Video Transcript: SBAR

Doug Bonacum, CPPS; Vice President, Quality, Patient Safety, and Resource Stewardship, Kaiser Permanente

So I was sitting in a perinatal patient safety training actually at one of our medical centers in 2002, listening to the doctors and nurses sort of talking at each other about how disappointed they were with each other on their communications. And the nurses would say, “You know, when I call the doctor in the middle of the night, I tell the doctor what’s wrong and I really think I’m making a strong recommendation but I don’t get the sort of response that I would hope for.” And our physicians were saying, “You know, when they call me in the middle of the night, they tend to ramble, it’s not very clear what their assessment is, I don’t know what they want most of the time, and most of the calls, quite frankly, are of no use.” And I recognized that the patient was at the middle of all this and it didn’t need to be that way and that a more structured communication might help both the receiver and the transmitter of that information.

So I reflected on how we would make similar conversations in the Navy. Now, of course, we weren’t helping moms give birth to babies, but we were doing important things across some hierarchical structures that existed within my submarine. And we used a technique that I later labeled as SBAR, which was just to describe the Situation we were seeing succinctly, give a little bit of a Background so the person hearing the information had the context to provide an Assessment ― because no matter where you were in the hierarchy in the Navy, your assessment of the situation was valued ― and most importantly to provide a Recommendation, which was very empowering for someone lower on the food chain, if you will, but gave the person higher up on the hierarchy the ability to say, “No, that’s not right” or “We’re going to make a change.”

And I don’t remember the exact moment that the S, the B, and the A, and the R came out, but it was as a result of those communications. And I didn’t really think it was going to go much further than perinatal patient safety and soon it was sort of everywhere. And now we’re using it to write emails to each other and people are using it during handoffs in transitions in care, so it really has caught on.