non-technical skills

Communication


Communication is much more than just talking


Wise men talk because they have something to say.
Fools talk because they have to say something.

Plato



teamwork_model_from_ltem.png


keystone-11.jpg

Communication is like the keystone in the "arch" of human factors; without it everything will fall down.

An alternative analogy, for the clinically minded, is to think of information as the oxygen needed for effective teamwork and to think of communication as the red cells and circulatory system that "perfuse" the team with the information it needs.

Good decisions will not generate good outcomes without effective communication

communication_chain.png
The single biggest problem in communication is the illusion that it has taken place.
GB Shaw
Presentation on communication: external image pdf.png communication ssc.pdf
Assertiveness

Briefing and debriefing

Briefing

Part of a leader's role is to communicate to team members about the "task" they are about to undertake (in an outdoor setting the task may be to summit a mountain).
The aim of the briefing is to help the team accomplish the task safely and effectively (and in the case of a recreational task enjoyably).
The briefing can be viewed as an opportunity to enhance the situational awareness of the team members and the shared mental model of the team as a whole.
The briefing will cover the items in the GRIPS mnemonic (see page on leadership).
The SMEAC or STICC structures (see below) are generally effective.

Debriefing

(this is difference from critical incident stress debriefing, where the focus is on well-being of team members)
Debriefing is done to improve performance of individuals and of teams.
Debriefings have been shown:
1) To improve performance by around 25%
2) To take, on average, 18 minutes.

The military use the term "after action review" to achieve the same purpose and the areas covered are shown below:
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The 4 questions addressed in an AAR




briefing/debriefing in SAR setting

Tools to improve communication

Some communication tools that as well as being useful in casualty care can also be valuable in the outdoors setting:
SBAR - for seeking help
CUS - when worried about safety of actions/decisions
Check back - to ensure shared understanding
SMEAC - for briefing others
SPEWI - for debriefing
MIST - when handing over a patient to another clinician
LATTE - when dealing with someone who is angry

Something often overlooked is a "lost comms plan". Decide beforehand what action all involved will take if communications are lost (this could be meeting at a specific place at a designated time).


SBAR

A structure to use when seeking help or advice: SBAR
- Situation - current concern(s)/problem - this should take no more than 10 seconds to say
- Background - things leading up to this, other issues
- Assessment - what you think is happening, what you have done and what effects of these have been
- Recommendation - what you think is needed, when it is needed


CUS

When there are worries about safety CUS is a tool to share concerns in an assertive and non-aggressive manner. It describes a phased approach to voicing concerns
It should be stressed that safety is greatest when all members of a team/group are equally able to voice concerns; the "leader" (fromal or informal) should state this at the start of any outdoor activity.
Concerned: "I am concerned that ..." This will often generate either an explanation of why a particular decision has been made or a change in plan.
Uncomfortable: "I am uncomfortable that we are continuing with the route even though the light is fading and we have only one head-torch between us". At this stage you are stating that the current course of action is unwise/unsafe and seeking a review of decisions.
Safety issue: "This is a safety issue - it is too dangerous to continue down this crag without any equipment. We need to move to higher ground now and find a better alternative" At this point you are putting up your hand (metaphorically) and saying "stop". It is very hard to continue wqhen someone does this.
Note that the comments are always about the action/decision and not about the personality.

cus.jpg





SMEAC

This is a structure that can be used for briefing:
Situation
Mission
Execution
Adminsitration (logisitics/equipment)
Command and control/communication/check understanding
Briefing: SMEAC structure external image msword.png SMEAC BRIEFING.doc (this comes from the EMA paper on leadership)

STICC

Is an alternative structure for briefings - perhaps better suited to emergency settings:
Situation
This is what I think we're facing
Task
This is what I think we should do
Intent
This is why
Concerns
This is what we need to keep an eye out for/what we need to avoid
Calibrate
Now talk to me about my proposal

SPEWI

A mnemonic to help remember the structure for a debriefing/after action review:
S Are there any SAFETY issues to address? (if so this should be the immediate priority)
P What was the PLAN? (refer to the briefing for this)
E What were the EVENTS that actually happened? (get input from everyone)
W What went WELL? (and why did it go well?)
I What needs to be IMPROVED? (and why & how?)



NASA paper on debriefing (ie reviewing performance with the aim of improvement, rather than psychological debriefing after a traumatic event)
Debriefing page on this site

What can happen if communication is not effective:



ETHANE

Exact location
Type of incident
Hazards
Access and egress routes
Number of casualties & nature of injuries (if multilpe casualties give triage classifications)
Emergnecy services needed (and on scene alrady)

CHALET

Snap_2010.01.17_13.36.00_001.png

MIST

Mechanism of injury
Injuries found
vital Signs (with trends if available)
Treatments given (and timings)

example of MIST checklist:




MIST.jpg

LATTE

Listen to the other person
Acknowledge their anger
Take action to solve the problem
Thank them for letting you know of the problem/issue
Explain why/how you think it occurred

Links

Why groups fail to share information effectively