Running head: PROTOCOL DEVELOPMENT FOR COMMUNICATION ENHANCEMENT AMONG

HEALTHCARE PRACTIONERS WORKING IN INPATIENT DEPARTMENT AT GENERAL HOSPITALS

Running head: PROTOCOL DEVELOPMENT FOR COMMUNICATION ENHANCEMENT AMONG
HEALTHCARE PRACTIONERS WORKING IN INPATIENT DEPARTMENT AT GENERAL
HOSPITALS
Developing protocol

In order to develop the protocol, National Institute for Clinical Excellence (NICE, 2002)

steps has been used as a guidance:

Step one: Selecting the protocol topic

The topic to be covered by the protocol was selected through; reviewing of the WHO

Strategic Communications Framework for Effective Communications and SCFHS

Communication Skills: Key to Understanding book that provides detailed guidance, based on

research evidence about the processes of communication among healthcare professionals to be

in place to deliver and achieve best practice.

Step two: Set up a team

A multidisciplinary team made up of clinical and non-clinical staff who are responsible

for the delivery of care is essential to the successful development and use of protocols. Several

experts in communication in healthcare including nurses and physicians should be included and

be part of the team to review the developed protocol. Unfortunately, the actual team members

involved in the protocol development have consisted only of two medical-surgical nurses and

one pediatric nurse.

Step three: Involve users in protocol development

The involvement of healthcare professionals who deliver direct care is an essential part

of the process of developing the protocol. feedback analysis should be assessed, valued, and

incorporated both positive and negative in the developed protocol.

Step four: Agree to objectives

The overall aim of this protocol is to enhance communication among healthcare

professionals working in Inpatient and Emergency Departments at general hospitals.

Specific objectives of the developed protocol:

a. To provide a detailed guide for healthcare professionals about better communication practices

in inpatient and emergency departments

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PROTOCOL DEVELOPMENT FOR COMMUNICATION ENHANCEMENT AMONG
HEALTHCARE PRACTIONERS WORKING IN INPATIENT DEPARTMENT AT GENERAL
HOSPITALS

b. Conduct frequent assessment and provide the knowledge and skills needed by healthcare

professionals to perform effective communication

c. Understand different roles, cultures, and linguistic barriers and enhance communication skills

among staff by conducting training.

Step five: Build awareness and commitment

A brief description of the benefits and aim of the developed protocol was done for the

management of the hospital to gain their commitment and to raise awareness of the benefits of

protocol-based care. In addition to using (NICE) guidance requirements as the basis for protocol

development.

Step six: Gathering information

Information was obtained from the following sources to evaluate performance.

- Search of the relevant studies on local, regional, and global references including; global

electronic websites; include PUBMED, EMBASE, and Cochrane, between 2000 to 2021. The

search was conducted in April 2021 to build evidence-based required to achieve good

communication practice, review several improvement projects locally and globally, and

guidelines and policies on professional communication among healthcare employees.

- Review of the national standard of CBAHI "Saudi Central Board for Accreditation of

Healthcare Institutions" which provides a framework for the organizational structure and

management.

- Assessment of the current healthcare professionals` communication practice during providing

care at Inpatient and Emergency departments.

Step seven: baseline assessment

Based on the analysis of the current communication practices of a healthcare

professional, the required interventions were developed.

Step eight: produce the protocol

The development team performed the following:

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PROTOCOL DEVELOPMENT FOR COMMUNICATION ENHANCEMENT AMONG
HEALTHCARE PRACTIONERS WORKING IN INPATIENT DEPARTMENT AT GENERAL
HOSPITALS

- Review and confirm the protocol objectives.

- Agreed to an appropriate protocol format to ensure that it is easy to use

- Some different strategies and interventions were found to be effective in the literature review.

However, only three interventions were selected to be part of developing this protocol. These

three have been found to significantly improve communication (Narasimhan et al., 2006)

(Sluiter JK et al., 2005) (Agarwal S et al., 2008) (Panesar et al., 2014), self-efficacy (Banerjee et

al., 2017) (Meurling L et al., 2013), patient safety (Velji et al., 2008), decrease the length of stay

(LOS) (Agarwal S et al., 2008), and quality of documentation (Panesar et al., 2014).

Content of the clinical protocol includes three parts:

Part I: First intervention is an implementation of a standardized communication tool, the SBAR,

as a guide for communicating changes in patient status. It was used to communicate patient

information and any status changes in an organized clear manner. In addition, it is very helpful

to use in building and preparing information required in difficult or urgent discussions among

healthcare providers. It was utilized as a framework for reporting on patients, as a means of

structuring assessments, and to structure succinct e-mail communications (Dingley et al, 2008)

(Ruhomauly et al, 2019) (Simamora & Fathi, 2019) (Velji et al., 2008) (Panesar et al., 2014)

Part II: Second intervention in daily multidisciplinary patient-centered rounds using patient

goals sheet. Any healthcare provider involved in patient care is included in the rounds. It

focused on open and collaborative communication, decision making, information sharing, care

planning, patient safety issues, cost and quality of care issues, setting daily goals of care, and

communicating with patients if possible. The patient goals sheet was a tool that served as a

simple way of clarifying work goals among providers. It provided the means for the care team

and patient to explicitly define the goals for the day. It is filled during the daily patient centered

rounds for each patient and approved by the attending physicians and kept in the patient file. all

healthcare providers involved in the care provide input and review the daily goals. Goals of care
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PROTOCOL DEVELOPMENT FOR COMMUNICATION ENHANCEMENT AMONG
HEALTHCARE PRACTIONERS WORKING IN INPATIENT DEPARTMENT AT GENERAL
HOSPITALS

were changed, and the form was updated accordingly (Dingley et al, 2008) (Narasimhan et al.,

2006) (Phipps& Thomas 2007) (Sluiter JK et al., 2005).

Part III: Third intervention is training using simulation, initial expert presentation, video

presentation, communication education notebook, practice scenarios (multidisciplinary), SBAR

practice worksheets, concept poster campaign, different roles understanding, communication

skills, and culture and linguistics barriers awareness. The goals of this training were to integrate

safe communication strategies into the organizational culture, to sustain the culture of

teamwork, psychological safety, and open, effective communication, and to maintain

consistency and high quality in all educational efforts (Dingley et al, 2008) (Banerjee et al.,

2017) (Liaw et al., 2020) (Meurling L et al., 2013). The communication practice guide contains

a theoretical (overview) and practical detailed descriptions (step by step) of the standard

procedures that, performed by healthcare professionals.

Evaluation of the developed protocol for validation:

The developed protocol will be circulated to several experts in communication in

healthcare including nurses and physicians to evaluate the content validity and format. All

instructions, comments, and feedback from the expertise will be documented and considered in

the formulation of the final protocol.

Discussion

The communication styles of caregivers differ based on their different training. Nurses

’education is characterized by describing asymptomatic cases, while doctors ’diagnosis is brief.

But if the methods of communication between nurses and doctors are standardized, there will be

more effective between them. Developed a technique called SBAR (Situation-Background-

Assessment-Recommendation). This technique has been implemented in health systems. Many

hospitals have incorporated the SBAR tool as a key component of their patient safety program.

SBAR – The standard communication format, SBAR, has been used as a brief situational guide
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PROTOCOL DEVELOPMENT FOR COMMUNICATION ENHANCEMENT AMONG
HEALTHCARE PRACTIONERS WORKING IN INPATIENT DEPARTMENT AT GENERAL
HOSPITALS

for staff and service provider communication regarding changes in patient status or needs for

non-emergency or related issues or events in the unit, in the laboratory, or within the healthcare

team. Teaching nurses how to conduct a quality handoff report using a standardized

communication technique such as SBAR has the potential to empower and enable them to

communicate handoff reports in a manner that enhances patient safety immediately upon

entering into practice (Simamora & Fathi, 2019).

Interdisciplinary tours using the Daily Goal Sheet focus on the patient and may include

any staff member or caregiver involved in the patient's care, such as a respiratory practitioner,

occupational therapist, pharmacist, psychologist, nurse officer, and patient nurse. A daily goal

sheet is an approach that provides effective communication and helps clarify work goals for all

health service providers. The form is usually completed during rounds on each patient, signed

by the treating colleague or physician, and delivered to the patient's nurse. The care team

provided input and reviewed today's goals. With the continuous innovation in healthcare goals,

the model has been updated to keep pace with the change. The model focuses on open

communication, as well as cooperation and information sharing, planning and decision-making

in providing care, patient safety, quality and cost of care, communication with patients and/or

family members, and setting daily goals. During the tours, information is shared and supported

by changes between caregivers. In the intensive care department of the hospital, the focus was

on the daily goals by applying a study multidisciplinary rounding, the result was an

improvement in communication between caregivers, and a significant improvement in the

caregivers ’understanding of those goals and the percentage was (from 10 - 95%), and a

decrease in the rate of stay in the intensive care unit was also observed. And it was found in

another study that 1.38% of employees noticed that effective communication skills between

them and their colleagues improved; Also, employee satisfaction and interaction improved by

76% to 92%, work pressure, fatigue, and the level of emotional fatigue problems decreased, and

significantly, 62% reported an improvement in communication among health team members in

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PROTOCOL DEVELOPMENT FOR COMMUNICATION ENHANCEMENT AMONG
HEALTHCARE PRACTIONERS WORKING IN INPATIENT DEPARTMENT AT GENERAL
HOSPITALS

the pediatric intensive care unit. Also, a study published that 85% of nurses reported the daily

goals sheet led to improved communication between physicians and nurses in the PICU

(Phipps& Thomas 2007). The beginning of the objective sheet was based on the theories of

CRM (crew resource management), and it has many uses and applications in the health work

environment, including those applied in several intensive care units in IHI and Veterans’ Health

Administration.

It is also necessary to educate the employees and activate courses on correct practices in

communication, on the importance of teamwork, psychological safety, and open, effective

communication, and the results in patient health. American Association of Colleges of Nursing

Specifically addresses the need to teach communication practices that enable the delivery of

high-quality and safe patient care (AACN, 2018). It is imperative to develop educational tools

that are easy and flexible to use and apply in a healthy work environment and work to intensify

and increase formal and informal continuing education in all hospital departments. The analysis

of communication events worked on several evaluation aspects, including the caregivers

’understanding of the patient’s daily goals, patient reports, and interviews with hospital

caregivers, and hospital surveys.

Conclusion and Recommendations

Effective clinical practice should focus on the human factor and not only the clinical

skills provided to the patients. One of the benefits of effective team communication is that it

helps prevent errors in providing care to patients. Organizations should offer programs that

help foster team spirit among caregivers to increase the effectiveness of communication within

the organization. In healthcare settings, strategies must be developed that promote teamwork to

achieve the highest levels of effective communication between caregivers to avoid any

problems or harm to the patient or to help create an unsafe environment for staff. Conversely, if

communication becomes effective, it helps prevent negative consequences for patients. Also, it

is important to maintain the continuity of strategies and practices in a clear and acceptable
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PROTOCOL DEVELOPMENT FOR COMMUNICATION ENHANCEMENT AMONG
HEALTHCARE PRACTIONERS WORKING IN INPATIENT DEPARTMENT AT GENERAL
HOSPITALS

manner among health providers, by using effective methods of communication. It is also

necessary to educate new employees and activate courses on correct practices in

communication and establishment with the planning stage in the organization.

Regarding the developed protocol, it was found that evaluation experts were strongly

agreed regarding the significance, the importance of the developed protocol to nursing. In

addition, most of them were strongly agreed that content is sufficient to achieve the purposes,

their opinions were considered, and the required modifications were performed.

The current study recommended applying the developed protocol at Inpatient

Department in general hospitals which can enhance communication among healthcare

professionals.