Communication Under Pressure: Make the Next Step Clear

Use a structure so you do not have to invent one

SBAR stands for Situation, Background, Assessment, Recommendation. One hospital adopted it after a nurse took a lab result by phone while caring for another patient, did not write it down, and a physician then increased a blood thinner dose based on older results. The hospital trained staff in SBAR, put pocket cards and cheat sheets by the phones, and used it for reporting at every level. Staff adapted quickly, though the authors noted hesitancy in giving the recommendation (Haig, Sutton, and Whittington, 2006). That paper is a case report, not a controlled trial, so it shows how SBAR was used rather than proving how much it helps.

The office version works the same way:

• Situation: “The payments page has been down for 20 minutes.”
• Background: “It started after the 2:10 deploy. Orders are queuing, not lost.”
• Assessment: “I think the new config is the cause, but I haven’t confirmed it.”
• Recommendation: “I want to roll back now. I need your yes in the next five minutes.”

The last line is the one people skip, exactly as the hospital staff did. Stating what you want, and by when, is what turns an update into a decision.

Close the loop on anything that matters

Closed-loop communication means the sender gives a message, the receiver repeats it back, and the sender confirms. In an exploratory study of 16 simulated trauma teams, these complete loops were rare, averaging 2.8 per team, and they were more frequent under a more egalitarian leadership style (Härgestam and colleagues, 2013). If trained clinicians in a simulated emergency rarely close the loop, a busy office team rarely does either unless someone makes it a habit.

It sounds like this: “Can you read back the two numbers you’re sending to the client?” and “Yes, that’s right: 4,200 units, ship date the 14th.” It takes eight seconds. Asking someone to repeat an instruction is a check on the message, not a test of the person, and saying so helps: “Humor me, I’ve garbled this once today already.”

Say the feeling in one line, then move on

Under pressure, many people try to hide stress entirely. That has costs. In experiments where pairs discussed an upsetting topic, the person instructed to suppress her emotional expression disrupted communication, raised her partner’s blood pressure and reduced rapport (Butler and colleagues, 2003). The other extreme, venting at the team, adds a second problem for everyone to manage.

The middle path is one plain sentence that explains your tone without making the listener responsible for it: “I’m stressed about the 5 p.m. deadline, so I’m going to be short. It’s not about you.” Then give the SBAR. If you are too flooded to do that, take 60 seconds before sending anything; the pause card lists a few ways to do it.

Make blockers cheap to report

The worst pressure situations are the ones you hear about too late. In Edmondson’s study of 51 manufacturing teams, team psychological safety, a shared belief that the team is safe for interpersonal risk taking, was associated with learning behavior, which in turn mediated its link with team performance (Edmondson, 1999). During a crunch, that belief is built or broken by small reactions. When someone says “I’m stuck,” respond with “Thanks. What do you need?” before any question about why.

After the crisis: a fifteen-minute review

The communication habits that hold up under pressure are built in the calm afterward. Within a few days, get the people involved together for fifteen minutes and ask four questions: What did we know, and when? Which message caused confusion? What did someone need that they did not ask for? What will we do differently next time? Keep the review about messages and handoffs, not about who panicked. Write down one change, such as “outage updates go in one channel, every 30 minutes, in SBAR format,” and put a name next to it. A review that produces no change trains people to stop taking reviews seriously.

Related skills

Clear structure is half of the job; the other half is staying regulated enough to use it. See emotional regulation at work and handling emotional overwhelm. For the conversation after the crisis, read giving and receiving feedback.