The Prime Directive
Skilled communication is one of the most elusive competencies to master. However, when the focus is patient safety, it is the prime directive for organizational excellence. The two documents that have been personally highly applicable in this author’s clinical practice are the research reports called Silence Kills (Maxfield et al., 2004) and Dialogue Heals (Maxfield et al., 2008). The full reports are available as a pdf download at www.silencekills.com if an email address is registered.
These reports focus on seven categories of conversations that are both challenging and perceived by most healthcare professionals as “risky”. These categories represent the problems in communication that lead to poor patient outcomes (Maxfield, et.al. 2004).
•Lack of Support
Maxfield et al., (2004) call the inability to communicate in these circumstances as a choice not to have a crucial confrontation. Addressing these problems in rural healthcare environments can present with an additional level of complexity, due to the financial interconnectivity of only a small group of providers.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share (for non-commerical purposes) the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).