What do you notice?

The son ran toward the team with a trembling voice and said, “I think he’s already dead.” His mother was visibly distressed.

The rescue team went inside and began working on the patient, but there was little or no information exchange with the family. The wife and son may have held relevant information about the patient’s condition and what had happened before the team arrived.

The Sufficiency issue: Potentially relevant information remained outside the shared picture.

The physician called the rescue organisation to send an ambulance. He had forgotten that the helicopter had landed directly in front of the house and could return to transport the patient.

The paramedic did not correct the error. We do not know why. He may have made the same error, hierarchy may have played a role, or he may have wondered about the decision but assumed that the physician knew what he was doing.

The rescue operations professional did notice the problem and tried to correct the physician’s cognitive error. But the physician reacted defensively and ended the exchange. The error had been detected — but communication did not allow it to be corrected.

The Accuracy issue: To err is human. Accuracy turns communication into a safety mechanism: what one person gets wrong, another may notice, question and help correct. Here, that safety mechanism was not used competently enough.

When the physician called for an ambulance, we do not know what happened in the paramedic’s mind. Perhaps a Clarity question mark arose in his mind — “Why are we calling an ambulance?” — but he resolved it for himself with something like, “I’m sure he knows what he’s doing.”

If there was a question mark in his mind, it remained there. It was not brought into the conversation.

Later, after the physician ended the telephone exchange, the rescue operations professional was left without the exact coordinates the ambulance needed. She did not call back or otherwise resolve that uncertainty.

The ambulance therefore set out with insufficient clarity about where it needed to go. In the context of an acute heart attack patient, the resulting search delayed its arrival by more than an hour.

The Clarity issue: Clarity turns communication into a safety mechanism by bringing uncertainty into the interaction and working to resolve it. Here, question marks remained in people's minds instead of becoming part of the shared conversation.

Several contextual conditions affected what happened between the people in this case. They were not sufficiently attended to, brought into the interaction or addressed for shared understanding.

FUNCTION: While resuscitating the patient, the physician was moving towards “We’ll stop soon,” while the paramedic was operating from “We have to do everything we can now.” They were pursuing different functional goals, but did not bring that difference into the conversation or establish a shared goal together.

RELATIONSHIP: Professional roles also affected the interaction. When the rescue operations professional questioned the decision to call an ambulance, the physician responded from his position of professional authority: he was the physician and he knew what he was doing. Her different perspective could have helped expose and correct his error, but the exchange was shut down.

ENVIRONMENT: When the team entered the house, they moved a coffee table with medication on it out of the way. The medication was part of the physical environment, but it could also have provided relevant information about the patient and his condition. Its potential significance was never brought into the conversation.

The Contextualisation issue: Context is always present. Contextualisation turns communication into a safety mechanism by recognising what surrounds an interaction and addressing what those conditions are doing to shared understanding. Here, differences in goals, professional roles and information in the physical environment were present, but were not sufficiently worked with through communication.

This case also gives us an example of Interpersonal Adaptation being practised successfully. The pilot saw the visibly distressed wife and let the rescue team out at a safe distance from her. He noticed what she needed in that moment and adapted his behaviour accordingly.

Between the physician and paramedic, this did not happen in the same way. While the paramedic was doing everything to resuscitate the patient, the physician showed increasing resignation. They were not only pursuing different goals; they were also in very different cognitive and emotional places, but neither sufficiently adjusted to what the other person needed communicatively.

These differences became visible in the interaction, but were not sufficiently brought into the communication. Neither appears to have adapted sufficiently to what was happening with the other so that they could work towards a shared understanding of how to proceed.

Their different positions therefore remained unresolved and increasingly contributed to the conflict between them.

The Interpersonal Adaptation issue: No two people have the same cognitive, linguistic or emotional needs. Interpersonal Adaptation turns communication into a safety mechanism by noticing those needs and adjusting to one another as the interaction unfolds. Here, we see both sides: adaptation to another person working — and insufficient adaptation allowing differences between people to interfere with shared understanding and safe action.