Letters
General medicine Health services administration
Volume 211 - Issue 2

Adding kindness at handover to improve our collegiality: the K‐ISBAR tool

Author:  Shyan Lii Goh

Med J Aust 2019; 211 (2): 93-93.e1. || doi: 10.5694/mja2.50241
Published online: 15 July 2019
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To the Editor: I refer to the opinion piece by Brewster and Waxman.1 The authors defined collegiality as “a work environment where responsibility and accountability are shared by colleagues, with mutual respect”. However, in a health care setting, professional competency and patient safety are paramount; medical collegiality is desirable, but should not trump these goals. Collegial courtesy can compromise good patient care, despite concerns of competency in clinical judgement or skills.

Poor communication contributes to most sentinel events,2 particularly during clinical handover. SBAR (Situation, Background, Assessment and Recommendation), which was what ISBAR (Introduction, Situation, Background, Assessment and Recommendation) was known as in 2009, was promoted to reduce dangerous transitions in the patient's journey in health care.3 Unfortunately, when first introduced in Australia, unnecessary local adaptations were applied to this simple tool — at least seven versions of SBAR existed across six states between 2009 and 2011.4,5,6,7,8,9,10,11

In 2002, SBAR was introduced by retired United States Navy Captain Doug Bonacum, while working at Kaiser Permanente on patient safety, to address the lack of effective communication in sentinel events similar to nuclear submarine incidents and airplane crashes. A quality and safety expert, he drew on his handoff experience from nuclear submarine crews needing to discuss strategies quickly during shifts changeover, thus improving communication, reducing unnecessary narratives and assisting decision making. SBAR improves communication both within the craft group and in interdisciplinary interaction as it flattens the hierarchy.12

ISBAR can fail when the giver (person providing ISBAR) neglects to prepare or perform ISBAR effectively; this is often due to inadequate training, preparation or consideration of what the receiver requires before initiating the handover. Hence, the success of ISBAR rests more on the giver rather than the receiver of the handover.

Kindness should be part of ISBAR, but it starts with the giver initiating the handover. Adequate consideration should be made by ensuring thoughtful preparation and organisation to deliver relevant information professionally and competently.13 Less experienced givers should be ready to furnish any specific details upon request. Such reflections enhance communication, reduce errors and improve confidence and morale.

Few can perform ISBAR properly “on the run”; formal re‐accredited requirements involving ISBAR should be mandatory for all health care professionals to ensure this critical clinical handover is done well. Slavish adherence to collegiality should not blur the fundamental issues of professional competency and patient safety.

Author

  • Shyan Lii Goh1
  • 1. Northmead, NSW

Correspondence: slgoh@yahoo.com

Competing interests

No relevant disclosures.

References

Linked content

  • MJA Reflection: Adding kindness at handover to improve our collegiality: the K-ISBAR tool

  • MJA Letter: In Reply

  • MJA Letter: Adding kindness at handover to improve our collegiality: the K‐ISBAR tool

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