Sentinel Event Data & The Case for Developing “Soft” Skills in Professional Staff and Nurse Managers

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Why should healthcare leaders invest in Improv for Healthcare Professionals and other interactive workshops that build communication, and collaboration skills, behaviors, and capacities?

Empirical Data, Behavioral Factors & Call to Action

As nurses, physicians, healthcare administrators and empowered consumers you are likely aware of the The Joint Commission’s, (TJC) statistics on root causes of sentinel events[1].  This report speaks to the inter-relationship of human behaviors, medical errors, and workplace culture.  This inter-relationship is a call to action for delegating resources on behavioral learning i.e. teaching, promoting and practicing “Soft Skills” such as communication, emotional intelligence, and authentic leadership.

Communication, Leadership, and Human Factors are the top three most frequent root cause categories for 2010, 2011, and 2012! 

Take a look at the categories of root causes in this report and as you do, ask, “What aspects of human behavior and/or workplace interactions might be part of the story?”  For instance, many of the descriptors in the ‘Leadership’ category below have at least some behavioral component often associated with emotional intelligence:

“Organizational planning, organizational culture, community relations, service availability, priority setting, resource allocation, complaint resolution, leadership collaboration, standardization (e.g., clinical practice guidelines), directing department/services, integration of services, inadequate policies and procedures, non-compliance with policies and procedures, performance improvement, medical staff organization, nursing leadership”[2].   

How we express ourselves, listen to others, perceive diversity and engage in conflict are examples of what I mean by ‘behavioral component’ while assertiveness and respectful listening represent the related skills we need to build.  For nurses, in particular, this translates into such important abilities as:

  • Asking for, offering and accepting help.
  • Setting limits, saying “No” and negotiating compromise.
  • Respecting one’s self and others.

“I need help”,  “I can’t work late tonight”, “Dr. Smith, that is the wrong leg” are all assertive comments and there is no such thing as developing selective assertiveness.  In other words, there are elements of this teaching that represent personal and professional growth and empowerment.  Some leaders may be afraid to help nurses develop more confident voices and advocacy for themselves as well as patients.  There may be varying degrees of welcoming these new skills in our workplaces and validating, advocating for and setting limits with staff is another challenging part of the work.

In her fascinating article, The Complex Work of RNs: Implications for Healthy Work Environments, Patricia Ebright, RN, DNS, CNS describes the complexity of delivering patient care along with the importance of supporting RN decision-making and establishing healthy work environments.  She describes the concept of RN [Cognitive] Stacking as, “…the invisible, decision-making work of RNs about the what, how, and when of delivering nursing care to an assigned group of patients”[3]

In some earlier work by Dr. Ebright and colleagues, Patterson, Chalko & Render provided a description of RN work patterns across medical-surgical units. They identified factors that make the work of nursing care very challenging and germane to our discussion, missing equipment and supplies, interruptions, waiting for needed resources, communication inconsistencies, and lack of time[4].

Investing in Effective Communication & Emotional Intelligence Training and Practice

Ultimately, the connections between the diverse and fluctuating composition of work relationships and evidence-based information on adverse events are difficult to quantify and the communication-based skills are tough to teach, practice and learn.  An additional dimension of challenge lies in the interconnectedness of individual and organizational behaviors.  Don’t we know enough now about the emotional and physical consequences and financial loss of sentinel events to invest resources in building related skills?  THIS is a critical contribution towards creating safer, kinder healthcare systems!

[1] Sentinel Event Data, Root Causes by Event Type, 2004-2011, The Joint Commission website,, 03/12/2012

[2] ibid

[3] Ebright, P., (Jan. 31, 2010) “The Complex Work of RNs: Implications for Healthy Work Environments”OJIN: The Online Journal of Issues in Nursing Vol. 15, No. 1, Manuscript 4.

[4] Ebright, P., Patterson, E., Chalko, B., & Render, M. (2003). Understanding the complexity of registered nurse work in acute care settings. Journal of Nursing Administration, 33(12), 630- 638.

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10 Responses to Sentinel Event Data & The Case for Developing “Soft” Skills in Professional Staff and Nurse Managers

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  8. Hi Lucy,

    Thank you so much for your feedback and comments. Please feel free to keep me posted on your work with incivility. I’m always interested in blogpost ideas as well as supporting colleagues! Also, happy for student perspectives as well.

    All the best,

  9. Lucy Pilon says:

    Hi Beth…this is my first visit to this blog and I think it’s great. I support your position! It seems that soft skills as you describe them have fallen by the wayside in nursing education. The degree program I teach in in very “paper” focused and that results in students becoming very adept at writing and less at communicating in the real world. I am currently working on a paper related to incivility in nursing and nursing education and practice settings and your comments are directly in line with what I have discovered! Thanks for sharing your insights…Lucy RN

What are your thoughts?