New Study Finds U.S. Hospitals Must Improve Workplace Communication to Reduce Medical Errors, Enhance Quality of Care

WASHINGTON – January 26, 2005 – According to findings from a study released today in a national briefing of healthcare stakeholders, the prevalent culture of poor communication and collaboration among health professionals relates significantly to continued medical errors and staff turnover. Additionally, a lack of adequate support systems, skills and personal accountability results in communication gaps that can cause harm to patients.

A national study of more than 1,700 nurses, physicians, clinical-care staff and administrators found that fewer than 10 percent address behavior by colleagues that routinely includes trouble following directions, poor clinical judgment or taking dangerous shortcuts. In all, the study pinpoints seven categories of problems that are frequently encountered, yet rarely addressed. The study was co-sponsored by the American Association of Critical-Care Nurses (AACN) and VitalSmarts, a company specializing in leadership training and organizational performance.

“This research validates what our 100,000 constituents have communicated to us as the number one barrier hindering optimal care for patients,” said Kathy McCauley, RN, PhD, BC, FAAN, FAHA, president, AACN. “Too often, improving workplace communication is seen as a ‘soft’ issue – the truth is we must build environments that support and demand greater candor among staff if we are to make a demonstrable impact on patient safety.”

To drive the cultural transformation needed to improve communication in hospitals, AACN unveiled today a set of national standards to promote skilled communication and collaboration among nurses and other caregivers. The AACN standards and VitalSmarts recommendations emphasize the urgent need for hospitals to implement initiatives, especially communication training and education, to ensure that healthcare professionals deliver safe, high quality care to their patients.

AACN and VitalSmarts combined their resources to better understand communication problems in hospitals through the survey Silence Kills: The Seven Crucial Conversations for Healthcare. Among the study’s key findings:

  • 84 percent of physicians and 62 percent of nurses and other clinical-care providers have seen coworkers taking shortcuts that could be dangerous to patients.
  • 88 percent of physicians and 48 percent of nurses and other providers work with people who show poor clinical judgment.
  • Fewer than 10 percent of physicians, nurses and other clinical staff directly confront their colleagues about their concerns, and one in five physicians said they have seen harm come to patients as a result.
  • The 10 percent of healthcare workers who raise these crucial concerns observe better patient outcomes, work harder, are more satisfied and are more committed to staying in their jobs.

“People frequently see these problems, but too often they fail to talk about them,” says Joseph Grenny, president of VitalSmarts and co-author of VitalSmarts’ New York Times best-selling books Crucial Conversations and Crucial Confrontations. “Healthcare professionals who embrace the findings of this study and start talking candidly and safely about these seven problems will find that outcomes can improve dramatically.”

According to panelist Dennis S. O’Leary, MD, president of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), communication is a top contributor to medical errors in healthcare facilities. “The standards and recommendations put forth today make an important contribution to beginning to solve the identified communication problems,” said Dr. O’Leary.

Panelist Karlene Kerfoot, RN, PhD, CNAA, FAAN, senior vice president for patient care services and chief nurse executive at Clarian Health Partners in Indianapolis, explained that by focusing on workplace communication improvements, Clarian has experienced greater recruitment and retention success and improved safety overall.

“Nurses must be as proficient at handling personal communication as they are in clinical skills,” said Connie Barden, RN, MSN, CCNS, CCRN, executive editor of AACN’s Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence. “According to the Standards, a culture of safety and excellence requires that individual nurses and healthcare organizations make it a priority to develop communication skills that are on par with expert clinical skills.”


For copies of the Silence Kills study report and the AACN Standards for Establishing and Sustaining Healthy Work Environments, visit


About AACN

With 100,000 members and constituents, the American Association of Critical-Care Nurses is the largest specialty nursing organization in the world. Its headquarters are located in Aliso Viejo, Calif. Founded in 1969, the association has more than 240 chapters in the U.S. and abroad and is working toward a healthcare system driven by the needs of patients and their families, where critical care nurses make their optimal contribution. Complete information about AACN is available at

About VitalSmarts

A world leader in leadership training and organizational performance, VitalSmarts. ( provides products and services to hundreds of companies, including over 300 of the Fortune 500. For over twenty-five years, and with over 20,000 participants, the company principals have researched methods for bringing about systematic and lasting change.

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