SPECIALITY FEAPRACTICAL PROBLEMSTURE
What drives a
good handover?
What can we learn from the Ferrari Formula 1 team and the civil aviation and
oil industries? How to perform better handovers, says Dr Ken Catchpole
from the University of Oxford, whose research received international acclaim
S
afety and quality situation in which humans management of a patient. great deal of ad-hoc variation
in healthcare are can excel. We can’t change Patients can experience – or in the overall success
rarely out of the our human nature and can many changes in care team of the handover. While an
spotlight. Seven years only improve on specific over a day, and successive acceptable standard was
ago, having worked in a abilities, such as surgical skill, poor handovers can lead to implied by everyone, there
range of industries, I was through hard and expensive a “Chinese whispers” effect appeared to be only a
invited to research errors in training, which may not where information becomes minimal level of agreement
surgical care. Since then, always be successful. continually degraded or on what that was. We
progress has been made However, we can more changed. Perhaps of less recognised the complexity
to understnd why patients easily influence the things importance for an individual and detail required for a
do not always receive the we do and the places we patient, but of enormous good transition of care,
most optimal treatment. work in – it is these that we importance to clinicians, is and the need for that to
By taking a new should focus on to generate how a good or bad handover be efficient and as smooth
perspective on every day the best handovers. can make you feel. and error-free as possible,
work and challenges faced It is extremely stressful which was made harder
by clinicians, my team
Why are good
if you’re not sure whether by time pressures, staffing,
and I have been able to handovers crucial? the information you have interruptions and distractions.
demonstrate that substantial been given is correct and,
improvements are possible. A handover is a transition of over time and hundreds
Identifying the
Furthermore, if we can take care: either between shifts, of patients, this can have problem
basic lessons and apply them where the patients remain an insidious effect on
across the healthcare system, in the same place but the teams and individuals. The most important first
fundamental improvements care team changes; between stage was to stand back and
can be achieved in the care phases of care, where both
Researching
observe handovers, asking
of patients, the cost of care the patient and the care team handovers “is this the best it can be?
delivery, and the working lives change, such as a handover And if not why not?” and
of healthcare practitioners. between wards; or between I became involved in getting staff to identify the
The reasons why community and hospital. handover research at problems they experienced.
catastrophic errors, or When continuity of care Great Ormond Street It is surprising how we
even small ones, happen was the responsibility of a hospital, where our work in accept the everyday hiccups
are identical wherever small team who knew each understanding surgical safety as part of our working lives.
you find them – a number other and their patients found that the handover Consequently, videoing
of everyday problems well, transitions could of patients from surgery to handovers and then viewing
gather together in a limited be easy and ad-hoc. intensive care was one of the them can be extremely
time or space, to create However, as the weakest parts of the system. enlightening for everyone. By
situations that predispose organisation of healthcare Since a handover is a getting this new perspective,
injury or catastrophe. has changed, so have transfer of responsibility, we were able to focus
Though healthcare differs the requirements for one of the most important on the inherent problems
in many contextual and effective handover. questions we first asked in our own work that we
operational respects, human If we don’t get it right, was “who is responsible?” could change, rather than
abilities, in an evolutionary our patients simply won’t This was not always clear, helplessly railing against
sense, are identical. get the care or attention even though a handover is the things we couldn’t.
We know that success they need. Though this a transfer of responsibility.
in a motor race, an aircraft, won’t always lead to We also recognised
Finding a solution
an oil rig or a hospital isn’t disaster, a poor handover that handovers were not
just about trying harder – can have a significant consistent, either in what However, finding the problem
it’s about finding the best downstream impact on the was done – there was a is the easy part. Generating
8 NEW DOCTOR | VOLUME 3 - ISSUE 1 | 2010 www.mps.org.uk
Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16