SACCIA
— is an acronym that abbreviates five evidence-based core competencies for safe communication. The letters stand for the terms "Sufficiency", "Accuracy", "Clarity", "Contextualization" and "Interpersonal Adaptation".
Premise
The five "SACCIA" competencies emerged from a communication science analysis of hundreds of critical healthcare incidents. They were identified as common deficient interpersonal processes that often cause and contribute to preventable patient harm and insufficient care. Thus, they represent an evidence-based set of core competencies for safe communication, which constitute the vehicle to patient care that is safe, efficient, timely, effective and patient-centered.
The interpersonal processes that are captured in the "SACCIA" acronym are considered "safe" because they lead to a shared understanding between all care participants. The accomplishment of a shared interpersonal understanding constitutes a core patient safety challenge across the globe. Therefore, successful healthcare provision requires "SACCIA safe communication" practice on behalf of all care participants in everyday healthcare encounters.
Content
The five SACCIA Core Competencies for Safe Communication are defined as follows:
S = Sufficiency assesses the extent to which participants convey, extract, and exchange a sufficient amount of information in order to arrive at a shared understanding.
A = Accuracy refers to the extent to which participants convey correct information, interpret information correctly, and utilize their communication with each other as a collaborative process to validate the accuracy of communicated contents.
C = Clarity assesses the extent to which verbal and nonverbal messages are expressed and interpreted clearly (i.e., unambiguously, not misleading or unorderly), and the extent to which participants utilize their interpersonal communication with each other to reduce perceived uncertainties.
C = Contextualization refers to the extent to which interpersonal communication is framed within the contextual circumstances that constitute barriers to a shared understanding in a given encounter. Communication is contextualized if it is sent, decoded, and dyadically exchanged in ways that directly address and neutralize these given contextual barriers. There are five different kinds of context: Functional (e.g. shared alignment of pursued communication objectives), relational (e.g. hierarchical status differences, relational history or conflict), chronological (e.g. timing, timeliness, point in time and duration for a given encounter), environmental (i.e. the physical setting of the conversation), and cultural (e.g. potentially differing rules and norms of the participants).
IA = Interpersonal Adaptation assesses the extent to which participants recognize and adapt to implicitly (nonverbal) and explicitly (verbal) expressed needs and expectations of their conversational partner for the purpose of arriving at a shared understanding.
SACCIA Core Truths
Communication science conceptualizes human communication as a complex, dynamic, holistic, interactive meaning-making activity that is co-produced between two or more individuals. By definition, communication encompasses
“all procedures by which one mind [and body] may affect another”
-- Shannon and Weaver 1964
In the context of healthcare, this means that interpersonal communication constitutes the vehicle through which understanding, affection, conflict, compassion, social support, and trust transpire in both provider-patient and inter-professional interactions. This conceptualization requires a more holistic and nuanced understanding than is generally found in the medical literature on how care objectives are achieved through interpersonal interactions, and a more robust consideration of contextual factors that influence interpersonal communication processes in the healthcare setting.
Clinical encounters are commonly compromised by insufficient or unclear information, time pressures, professional hierarchies, and conflictual relationships. In this context, the achievement of a mutual understanding is a necessary quality standard that requires advanced interpersonal skills (see Hannawa 2015). Safe communication encompasses complex encoding, decoding, and transactional sense-making activities of verbal messages and nonverbal (and other metalinguistic) cues that commonly make it difficult to reassemble what a speaker originally meant and intended. This is especially true when an interaction involves high emotional content, as is often the case in healthcare encounters.
This interpersonal sense-making process is complicated by the fact that encoding activities can be either intentional or unintentional in nature. Even silence, withdrawal, or immobility can convey messages that speak louder than words.
There are several incorrect assumptions or “myths” about human communication that are commonly shared by both patients and healthcare providers. These misperceptions often lead to insufficient interpersonal understandings that, in turn, directly compromise the safety and quality of care (visit SACCIA Resources below for scientific references). The SACCIA framework contrasts these myths with nine evidence-based "core truths” of safe communication:
Communication varies between thought, symbol and referent
Communication is a non-summative process
Communication is functional
Communication is more than words
Communication entails factual and relational information
Communication is contextual
Preconceptions and perceptions vary among communicators
Redundancy in context and directness in channel enhance accuracy
Communication is equifinal and multifinal
These core truths constitute the fundament for a successful implementation of the five SACCIA safe communication core competencies in everyday practice.
SACCIA Safety Domains
“Safe Communication” as a Core Competency for Patient Safety
The SACCIA safe communication competencies are evidence-based in scientific analyses of the processes that frequently lead to preventable healthcare-induced patient harm. SACCIA is framed within the basic tenets of human communication science. With that, it replaces common safety-compromising “myths” of human communication with evidence-based “truths” of what safe communication “looks like” in diverse healthcare settings.
Better Communication for Better Prevention
At least 80% of preventable healthcare-induced patient harm is caused by unsafe interpersonal communication among clinicians and with patients. SACCIA builds organizational and individual resilience by providing safe communication skills for all care participants. Grounded in direct empirical evidence, it addresses exactly those deficient interpersonal care processes that frequently cause preventable patient harm.
Better Communication for Better Intervention
In everyday practice, clinicians, patients and care companions frequently notice adverse events “in-the-making.” However, they commonly fail to intervene. The SACCIA safe communication competencies equip all care participants with the skills for a timely detection and effective intervention with preventable patient safety events.
Better Communication for Better Response
The SACCIA model proposes safe communication skills for 100% of all adverse and sentinel events that require effective and appropriate response and disclosure. It conveys how to respond to preventable adverse events effectively and appropriately through safe communication that mitigates patient harm and prevents further negative consequences of adverse events.
Focal Areas: Where can SACCIA Safe Communication improve Patient Safety?
1. Diagnostic errors
Poor information coordination among care participants and with patients/care companions frequently causes misdiagnoses and delayed diagnoses.
2. Medication errors
Insufficient shared understanding between care participants frequently leads to misuse, overuse, and non-indicated use of medications. Safe communication is also the pathway to intervening with errors related to sound-alike and look-alike medications.
3. Handoffs / Care transitions
An endemic lack of successful information exchange and contextualization commonly contributes to care inconsistencies, which result in non-indicated and inaccurate treatment and unsafe post-treatment care.
4. Digitization of care
Digital technologies claim to resolve communication problems. However, they merely store information. Currently, they do not provide active support for safe interpersonal sense-making processes. From a communication science perspective, digitization can cause more and particular kinds of patient safety events because they reduce direct interpersonal contact. The SACCIA safe communication skills also focus on the context of digitized care and can teach us how existing digital tools can be used in ways that support the accomplishment of a shared understanding as a prerequisite for safe patient care.
Scientific Background
Hannawa, A. F., Wu, A. W., Kolyada, A., Potemkina, A., & Donaldson, L. (2021). The aspects of healthcare quality that are important to health professionals and patients: A qualitative study. Patient Education & Counseling.
Hannawa, A. F. (2018). “SACCIA Safe Communication”: Five core competencies for safe and high-quality care. Journal of Patient Safety and Risk Management, 23(3), 99-107.
Pek, J. H., de Korne, D. F., Hannawa, A. F., Hong Leong, B. S., et al. (2019). Dispatcher-assisted cardiopulmonary resuscitation for paediatric out-of-hospital cardiac arrest: A structured evaluation of communication issues using the SACCIA safe communication typology. Resuscitation, 139, pp. 144-151.
Hannawa, A. F. & Postel, S. (2018). „SACCIA-Sichere Kommunikation“: Fünf Kernkompetenzen mit Fallbeispielen aus der pflegerischen Praxis. Berlin/Boston: Walter deGruyter.
Hannawa, A. F., Juhasz, R., & Wu, A. (2017). New horizons in patient safety: Understanding communication – Case studies for physicians. Berlin/Boston: Walter deGruyter.
Hannawa, A. F. & Jonitz, G. (2017). Neue Wege für die Patientensicherheit: “Sichere Kommunikation” – Evidenzbasierte Kernkompetenzen mit Fallbeispielen aus der medizinischen Praxis. Berlin/Boston: Walter deGruyter.
Hannawa, A. F., Wendt, A., & Day, L. (2017). New horizons in patient safety: “Safe communication” – Evidence-based core competencies with case studies from nursing practice. Berlin/Boston: Walter deGruyter.
SACCIA in Switzerland and Germany
Sichere Kommunikation mit SACCIA (Competence H+ Hospital Forum, 6/2021, Swiss Association of Hospital Directors)
SACCIA Patientensichere Kommunikation im Krankenhaus (Verband der Krankenhausdirektoren Deutschlands, 2018)
SACCIA Sichere Kommunikation (Pflegekammer interaktiv, 2019)