Presented September 3, 2025 at the 2025 APSF Stoelting Conference on “Transforming Maternal Care: Innovations and Collaborations to Reduce Morbidity and Mortality”
SUMMARY
May Pian-Smith, MD, MS’s presentation emphasizes that communication and trust are the essential, often-missing components needed to translate safety initiatives and best practices into scalable, impactful solutions in maternal care. Lapses in communication frequently precede adverse events, often because team members are self-censoring vital information due to a lack of psychological safety. She introduces the concept of Relational Coordination as a framework to intentionally foster high-quality communication and relationships within healthcare teams, which has been shown to improve clinical and operational outcomes. The ultimate goal is to apply these principles to patient interactions using the Platinum Rule—treating others as they would like to be treated—to build rapid trust and enhance equitable care access.
Key Points:
- Communication as a Root Cause of Error
Lapses in communication are a common theme in case reviews of adverse events [03:01]. In many instances, a team member knew something was wrong but failed to speak up (self-censored) due to a greater perceived risk to themselves than to the patient in the moment [03:15, 03:44]. - Psychological Safety and Reporting
The quality of communication is a marker of psychological safety [05:46]. An increase in safety reports indicates a healthier safety culture where team members feel safe to speak up and report errors, leading to opportunities for learning and improvement [06:08]. - Relational Coordination (RC) Framework
RC is a validated social construct that drives better outcomes. It is defined by two interlocking components: High-Quality Communication (frequent, timely, accurate, problem-solving) and High-Quality Relationships (shared goals, shared knowledge, mutual respect) [08:15, 08:32]. - Outcomes of Strong Relational Coordination
Getting RC right improves operational metrics (decreased length of stay, decreased infection rates) and clinician well-being, leading to increased resiliency, decreased burnout, and increased job satisfaction [09:46, 12:15]. Conversely, poor RC leads to worse team performance and decreased adherence to safety protocols [10:48, 11:17]. - The Platinum Rule for Patient Trust
In fast-paced intrapartum care, quickly establishing trust can be achieved through the Platinum Rule: “Treat others as they would like to be treated” [19:08]. This requires a deliberate pause to understand the patient’s values, emotional state, and needs, rather than relying on the Golden Rule [19:15, 19:36]. - Systemic Support for Teaming
Institutions must hardwire communication principles (e.g., closed-loop communication, rapid debriefs) into standard practice. For example, surgeons should explicitly invite team members to speak up during high-risk cases. When a team member does speak up and is wrong, they must still be thanked to encourage future contributions [16:03, 17:09].
ABOUT THE SPEAKER(S)
May Pian-Smith, MD, MS
Associate Professor of Anesthesia,
Harvard Medical School
Senior Obstetric Anesthesiologist,
Mass General Brigham (MGB), Boston, MA
May Pian-Smith, MD, MS is an Associate Professor of Anesthesia at Harvard Medical School, and a senior obstetric anesthesiologist at Mass General Brigham (MGB). Until recently, she served as the MGB Enterprise Director for Anesthesiology Quality and Safety, leading synergies between 14 different hospital sites.
In addition to being a clinically-active expert, she is a grant-funded researcher in the fields of women’s health, education, communication, quality and safety, and safety culture; subjects on which she has published, and lectured nationally and internationally. Pian-Smith’s research that has been funded by the Foundation for Anesthesia Education and Research (FAER) and the Anesthesia Patient Safety Foundation (APSF) has focused on “speaking up” across hierarchical gradients, with the goal of improving education, enhancing the role and responsibility of all members of care teams, and supporting safety culture. She has advanced fellowship training in medical education (Harvard Medical School) and patient safety leadership (NPSF-AHA).
She currently serves on the Board of Directors for APSF, FAER, and for the Society for Obstetric Anesthesia and Perinatology (SOAP) as its Past President.
