Table 1.

Approaches for Improving Communication

Sources of Conflict	Approach
Differing expectations for information needs, communication content and style	Team Training
	Structured communication tools (e.g., SBARa; structured handoffs)
	Board rounds
	Huddles
	Attentive listening
Failure to communicate rationale	Routinely ask for plan and reasoning
Inattention to concern	Persistently restate concerns until resolved
	Consider instituting laboristb in-house if provider fatigue frequent concern or service is large with many primary providers
Concerns remain unresolved	Ensure adequate staffing and break relief
	Ratify plan before concluding conversation
Differing “world views, ” e.g., “Oxytocin Wars”c	Standardize oxytocin protocol
Fetal monitoring methods, interpretation, and management of complex tracings	Standardize fetal monitoring language and application
	Provide regular interprofessional case reviews to discuss management; role model expression of concern and positive resolution of differences
	Standardize expectations for notification of complications
	Articulate and plan for potential problems early in care
	Individuals take responsibility for collaboratively discussing differing views
	Avoid professional stereotyping as an explanation for behavior
	Consider instituting laborist in-house (especially at night)
Disruptive Behavior	“Good Citizen” policy consistently enforced
	Individuals and peers stand up to unprofessional behaviors
	Administrative commitment to addressing any chronic issues
	Availability of anonymous incident reporting system

^aSBAR: Situation, Background, Assessment, Recommendation

^bLaborist: An obstetric hospitalist

^c“Oxytocin Wars”: Tug of war between physicians and nurses over management of oxytocin

Sources: ACOG. Committee Opinion No. 459: The Obstetric-Gynecologic Hospitalist. Obstet. Gynecol. July, 2010 2010;116(1):237–239; Knox GE, Simpson KR. Perinatal high reliability. Am J Obstet Gynecol. In Press, Corrected Proof; Knox GE, Simpson KR, Garite TJ. High reliability perinatal units: an approach to the prevention of patient injury and medical malpractice claims. J Healthc Risk Manag. Spring 1999;19(2):24–32; Simpson KR. Failure to rescue: Implications for evaluating quality of care during labor and birth. J Perinat Neonatal Nurs. 2005;19(1):24–34; AHRQ. TeamSTEPPS®: Strategies and Tools to Enhance Performance and Patient Safety; Pronovost PJ, Holzmueller CG, Ennen CS, Fox HE. Overview of progress in patient safety. Am J Obstet Gynecol. Jan 2011;204(1):5–10.