Blindfolded Resuscitation

Last time I briefly mentioned a concept known as "closed loop communication", which many High Reliability Organizations (HROs) utilize to prevent errors or minimize their impact.  Briefly defined, "closed loop communication" is when the individual receiving a command or instruction immediately repeats it back to make sure that the message is understood correctly.  The sender then acknowledges that the message repeated back is the correct one.  The American Heart Association's Center for Health Innovation uses the following diagram to depict the principle of "closed loop communication":

Consider the following example, taken from the script used during the United States Navy's Change of Command Ceremony.  In this particular example (completely fictitious), Captain Jones is assuming command of the USS America from Captain Smith:

Captain Jones: "I am ready to relieve you, sir."

Captain Smith: "I am ready to be relieved, Captain."

Captain Jones: "I relieve you, Captain."

Captain Smith: "I stand relieved, sir."

There is absolutely no question that the sender's (Captain Jones) communication was both heard and understood by the receiver (Captain Smith).  We also know the exact point in time that command authority has exchanged hands.

Let's look at another example, again from the U.S. Navy, as depicted in the 1990 movie, "The Hunt for Red October".  Watch the following film clip, "Conn Sonar, Crazy Ivan".  Here, the Captain's command "All Stop, Quick Quiet" is repeated by the crew member who is responsible for shutting off the submarine's engines.  Again, the sender's message is understood and acknowledged in such a way that the sender knows with absolute certainty that the message was delivered and understood.

I recently came across a couple of articles on "blindfolded resuscitation", a concept used to train health care workers in the importance of "closed loop communication" (see "The blindfolded code training exercise" and "Advanced closed-loop communication training: The blindfolded resuscitation").  Here, the "Code Blue" team leader wears a blindfold and is positioned facing away from the rest of the members of the team (forcing him/her to speak loudly and clearly).  The only way that the team can successfully resuscitate the "patient" during the simulation is to communicate clearly using "closed loop communication".  Studies using this training technique in a variety of different scenarios have demonstrated that it can significantly improve both the quantity and quality of "closed loop communication" used during resuscitations.

Next time we will continue along this theme of high reliability leadership and communication techniques.