Clinical handover as an interactive event: Informational and interactional communication strategies in effective shift-change handovers
Issue: Vol 9 No. 3 (2012)
Journal: Communication & Medicine
Clinical handover – the transfer between clinicians of responsibility and accountability for patients and their care (AMA 2006) – is a pivotal and high-risk communicative event in hospital practice. Studies focusing on critical incidents, mortality, risk and patient harm in hospitals have highlighted ineffective communication – including incomplete and unstructured clinical handovers – as a major contributing factor (NSW Health 2005; ACSQHC 2010). In Australia, as internationally, Health Departments and hospital management have responded by introducing standardised handover communication protocols. This paper problematises one such protocol – the ISBAR tool – and argues that the narrow understanding of communication on which such protocols are based may seriously constrain their ability to shape effective handovers. Based on analysis of audio-recorded shift-change clinical handovers between medical staff, we argue that handover communication must be conceptualised as inherently interactive and that attempts to describe, model and teach handover practice must recognise both informational and interactive communication strategies. By comparing the communicative performance of participants in authentic handover events we identify communication strategies that are more and less likely to lead to an effective handover and demonstrate the importance of focusing close up on communication to improve the quality and safety of healthcare interactions.
Author: Suzanne Eggins, Diana Slade
ACSQHC (2010) OSSIE Guide to Clinical Handover Improvement. Sydney: Australian Commission for Safety and Quality in Health Care. Available from: http://www.safetyandquality.gov.au/internet/safety/publishing.nsf/content/PriorityProgram-05#
Arora, V., Johnson, J., Lovinger, D., Humphrey, H. J., Meltzer, D. O. (2005) Communication failures in patient sign-out and suggestions for improvement: A critical incident analysis. Quality and Safety in Health Care 14: 401–407.
AMA (2006) AMA Clinical Handover Guide: Safe Handover Safe Patients. Sydney: Australian Medical Association. Retrieved from http://ama.com.au/node/4064
Behara, R., Wears, R., Perry, S., Eisenberg, E., Murphy L., Vanderhoef, M., Shapiro, M., Beach, C., Croskerry, P., Cosby, K. (2005) A conceptual framework for studying the safety of transitions in emergency care. In K. Henriksen, J. B. Battles, E. S. Marks and D. I. Lewin (eds) Advances in Patient Safety: From Research to Implementation, Volume 2: Concepts and Methodology, 309–321. Rockville: Agency for Healthcare Research and Quality.
Bomba, D. T. and Prakash, R. (2005) A description of handover processes in an Australian public hospital. Australian Health Review 29 (1): 68–79. http://dx.doi.org/10.1071/AH050068
ECCHo (2012) Effective Clinical Communication in Handover (ECCHo) project description. Sydney: University of Technology Sydney. Retrieved from http://datasearch2.uts.edu.au/research/news/detail.cfm?ItemId=29030
Eggins, S. (2004) An Introduction to Systemic Functional Linguistics. 2nd edn. London: Continuum.
Eggins, S. and Slade, D. (1997/2004) Analysing Casual Conversation. London: Equinox.
Eggins, S. and Slade, D. (under review) Contrasting Verbal Styles and Barriers to Patient Participation in Bedside Nursing Handovers.
Eggins, S. and Slade, D. (in preparation) Evaluating a training intervention to improve bedside nursing handovers.
Garfinkel, H. (1967) Studies in Ethnomethodology. Englewood Cliffs, NJ: Prentice Hall,
Garfinkel, H. (2006) Seeing Sociologically: Routine Grounds of Social Action. Colorado: Paradigm Publishers.
Halliday, M. A. K. (1978) Language as Social Semiotic. London: Edward Arnold.
Halliday, M. A. K. and Matthiessen, C. M. I. M. (2004) An Introduction to Functional Grammar. London: Edward Arnold.
Heritage, J. and Clayman, S. (2010) Talk in Action – Interactions, Identities and Institutions. Chichester: Wiley-Blackwell.
Levinson, S. (1979) Activity types and language. Linguistics 17: 365–399. http://dx.doi.org/10.1515/ling.1979.17.5-6.365
Manias, E., Jorm, C., White, S. and Kaneen, T. (2008) Handover. How is patient care transferred safely? Chapter 5 in Final Report of the Australian Commission on Safety & Quality in Healthcare: Windows into Safety and Quality in Health Care. Sydney: Australian Commission on Safety & Quality in Healthcare. Retrieved from http://www.health.gov.au/internet/safety/publishing.nsf/Content/windows-into-safety-and-quality-in-health-care-2008
McFetridge, B., Gillespie, M., Goode, D. and Melby, V. (2007) An exploration of the handover process of critically ill patients between nursing staff from the emergency department and the intensive care unit. Nursing in Critical Care 12: 261–269. http://dx.doi.org/10.1111/j.1478-5153.2007.00244.x
McGregor, J., Lee, M., Slade, D. and Dunston, R. (2011) Effective Clinical Handover Communication: Improving Patient Safety, Experiences and Outcomes. Sydney: University of Technology Sydney.
NSW Health (2005) Clinical Services Redesign Program: Redesigning a Better Patient Journey. Sydney: New South Wales Department of Health.
NSW Health (2010) Improving Junior Medical Officer (JMO) Clinical Handover at all Shift Changes: Clinician’s Summary. Sydney: NSW Department of Health.
Patterson, E. (2007) Structuring flexibility: The potential good, bad and ugly in standardisation of handovers. Quality and Safety in Health Care 17 (1): 4–5. http://dx.doi.org/10.1136/qshc.2007.022772
Patterson, E., Roth, E., Woods, D., Chow, R. and Gomes, J. (2004) Handoff strategies in settings with high consequences for failure: Lessons for health care operations. International Journal for Quality in Health Care 16 (2): 125–132. http://dx.doi.org/10.1093/intqhc/mzh026
Sacks, H. (1984) Notes on methodology. In J. M. Atkinson and J. Heritage (eds) Structures of Social Action, 21–27. Cambridge: Cambridge University Press.
Sacks, H. (1992) Lectures on Conversation. Volumes 1 and 2. Oxford: Blackwell.
Sacks, H., Schegloff, E. and Jefferson, G. (1974) A simplest systematics for the organization of turn-taking for conversation. Language 50 (4): 696–735. http://dx.doi.org/10.2307/412243
Schegloff, E. (1981) Discourse as an interactional achievement: Some uses of ‘Uh huh’ and other things that come between sentences. In D. Tannen (ed.) Analyzing Discourse: Text and Talk, 71–93. Washington, DC: Georgetown University Press.
Schegloff, E. and Sacks, H. (1974) Opening up closings. In R. Turner (ed.) Ethnomethodology, 233–264. Harmondsworth: Penguin.
Slade, D., Manidis, M., McGregor, M., Scheeres, H., Stein-Parbury, J., Dunston, R., Stanton, N., Chandler, E., Matthiessen, C. and Herke, M. (2011) Communicating in Hospital Emergency Departments. Sydney: University of Technology Sydney. Executive summary and full report available at www.rilc.uts.edu.au/projects/emergency-communication.html.
WHO (2007) Conceptual Framework for the International Classification for Patient Safety Version 1.0 for Use in Field Testing. World Health Organisation. Retrieved from http://www.who.int/patientsafety/implementation/taxonomy/en/.
Wong, M. C., Yee, K. C. and Turner, P. (2008) A Structured Evidence-Based Literature Review regarding the Effectiveness of Improvement Interventions in Clinical Handover. The eHealth Services Research Group University of Tasmania for the Australian Commission on Safety and Quality in Healthcare. Retrieved from http://www.safetyandquality.gov.au/internet/safety/publishing.nsf/Content/PriorityProgram-05
Yates, J. and Orlikowski, W. (1992) Genres of organizational communication: A structurational approach to studying communication and media. The Academy of Management Review 17 (2): 299–326.
Ye, K., Taylor, D. M., Knott, J. C., Dent, A. and MacBean, C. E. (2007) Handover in the emergency department: Deﬁciencies and adverse effects. Emergency Medicine Australasia 19 (5): 433–441. http://dx.doi.org/10.1111/j.1742-6723.2007.00984.x