What’s the difference between a 15-year-old volunteer emergency responder and a doctor? Well, lots of things, but here’s one you might not expect: until recently, only the 15-year-old practiced a standard protocol of communicating with other health care providers.

This is big news to me. I was trained as a volunteer ski patroller back in high school, completing both my Outdoor Emergency Care and Wilderness First Responder certifications. In both courses, my instructors emphasized clear communication from day one. There was a strict protocol for each dialogue, and although we were all medical novices, by the end of training we were pros in reciting a SOAP Note: Summary (age, sex, chief complaint, etc), Observations (patient exam, vital signs), Assessment (what you think the problem is), and Plan (what you think should be done about each problem).

It never occurred to me that doctors did not all follow a similar protocol. If first responders—even teens on skis—are trained to streamline communication to get patients the best care as quickly as possible, shouldn’t doctors be too? Now, thanks to Doug Bonacum, VP of Safety Management for Kaiser Permanente, such standards are becoming more common. In an Institute for Healthcare Improvement: Profile in Improvement, Bonacum describes his experience with suboptimal communications between providers in the perinatal unit, and how he applied a communication strategy he had used in the Navy to improve patient safety:

I was sitting in a perinatal patient safety training […] in 2002, listening to the doctors and nurses sort of talking at each other about how disappointed they were with each other on their communications. And the nurses would say, “You know, when I call the doctor in the middle of the night, I tell the doctor what’s wrong and I really think I’m making a strong recommendation but I don’t get the sort of response that I would hope for.” And our physicians were saying, “You know, when they call me in the middle of the night, they tend to ramble, it’s not very clear what their assessment is, I don’t know what they want most of the time, and most of the calls, quite frankly, are of no use.” And I recognized that the patient was at the middle of all this and it didn’t need to be that way and that a more structured communication might help both the receiver and the transmitter of that information

So I reflected on how we would make similar conversations in the Navy. … And we used a technique that I later labeled as SBAR, which was just to describe the Situation we were seeing succinctly, give a little bit of a Background so the person hearing the information had the context to provide an Assessment … and most importantly to provide a Recommendation…

We quickly developed some training around it, allowing people to try to test it out and to give them feedback in a classroom environment. And I didn’t really think it was going to go much further than perinatal patient safety and soon it was sort of everywhere. And now we’re using it to write e-mails to each other and people are using it during handoffs in transitions in care, so it really has caught on.[…] And both the receiver and the transmitter of the information actually benefit from it, so it’s a win-win for everybody and, I would say most importantly, for the patient or the family.

After Bonacum’s 2002 initiative, the Joint Commission added communication protocols to their list of patient safety goals in 2006, and since then, hospitals have begun to adopt SBAR or similar models of their own. Fixing health care is going to require big things from Washington, but also littler ones from health care providers themselves. Things like clearer communication, whether on the ski slope or when caring for a tiny sick baby, can add up to make a big difference.