Communication

toc 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





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**

 The single biggest problem in communication is the illusion that it has taken place. GB Shaw Presentation on communication: [| communication ssc.pdf] [|Assertiveness]

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). <span style="font-family: Georgia,serif;">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. <span style="font-family: Georgia,serif;">The briefing will cover the items in the GRIPS mnemonic (see page on leadership). <span style="font-family: Georgia,serif;">The SMEAC or STICC structures (see below) are generally effective.

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

<span style="font-family: Georgia,serif;">The military use the term "after action review" to achieve the same purpose and the areas covered are shown below:

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<span style="font-family: Georgia,serif;">[|briefing/debriefing in SAR setting]

<span style="font-family: Verdana,Geneva,sans-serif;">Tools to improve communication
<span style="font-family: Georgia,serif;"> Some communication tools that as well as being useful in casualty care can also be valuable in the outdoors setting: <span style="font-family: Georgia,serif;"> **SBAR** - for seeking help <span style="font-family: Georgia,serif;"> **CUS** - when worried about safety of actions/decisions <span style="font-family: Georgia,serif;"> **Check back** - to ensure shared understanding <span style="font-family: Georgia,serif;"> **SMEAC** - for briefing others <span style="font-family: Georgia,serif;">**SPEWI** - for debriefing <span style="font-family: Georgia,serif;"> **MIST** - when handing over a patient to another clinician <span style="font-family: Georgia,serif;">**LATTE** - when dealing with someone who is angry

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

<span style="font-family: Georgia,serif;">

CUS
<span style="font-family: Georgia,serif;"> 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 <span style="font-family: Georgia,serif;"> 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. <span style="font-family: Georgia,serif;"> 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. <span style="font-family: Georgia,serif;"> 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. <span style="font-family: Georgia,serif;"> 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. <span style="font-family: Georgia,serif;"> Note that the comments are always about the action/decision and not about the personality.

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<span style="font-family: Verdana,Geneva,sans-serif;">SMEAC
<span style="font-family: Georgia,serif;">This is a structure that can be used for briefing: <span style="font-family: Georgia,serif;">Situation <span style="font-family: Georgia,serif;">Mission <span style="font-family: Georgia,serif;">Execution <span style="font-family: Georgia,serif;">Adminsitration (logisitics/equipment) <span style="font-family: Georgia,serif;">Command and control/communication/check understanding <span style="font-family: Georgia,serif;">Briefing: **SMEAC structure** SMEAC BRIEFING.doc (this comes from the EMA paper on leadership)

<span style="font-family: Verdana,Geneva,sans-serif;">STICC
<span style="font-family: Georgia,serif;">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 ||

<span style="font-family: Verdana,Geneva,sans-serif;">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?)

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<span style="font-family: Georgia,serif;">NASA paper on debriefing (ie reviewing performance with the aim of improvement, rather than psychological debriefing after a traumatic event) <span style="font-family: Georgia,serif;">Debriefing page on this site

<span style="font-family: Georgia,serif;"> What can happen if communication is not effective:

<span style="font-family: Georgia,serif;"> media type="youtube" key="Wra0_xqRp24&rel=1" height="355" width="425"

<span style="font-family: Verdana,Geneva,sans-serif;">ETHANE
<span style="font-family: Georgia,serif;">Exact location <span style="font-family: Georgia,serif;"> Type of incident <span style="font-family: Georgia,serif;"> Hazards <span style="font-family: Georgia,serif;"> Access and egress routes <span style="font-family: Georgia,serif;"> Number of casualties & nature of injuries (if multilpe casualties give triage classifications) <span style="font-family: Georgia,serif;"> Emergnecy services needed (and on scene alrady)

<span style="font-family: Verdana,Geneva,sans-serif;">MIST
<span style="font-family: Georgia,serif;">Mechanism of injury <span style="font-family: Georgia,serif;"> Injuries found <span style="font-family: Georgia,serif;"> vital Signs (with trends if available) <span style="font-family: Georgia,serif;"> Treatments given (and timings)

<span style="font-family: Georgia,serif;">example of MIST checklist:



<span style="font-family: Verdana,Geneva,sans-serif;">LATTE
<span style="font-family: Georgia,serif;">Listen to the other person <span style="font-family: Georgia,serif;">Acknowledge their anger <span style="font-family: Georgia,serif;">Take action to solve the problem <span style="font-family: Georgia,serif;">Thank them for letting you know of the problem/issue <span style="font-family: Georgia,serif;">Explain why/how you think it occurred

<span style="font-family: Verdana,Geneva,sans-serif;">Links
<span style="font-family: Georgia,serif;">[|Why groups fail to share information effectively]