Situational Awareness in Effective Clinical Communication

January, 2018

Situational awareness is one of the seven elements of effective clinical communication explored in a recent report from the Experience Innovation Network, part of Vocera. The report is called Clinical Communication Deconstructed: A framework for successful, human-centered clinical communication.

“I was diagnosed with late-stage colon cancer shortly after my second son was born. My treatment was incredibly intense – chemo, radiation, surgery, more chemo, more surgery. At times, it felt like needing to psych myself up to put my hand into a moving blender.”

This is the beginning of a story Julie Wheelan, MBA, shared as part of our recent Clinical Communication Deconstructed report. She is a cancer survivor and CEO/Founder of Navius, a company focused on connecting patients facing a life-changing health condition with personalized integrative medicine and supportive services. Her story illustrates the importance of situational awareness from the perspective of a patient. It continues:

“I’m grateful for the medical care I received, but I needed so much more to actually survive. I couldn’t have gotten through the treatment my doctors prescribed had I not cobbled together other healing services, such as nutrition and exercise support, acupuncture, herbs and supplements, and therapeutic massage. Guided imagery is what kept me sane throughout my whole journey.

Three months into treatment, I had surgery to determine whether I was stage 3 or stage 4. The uncertainty surrounding that surgery was overwhelming, but through guided imagery, I envisioned the outcome I wanted and wrote it down on paper. I gave that written description to my husband and told him, ‘You need to post this on my blog while I’m in surgery.’ It’s what I wanted my outcome to be and it’s exactly what happened.

After I was through treatment, I realized how crazy it was that I had to piece together my healing support by myself. And I knew that every cancer patient diagnosed after me would be forced to the do the same thing, but perhaps with less time, connections, and resources than I had. So I approached my oncologist and the hospital COO and, together, we created a truly integrated center for integrative health and wellness for my community. We offered both inpatient and outpatient programs and services that were developed in response to what patients said they really needed and these offerings were woven into the patient’s clinical care plan. There is an enormous difference between curing and healing. I am grateful that doctors are so focused on curing, but in order to survive, patients also need to heal.

Innovation in healthcare is not easy. I met many pockets of resistance as I built the Center. In one meeting, the hospital’s physicist told me I was ‘sullying the scientific reputation of the cancer program.’ My response was: ‘With all due respect, I could not have survived the treatment this cancer center put me through without guided imagery, without running, without nutritional and emotional support. I am not a robot.’

The journey to the cure is as important as the cure, but each person is unique and each path to healing is as well. And so we must meet people where they are today and also understand where they want to be. Only once our healthcare system acknowledges this and begins to deliver truly personalized, whole-person care, can we call ourselves ‘patient-centric.’”

Situational Awareness Requires Situational Context

Situational awareness is thoughtful consideration people give to factors about a situation or task that dictate what information they and others need, when they need it, and how to prioritize competing demands.

Julie Wheelan needed her care team to understand and recognize her whole-person needs along her path to healing – she needed her team to be more situationally aware. When they weren’t, she created an integrated healing support system for herself and now also for many others. Her story underscores how important it is for caregivers to listen more deeply in order to hear more and to better understand what their patients need not just as patients, but as whole people.

Clinical communication takes place in the context of a specific patient journey, as well as in the context of a specific task to be completed or human interaction. It also takes place in the context of multiple competing priorities, overlapping responsibilities, and potentially interruptive experiences.

Situational context influences communication timing, urgency, and tone, and other key elements of its success. Understanding the factors that inform clinical communication provides context for understanding where, how, and why to deliver certain communication at certain times so that people can absorb, process, and act on the communication to achieve the best outcomes.

Case Study: Caring Conversations for Difficult Diagnoses

In the report, Dr. Chris DeRienzo, system chief quality officer and a neonatologist at Mission Health, shared how as a caregiver he learned to create the emotional space in which a patient and family can both receive life-changing news and feel comfortable and supported in expressing their needs.

Like many of his peers across specialties, Dr. DeRienzo has had to deliver his share of emotionally-charged news to his patients’ families. It’s never easy. Early in his medical training, Dr. DeRienzo received guidance and opportunities to practice delivering hard news with as much compassion and empathy as possible, despite his own discomfort. “We first learned the basics of structuring a difficult yet compassionate conversation. Then we actually practiced and our practice sessions were recorded. It was awful watching myself but it was invaluable to improving as a communicator because seeing my posture and my own non-verbal cues and hearing my own voice dramatically increased the velocity of change.”

The basics Dr. DeRienzo learned included beginning with a “warning shot,” pausing long enough so families could absorb the emotional impact of the difficult news, and offering the first steps in a path forward. “By the fifth time we went through the practice sessions, pausing for seven seconds of silence didn’t seem so awkward.”

Dr. DeRienzo recounted the first time he had to put those skills into practice, telling young parents in the emergency department that their child had cancer. “I will forever remember that day, the room we were in, the clothes they were wearing, even the pictures on the wall. When I close my eyes I can still see their eyes when my words turned their whole world sideways, and I recall how hard it was guiding them back. But I learned two fundamental truths about that moment – first, that the orbit of their lives would never be the same; and second, that it was my job to make sure they didn’t wander through space alone. I was so glad I had practiced.”

Learn More

The Clinical Communication Deconstructed report’s situational awareness chapter showcases a variety of perspectives and insights from healthcare leaders. At the end of the chapter you’ll find questions designed to help you reflect on your system’s strengths and opportunities for improvement with regard to situational awareness.

I invite you to download the report today to learn more about situational awareness and the other elements of effective clinical communication.

You can also listen to Dr. DeRienzo discussing his framework for communicating with patients and training his peers to communicate clearly and with empathy through the most difficult circumstances in a recent webinar from the Experience Innovation Network. The webinar is called Communication and Conflict. View the webinar.