Context, culture and (non-verbal) communication affect handover quality

Abstract

Background: Transfers of care, also known as handovers, remain a substantial patient safety risk. Although research on handovers has been done since the 1980s, the science is incomplete. Surprisingly few interventions have been rigorously evaluated and, of those that have, few have resulted in long-term positive change. Researchers, both in medicine and other high reliability industries, agree that face-to-face handovers are the most reliable. It is not clear, however, what the term face-to-face means in actual practice. Objectives: We studied the use of non-verbal behaviours, including gesture, posture, bodily orientation, facial expression, eye contact and physical distance, in the delivery of information during face-toface handovers. Methods: To address this question and study the role of non-verbal behaviour on the quality and accuracy of handovers, we videotaped 52 nursing, medicine and surgery handovers covering 238 patients. Videotapes were analysed using immersion/crystallisation methods of qualitative data analysis. A team of six researchers met weekly for 18 months to view videos together using a consensus-building approach. Consensus was achieved on verbal, non-verbal, and physical themes and patterns observed in the data. Results: We observed four patterns of non-verbal behaviour (NVB) during handovers: (1) joint focus of attention; (2) 'the poker hand'; (3) parallel play and (4) kerbside consultation. In terms of safety, joint focus of attention was deemed to have the best potential for high quality and reliability; however, it occurred infrequently, creating opportunities for education and improvement. Conclusions: Attention to patterns of NVB in face-toface handovers coupled with education and practice can improve quality and reliability.

Clinical handover within the emergency care pathway and the potential risks of clinical handover failure (ECHO): primary research

“…60,65 This would enable better understanding of the risks that arise from handover failures and their underlying causes. Such a broader view might also contribute to understanding why standardisation of communication has not achieved its potential, 47 and it may provide insights as to when and how standardisation could improve handover practice. l The embeddedness of handover in the activities and goals of actors across departments and organisations The second area where further research is required is in understanding handover across organisational boundaries.…”

“…The authors concluded that participants frequently adopted forms of non-verbal behaviour that may result in suboptional transfer of information. 47 Such forms of non-verbal behaviour included holding patient lists or other artefacts in such a way that they could not be seen by the other participant ('poker hand'), not having a joint visual focus ('parallel play') and situations where the person giving the handover was standing while the other party was sitting, which resulted in hurried handovers with fewer questions ('kerbside consultation'). The most productive form of non-verbal behaviour was reported to be the joint focus of attention, where both parties co-ordinate their verbal and visual attention jointly on an object.…”

Clinical Handover among Physicians: A Survey in a North Eastern Italian Academic Hospital

“…It was a hazardous methods of transferring information. A verbal report has the potential weakness of poor retention of information by the receiver, and there may be discrepancies between the reported status and the actual patient status because of memory failure on the part of the reporter (Frankel, 2012). Literature shows that after five handover cycles, only 2.5% of patient information was retained using the verbal-only handover method while 85.5% was retained when using the verbal with note taking method and 99% was retained when a printed handout containing all patient information was used (Bhabra et al, 2007).…”

“…Some studies found that face-to-face handoffs were preferable to those that exclude a face-to-face conversation (Arora et al, 2008;Friesen et al, 2008). In fact many other modalities, besides the written ones, are involved in the handover communication such as paralinguistic features (pitch, pace, intonation, hesitations) and non verbal behaviour including information delivered throughout gesture, posture, bodily orientation, facial expression, eye contact and physical distance (Frankel et al, 2012).…”

“…Computerised tools should be designed to aid communication between doctors, during handover preparation, as well as the handover itself and subsequent activities. These electronic solutions are designed to improve the accuracy of information transfer, but do not take into consideration the behavioural aspects and, therefore, do not always assess all the functions of handover (Frankel et al, 2012).…”