Reflection

Adding kindness at handover to improve

our collegiality: the K-ISBAR tool

M
uch has been written recently about the
mental health of the Australian medical
workforce, with doctors being burned out,
bullied, harassed and mentally unwell.1,2 Why are
doctors so unkind to each other? What has happened
to collegiality? While we are from different medical
backgrounds, we are united in the belief that it is time
for change; time for a united response from the
Australian medical profession focusing on collegiality,
using kindness and understanding as the catalyst and
clinical handover as the opportunity.

Collegiality describes a work environment where

responsibility and accountability are shared by
colleagues, with mutual respect. Kindness gets its roots
from the old English word “cynd”, meaning “nature,
family and lineage”, hence kinship. Collegiality requires compassion for patients, can display more compassion
people to co-operate, be generous and treat colleagues towards each other. Junior doctors become too concerned
with understanding. Recent discussions have highlighted to call colleagues to refer a patient because of fear of how
the need for a kinder Australian health system which they will respond. As a profession, we have become too
will help to improve the wellbeing of our colleagues and judgemental of our peers.
their patients.3
Surgeons blame anaesthetists for the speed of turnovers
Medical practitioners often use ISBAR (Introduction, during an operating list, while anaesthetists joke that
Situation, Background, Assessment and surgeons operate too slowly. In a landscape where we
Recommendation) to guide clinical handover.4 This tool need to build trust among each other, how does this
aims to improve patient safety by providing a systematic commentary and innuendo help? A divisive workplace
approach to patient handover.5 The focus is on the does not engender collegiality and support. Collegiality
clinical content, rather than the manner in which the is crucial to our profession and instrumental in allowing
handover is delivered. We suggest a greater emphasis on us to perform efficiently, excel in patient care and be
kindness, trust and respect, with the aim of improving perceived as kind, cohesive and compassionate by our
collegiality. Hence, a new acronym: “K-ISBAR”. At every patients.
handover, doctors can display kindness (utilising
empathy and understanding) towards each other, which Working in the emergency department (ED) can be
may slowly rebuild our collegiality. draining. A full waiting room, sick patients without a clear
diagnosis, anxious parents and patients; the list of
We should all be more reflective in our behaviour towards stressors must seem endless. ED staff are constantly
our colleagues, putting ourselves in their shoes and judged on their standard of care and are expected to be
modelling our language and behaviour on what we forever kind and compassionate. General practitioners do
would expect to receive. How should an intensive care not have the luxury of point-of-care investigations and
physician respond to a tired surgeon asking to admit a working into the evening. They are constantly waiting
patient to an intensive care unit (ICU) already at capacity? for results and opinions. And yet, these two disciplines
must communicate effectively. This cannot happen if
We have all been guilty of uttering critical they speak ill of each other and fail to respect the work
10 December 2018

David J
Brewster1,2 colloquialisms in the workplace that resist positive done on the other side of their telephone.
interdisciplinary relationships. Unfortunately, our
Bruce P Waxman3 Changing negative culture requires a focal point and
apprentice junior doctors adopt these expressions that
should start at handover. A kind handover needs to occur
1 Cabrini Clinical School, promote lack of collegiality. Doctors learn to criticise
Monash University, at all points throughout the patient’s time in hospital,
and blame each other, rather than understand the
Melbourne, VIC. between the GP and ED staff, physicians and surgeons,
differences we all face in providing the best care to
and finally within handover back to the GP. This kind
j

2 Cabrini Health,
MJA 209 (11)

Melbourne, VIC. our patients.

3 School of Clinical
handover can follow the structured clinical framework of
Sciences at Monash Constant negative commentary cannot create a positive ISBAR, while acknowledging the assistance of the
Health, Monash
University, workplace environment. Surgeons may say to their receiving practitioner and being thankful for their
Melbourne, VIC. registrars “ICU is being unreasonable and won’t take ongoing care. Mistakes in diagnosis and treatment can be
dbrewster@cabrini. our patient” and intensive care physicians mutter “that discussed openly without fear of prejudice or criticism
com.au rude surgeon is too busy to come and talk to the family from the receiving practitioner, as should requests for
482 themselves”. There is rarely truth in any of these procedures. Indeed, humility and insight are important
doi: 10.5694/mja18.00755 comments. Surely our profession, which prides itself on adjuncts to acts of kindness.
 Reflection
So, what do acts of kindness look like at handover? after a tough night in theatre if they would like a cup
They can be as simple as saying thank you. A surgeon can of tea.
thank an intensive care physician for making a bed
available for their patient in the ICU; the intensive care Throughout our medical careers, we should never shy
physician can reply in kind by thanking the surgeon for away from dealing with each other in a kind and
talking to the patient’s family. compassionate way. We challenge all Australian doctors
to now consciously hand over with kindness. It may help
Kindness can be a compliment, acknowledging the work us create the culture of respect and trust required in our
of the referring practitioner and the potential barriers they workplace. Reflect on your own behaviour and be kind to
have faced in helping you. A surgeon can say to the doctor your colleagues. Use K-ISBAR, to improve collegiality
in the ED, “I really appreciated you organising the with kindness as the catalyst and clinical handover as
cardiologist to review the patient when you were so busy. the tool.
Thank you.”
Acknowledgements: We thank Dr Malcolm Clark for his contribution to an earlier draft of
Kindness can be how we use our body language. A this article.
genuine smile goes a long way and can ease the
Competing interests: No relevant disclosures.
anxiety of your colleague during handover, especially
when your colleague may feel the referral has been Provenance: Not commissioned; not externally peer reviewed. n
delayed or their initial treatment has not been helpful. ª 2018 AMPCo Pty Ltd. Produced with Elsevier B.V. All rights reserved.
Kindness can be acts of thoughtfulness and generosity,
such as an intensive care physician asking a surgeon References are available online at www.mja.com.au.

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 Reflection
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(viewed Oct 2018). www.safetyandquality.gov.au/wp-content/
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