Intentional Communications: Build Safety Into Daily Practice

Imagine that you are taking over command of a US Navy submarine. Not just any submarine, but you are about to command a nuclear missile submarine. The captain assigned to take over this submarine had been studying for more than a year and was scheduled to become the commander of a different submarine. The current captain of the Santa Fe had just quit. Morale on the Santa Fe was at an all-time low. The Santa Fe ranked dead last in preparedness, safety, resignations, and almost any other measured category. With sea trials in just a few months, and his career in the balance, Captain David Marquet assumed command of this derelict submarine. He had little time to study this ship or its crew. His responsibility? Turn this ship around!

Recently, we have seen disasters in off-label hyperbaric chambers. An incident in Michigan claimed the life of a 5-year-old boy. Public and private hearings have allowed the Undersea and Hyperbaric Medical Society to highlight the dangers posed by unregulated hyperbaric facilities and spas, sometimes located in strip malls. Yet these accidents also highlight some of our own shortcomings: training, safety, maintenance, and communication skills.

As a result of these disasters, you may wish to change how your clinic operates; assign responsibility for certain tasks, enhance safety practices (such as five-minute team huddles every day), establish ‘maintenance Mondays,’ or cross-train your staff.

I suggest you start by changing the way you communicate in your clinic.  Intentional communication skills benefit staff, patients, family, and visitors to your clinic, who will see the difference. In the daily huddle, the hyperbaric technologist might start with: “We have three monoplace chambers. All are on line and functional. There are no safety concerns with the equipment. X, Y, Z company will be here in three weeks for annual maintenance. We have all the required parts. Today, we have four treatments in each chamber. I intend to treat these patients at 2.4 ATA for a total of 90 minutes of oxygen at pressure, with two air breaks per treatment. If there are any problems with the treatment or patient complications, I will report to Nurse Nancy and Dr. Alpha. Are there any questions?” This is intentional communication. “I intend” is much better than “I’d like to,” “We usually,” or some other request. This type of communication shows that the technologist is prioritizing items on the daily schedule and alerting the team to an upcoming potential disruption to treatments due to chamber maintenance. Everyone on the team knows what is occurring.

I have seen huddles that ended with, “Does anyone have anything to add?” The undercurrent unspoken emotion is, “Don’t say anything that might require some discussion.” In this situation, we frequently see a “leader-follower” leadership style. It goes like this: “You are the staff member. You need to do as I say. I just want the numbers to reflect well. Got it?”

I prefer seeing a clinic where decisions are made by all the staff in ways that enhance their roles in the clinic. When the staff members have skin in the game, many good things can happen in your clinic. This style of management is called “leader-leader.”

I was always surprised when our hospital administration came by for a visit. They really didn’t understand why a certain staffing pattern was required, what equipment was used, and how it was maintained. Another example of “leader-leader” communication occurs when you have visitors to your clinic. This can be a UHMS accreditation survey, a DNV or Joint Commission survey, or a visit by the hospital administration.

Every staff member who interacts with the visitors can: 1) Introduce themselves, 2) State their function in the clinic, 3) Welcome the visitor, and 4) offer to show them the equipment. This might look like: “Hello, my name is Kirt Cartwright. I’m a certified hyperbaric technologist. I operate the hyperbaric chambers and am responsible for the safety of our patients. Is there anything I can show you today?” In the thirty-seconds this takes, the visitor feels like they know you, have an idea of your job responsibilities, and observe that you like your job.

Captain Marquet immediately began learning about each of the sailors, their families, their job responsibilities, and how to improve morale and enhance safe operations. He was genuinely inquisitive. Early in training dives, he was following the procedural protocol in a maneuver. He commanded, “All ahead two-thirds.” The executive officer and chief of the boat echoed his order. Nothing happened. The helmsman was asked why he refused to follow orders. His response was, “Sir, the propulsion system on this sub does not have a two-thirds detent.” Why did the executive officer and chief of the boat repeat the command? They thought the captain had some new training that they didn’t have. As a “follower,” they were afraid to speak up because it might be seen as undermining the captain. Instead, through intentional communication, this event opened a way to enhance the sub’s safe operation.

Each person in our hyperbaric unit needs to become a “leader-leader.” Intentional communication is key to safe operation. The Santa Fe not only passed seaworthiness cruises but also became the leader of the US Navy submarine fleet. From last to first, from a leader with genuine inquisitiveness to sailors who cared about their jobs and the safety of the boat, the Santa Fe became an example of excellence.

I encourage each of you to read the book (Turn This Ship Around) and to find ways of implementing the “leader-leader” communication style in your department.

Now is the time that I wish each of you well in your future hyperbaric medicine careers. When I looked in the mirror this morning, I saw a little old man staring back at me. It’s time to let the little old man out of the mirror. I have resigned from duties on the UHMS Safety Committee. Best wishes to every one of you. It has been my pleasure to serve you and the Society.

Turn This Ship Around. Author: David Marquet. Publication date: May 16, 2013. ISBN-13: ‎ 978-1591846406. Available at any bookseller.