In the training film, the paramedic breathes into the mannequin's mouth, while another performs chest compressions a couple of feet away. That's possible because the head has been severed from the body.

That's what poor communication looks like in a health-care setting. And it is one of the root causes of medical errors and bad outcomes, according to the Department of Veteran Affairs' National Center for Patient Safety, in Salt Lake Thursday for daylong medical team training at the VA medical center.

Communication failures are a factor in 80 percent of cases where care results in an adverse event or close call, according to the center's research.

The goal of the training, being conducted nationwide at veterans hospitals, is to replace a "culture of blame" with systemic improvements, including better communication and respect between the care providers at all levels. That extends, as well, to the patient and family.

Bad communication in a hospital setting has hit no one harder than Sorrell King, whose 18-month-old daughter, Josie, died at Johns Hopkins Medical Center in 2001 because of communication failures. The toddler had been admitted with burns and after 10 days was well enough to move to intermediate care.

But two days before she was to go home, she was back in ICU, dying of dehydration and narcotic overdose. It was not, noted King in a film clip that's part of the training, a failure of one doctor or one nurse or one misplaced decimal point. It was lack of communication and not paying attention to the family's concerns.

"Hospitals are a manmade epidemic," she said, adding that care providers must listen to each other and trust the instincts of those who best know the patient. "Not all your answers are on the computer or clipboard. I will not rest until hospitals become safer places."

The training, based on team communication concept called Crew Resource Management, honed by the aviation industry over two decades, interlaced film clips and role playing with research findings. Emphasis is on building a strong multidisciplinary team out of the hospital's different departments. Instructors also broke down communication components into some rules — avoid blame words like "you" or judgments like "should." Attack the problem, not the person.

Each medical center is asked to set a measurable goal, with a timeline.

The program works, say national center's Jim Hay, Amy Carmack and Dr. Douglas Paull, who conducted the Salt Lake sessions.

At Houston, for instance, 95 percent of patients now get a prophylactic antibiotic within an hour of surgery. Steps to prevent deep vein thrombosis are taken before anyone is anesthetized. And preoperative briefings identify patients with risks that should scrub the surgery.

A study of 125 VA medical centers also found strong correlation between the teamwork culture and patient satisfaction, Carmack said.

Paull said research shows the surgeries most likely to result in complications and adverse events are not those that are complex or involve young doctors. "Usually, they are common operations with the most experienced surgeons." That's one reason, he said, briefings should be part of each surgery. A pilot doesn't skip his checklist just because he's only going a short distance or knows the route.


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