WIHI: SBAR: Structured Communication and Psychological Safety in Health Care

Date: January 30, 2014


  • Michael Leonard, MD, Safe & Reliable Healthcare LLC; Adjunct Professor of Medicine, Duke University School of Medicine
  • Audrey Lyndon, PhD, RNC, CNS-BC, FAAN, Associate Professor, UCSF School of Nursing
  • Jill Morgan, BSN, MBA, NE-BC,Nurse Manager, ICU, UnityPoint Health – St. Luke’s Hospital
  • Ansley Stone, OB Quality Coordinator, Carolinas HealthCare System

A few key concepts are ubiquitous in the world of health care improvement, and one of them is most definitely SBAR, an acronym for Situation-Background-Assessment-Recommendation. We have the Navy to thank and Kaiser Permanente’s Doug Bonacum and Suzanne Graham, along with Dr. Michael Leonard, for migrating this structured communication framework into the world of health care more than a decade ago. At its core, SBAR is a way for health professionals to effectively and succinctly convey critical information to one another to protect patient safety. Over time, SBAR has proven useful in a myriad of other ways as well. Still, how might we evaluate the utility of SBAR to advance today’s quality improvement and patient safety challenges? Has its singular power to “cut to the chase”  eroded over time? These questions and more are discussed on this WIHI.

The good news about SBAR is that it’s become part of broader ambitions around safety and reliability in many organizations. But, as we’ll learn from Michael Leonard and Audrey Lyndon, folding SBAR into a larger agenda can mask weaknesses that have crept in with the tool itself. For instance, nurses may have an easier time speaking “up the medical chain of command” using SBAR, but Lyndon says many still struggle with making clear recommendations… the R part. And it’s not always clear if those on the receiving end of structured communication listen effectively. Lyndon suggests there may be a need for a corollary tool to confirm “message received.”

Jill Morgan and Ansley Stone are nursing and quality leaders who can’t imagine health care today without SBAR. They point to the critical role that SBAR plays in ensuring safe care for pregnant women undergoing labor and delivery, and in drawing attention to any patient or staff situation that requires immediate attention and decision making. What’s your experience with SBAR? How might it be strengthened for safety work over the next ten years? How can SBAR become a solid communication tool for improved handoffs or enhance newer processes, such as daily safety huddles, to achieve what Michael Leonard calls “psychological safety” among all staff? Listen to the rich discussion with WIHI Host Madge Kaplan and guests.



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