received from the National Institutes of Health or any other funding source.

This research received approval from the institutional review boards at both the University of Memphis and Baptist Health Systems.

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

© 2012 Lippincott Williams & Wilkins, Inc.