New research shows communication breakdowns in hospitals undercut the effectiveness of safety tools and negatively impact patient outcomes

PHILADELPHIA – March 22, 2011 – Health care professionals make calculated decisions daily to not alert their colleagues when a safety tool signals potential harm to a patient, according to a new study of 6,500 nurses and nurse managers released today during a national briefing in Philadelphia.

Over the past decade, the health care community has developed safety tools to prevent communication errors and breakdowns, such as handoff protocols, checklists, computerized order entry systems and automated medication-dispensing systems.
According to the national study, ―The Silent Treatment: Why Safety Tools and Checklists Aren’t Enough to Save Lives, 85 percent of health care workers reported a safety tool warned them of a problem that otherwise might have been missed and could have harmed a patient. And yet, more than half (58 percent) of the participants said while they got the warning, they failed to effectively speak up and solve the problem.

These results indicate that while safety tools are an essential part of the formula for preventing avoidable medical errors caused by poor communication, cultures of silence in U.S. hospitals undermine their effectiveness.
―The Silent Treatment research focuses on an especially dangerous kind of communication breakdown: known risks that are left undiscussed.

More than four of five study participants expressed particular concerns about three ―undiscussable issues: dangerous shortcuts, incompetence and disrespect. Many have witnessed these ―undiscussables lead to near misses or cause actual harm to patients.

Two of the nation’s largest specialty nursing associations — American Association of Critical-Care Nurses (AACN) and Association of periOperative Registered Nurses (AORN) — partnered with VitalSmarts, an innovator in evidence-based corporate training and organizational performance, on ―The Silent Treatment study to identify communication barriers that contribute to avoidable medical errors. Additionally, all three organizations focused attention on identifying and providing solutions to improve patient outcomes.

―The report confirms that tools don’t create safety; people do. Safety tools will never compensate for communication failures in the hospital, says David Maxfield, vice president of research at VitalSmarts and lead researcher of ―The Silent Treatment.

Among the study’s key findings:

  • More than four of five nurses have concerns about dangerous shortcuts, incompetence and disrespect demonstrated by their colleagues.
  • More than half say shortcuts led to near misses or harm, and only 17 percent of those nurses shared their concerns with colleagues.
  • More than a third say incompetence led to near misses or harm, and only 11 percent spoke to the colleague considered incompetent.
  • More than half say disrespect prevented them from getting others to listen to them or respect their professional opinion, and only 16 percent confronted their disrespectful colleague.

AORN Executive Director/CEO Linda Groah, RN, MSN, CNOR, CNAA, FAAN, speaks to the implications these findings have on nurses in the operating room.
“Safety tools such as protocols and checklists guard against honest mistakes,” Groah says. “However, this study tells us there is more work needed in the OR to support the surgical team’s ability to establish a culture of safety where all members can openly discuss errors, process improvements or system issues without fear of reprisal.”

AACN President Kristine Peterson, RN, MS, CCRN, CCNS, cardiac clinical nurse specialist, Aspirus Wausau Hospital, Wis., notes the tremendous progress made by the health care community.
“Compared with what we learned in 2005, nurses now speak up at much better rates and are now nearly three times more likely to have spoken directly to the person and shared their full concerns”, Peterson says. “This increased focus on creating cultures of safety needs to continue until every health professional feels empowered to speak up to reduce errors and improve quality of care.”

“The Silent Treatment” builds on findings from research conducted in 2005 by AACN and VitalSmarts as documented in the study “Silence Kills: The Seven Crucial Conversations for Health Care.
For copies of “The Silent Treatment” study report and a complete online media kit, visit
About AACN
Founded in 1969 and based in Aliso Viejo, Calif., the American Association of Critical-Care Nurses (AACN) is the largest specialty nursing organization in the world. AACN joins together the interests of more than 500,000 acute and critical care nurses and claims more than 235 chapters worldwide. The organization’s vision is to create a health care system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. To learn more about AACN, visit, connect with the organization at or

About AORN
The Association of periOperative Registered Nurses, representing the interests of more than 160,000 perioperative nurses, provides nursing education, standards and services that enable optimal outcomes for patients undergoing operative and other invasive procedures. AORN’s 40,000 registered nurse members facilitate the management, teaching and practice of perioperative nursing, are enrolled in nursing education or engaged in perioperative research. For more information, visit

About VitalSmarts
An innovator in corporate training and organizational performance, VitalSmarts is home to award‐winning training products that deliver powerful tools for enriching relationships and improving end results. The company also has four New York Times bestselling books, Crucial Conversations, Crucial Confrontations, Influencer, and Change Anything. VitalSmarts has consulted with 300 of the Fortune 500 and trained more than 695,000 people worldwide.

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