Table 2

 Definitions of types of communication failure with illustrative examples and notes

FailureDefinitionIllustrative example and analytical note (in italics)
Occasion failuresProblems in the situation or context of the communication eventThe staff surgeon asks the anesthesiologist whether the antibiotics have been administered. At the point of this question, the procedure has been underway for over an hour.
Since antibiotics are optimally given within 30 minutes of incision,21the timing of this inquiry is ineffective both as a prompt and as a safety redundancy measure.
Content failuresInsufficiency or inaccuracy apparent in the information being transferredAs the case is set up, the anesthesia fellow asks the staff surgeon if the patient has an ICU (intensive care unit) bed. The staff surgeon replies that the “bed is probably not needed, and there isn’t likely one available anyway, so we’ll just go ahead.”
Relevant information is missing and questions are left unresolved: has an ICU bed been requested, and what will the plan be if the patient does need critical care and an ICU bed is not available? [Note: this example was classified as both a content and a purpose failure.]
Audience failuresGaps in the composition of the group engaged in the communicationThe nurses and anesthesiologist discuss how the patient should be positioned for surgery without the participation of a surgical representative.
Surgeons have particular positioning needs so they should be participants in this discussion. Decisions made in their absence occasionally lead to renewed discussions and repositioning upon their arrival.
Purpose failuresCommunication events in which purpose is unclear, not achieved, or inappropriateDuring a living donor liver resection, the nurses discuss whether ice is needed in the basin they are preparing for the liver. Neither knows. No further discussion ensues.
The purpose of this communication—to find out if ice is required—is not achieved. No plan to achieve it is articulated.