Although hospitals continue to develop tools to structure patient handoffs and improve communication transfer, numerous facilities still struggle to reduce medical errors after implementing these initiatives, calling for a need to improve these processes in the long-term, two authors argue in a Harvard Business Review article.
Margaret Luciano, PhD, assistant professor in the WP Carey School of Business at Tempe-based Arizona State University and Bob Dent, DNP, RN, senior vice president, COO and Chief Nursing Officer at Midland (Texas) Memorial Hospital, discuss this issue, noting long-term improvements from Midland Memorial Hospital's initiative to improve hospital staff communication.
Here are seven insights from the article.
1. Midland Memorial Hospital leaders noticed communication issues in the hospital's perioperative unit, where the majority of patient handoffs had missing information at some level. Although the missing information was not always critically important or time-sensitive, such as patient age being more likely to be omitted than patient drug allergies, the incomplete handoffs delayed patient care and led to important information being lost.
2. To address this problem, hospital administrators implemented TeamSTEPPS in 2012, which is a commonly used set of evidence-based strategies and tools for improving communication among providers. The tools included paper checklists and mnemonic devices. The hospital required staff, including surgeons, anesthesia providers, nurses, technicians and other perioperative unit providers, to receive training for the program.
3. Although the program initially appeared to be successful, within several months, only some care providers were using the new checklists and communication techniques. Additionally, nurses reported over 20 percent of patient handoffs still had missing information by the end of 2013.
4. To establish a more systematic, long-term approach for improving patient handoffs from the operating room to the post-anesthesia care unit, the authors started working with management and staff in the perioperative unit in 2014. "We knew that a checklist and one-time training wouldn't produce sustainable change, so we created a plan with six stages: 1) preparing, 2) launching, 3) adjusting, 4) boosting, 5) formalizing, and 6) refreshing."
5. The six-stage approach worked to engage management and staff throughout the change and took in their feedback. During each stage of the process, perioperative unit managers and care providers performing the handoffs had to learn and execute their tasks while openly communicating and evaluating how effective the initiative was. "The core idea was that managers and staff would systematically work together to change their behaviors and work processes, rather than working in a limited and idiosyncratic fashion," the authors noted.
6. The handoff improvement program successfully decreased how many handoffs had missing or inaccurate information, and the hospital's team is keeping up with these improvements. Nearly three years after the program launched, staff members report they "follow a standardized method of sharing information when handing off patients," the authors noted. Additionally, managers suggest the percentage of handoffs with missing or inaccurate information is consistently less than 10 percent.
7. "Ultimately, patient handoffs are one of many areas for quality improvement in healthcare, and a similarly structured approach may help with other initiative," the authors wrote. For the authors, success depends on viewing change as a process as opposed to an event, engaging management and staff members and using quality indicators to evaluate the initiative across all stages. "Healthcare organizations have an important opportunity to improve the quality of patient care, but they have to make their efforts last."