co-ordination of clinical handover: a contingency approach manda broekhuis and tanja lips university...
TRANSCRIPT
![Page 1: Co-ordination of clinical handover: a contingency approach Manda Broekhuis and Tanja Lips University of Groningen, University Hospital Groningen The Netherlands](https://reader036.vdocuments.site/reader036/viewer/2022062308/56649f0c5503460f94c1f652/html5/thumbnails/1.jpg)
Co-ordination of clinical handover: a contingency approach Co-ordination of clinical handover: a contingency approach
Manda Broekhuis and Tanja LipsUniversity of Groningen, University Hospital
GroningenThe Netherlands
![Page 2: Co-ordination of clinical handover: a contingency approach Manda Broekhuis and Tanja Lips University of Groningen, University Hospital Groningen The Netherlands](https://reader036.vdocuments.site/reader036/viewer/2022062308/56649f0c5503460f94c1f652/html5/thumbnails/2.jpg)
The definition of clinical handoversThe definition of clinical handovers
• The process of receiving and providing information of a certain patient, in order to provide the right kind of care to this patient
• Subjects:Daily and weekly handoversSupervisionPatient recordLarge ward roundMultidisciplinary handovers
- delineation: handovers between physicians
![Page 3: Co-ordination of clinical handover: a contingency approach Manda Broekhuis and Tanja Lips University of Groningen, University Hospital Groningen The Netherlands](https://reader036.vdocuments.site/reader036/viewer/2022062308/56649f0c5503460f94c1f652/html5/thumbnails/3.jpg)
IntroductionIntroduction
Clinical handover:
Weak link in the chain of the health care processAnd, at the same time,little research on the subject
![Page 4: Co-ordination of clinical handover: a contingency approach Manda Broekhuis and Tanja Lips University of Groningen, University Hospital Groningen The Netherlands](https://reader036.vdocuments.site/reader036/viewer/2022062308/56649f0c5503460f94c1f652/html5/thumbnails/4.jpg)
HandoversHandovers
Federal fuses are the result of years of scientific study combined with the experience of years
![Page 5: Co-ordination of clinical handover: a contingency approach Manda Broekhuis and Tanja Lips University of Groningen, University Hospital Groningen The Netherlands](https://reader036.vdocuments.site/reader036/viewer/2022062308/56649f0c5503460f94c1f652/html5/thumbnails/5.jpg)
Research questions and definitionResearch questions and definition
Research questions:- How does the organization of clinical handovers differ in
different medical departments- Which factors can be identified to explain these differences?
Organization of clinical handovers; some elements distinguished: pattern in daily and weekly handover meetings, degree of formalization, supervision, multidisciplinary handovers
Medical departments: functional grouping
![Page 6: Co-ordination of clinical handover: a contingency approach Manda Broekhuis and Tanja Lips University of Groningen, University Hospital Groningen The Netherlands](https://reader036.vdocuments.site/reader036/viewer/2022062308/56649f0c5503460f94c1f652/html5/thumbnails/6.jpg)
Theoretical frameworkTheoretical framework
• Focus on the intensity in pattern of clinical handovers meetings and degree of formalization
• Tension between accountability (formalization, protocols, patient record) and quality of information transferred and transformed (differences in level of uncertainty, ambiguity and predictability require different information tools)
• Pattern depends on characteristics of - Department: e.g. number of beds and of staff members- Patient flow: e.g. ratio outpatients to inpatients, turnover
rate, predictability of HC process- Patient characteristics: e.g. seriousness of illness,
uncertainty and/or ambiguity in needs
![Page 7: Co-ordination of clinical handover: a contingency approach Manda Broekhuis and Tanja Lips University of Groningen, University Hospital Groningen The Netherlands](https://reader036.vdocuments.site/reader036/viewer/2022062308/56649f0c5503460f94c1f652/html5/thumbnails/7.jpg)
Preliminary propositionsPreliminary propositions
Contingency Intensity Formalization
SizePatiënt flow-Inpatients-Outpatients-Turnover rate-Predictability Patient characteristicsNumber of medical sub specialisms
+
+---+
+
+
No impact+-+-
No impact
![Page 8: Co-ordination of clinical handover: a contingency approach Manda Broekhuis and Tanja Lips University of Groningen, University Hospital Groningen The Netherlands](https://reader036.vdocuments.site/reader036/viewer/2022062308/56649f0c5503460f94c1f652/html5/thumbnails/8.jpg)
University Hospital GroningenUniversity Hospital Groningen
![Page 9: Co-ordination of clinical handover: a contingency approach Manda Broekhuis and Tanja Lips University of Groningen, University Hospital Groningen The Netherlands](https://reader036.vdocuments.site/reader036/viewer/2022062308/56649f0c5503460f94c1f652/html5/thumbnails/9.jpg)
University Hospital GroningenUniversity Hospital Groningen
• 1300 beds • 400,000 outpatient visits• 9900 day care operations• 30,000 admissions• 25,500 surgery • 76.72 occupancy rate• 8300 employees• 22 medical departments, grouped
by specialism
![Page 10: Co-ordination of clinical handover: a contingency approach Manda Broekhuis and Tanja Lips University of Groningen, University Hospital Groningen The Netherlands](https://reader036.vdocuments.site/reader036/viewer/2022062308/56649f0c5503460f94c1f652/html5/thumbnails/10.jpg)
MethodMethod
• See outline• Core activity: 8-13 dialogues between
(a) physicians of the visited unit and (b) committee of physicians of different units
• Reflection, feedback, report, and follow-up (6-9 months later)
• 20 case studies and 17 follow ups • Qualitative analysis of the reports and the
follow-ups
![Page 11: Co-ordination of clinical handover: a contingency approach Manda Broekhuis and Tanja Lips University of Groningen, University Hospital Groningen The Netherlands](https://reader036.vdocuments.site/reader036/viewer/2022062308/56649f0c5503460f94c1f652/html5/thumbnails/11.jpg)
Pattern in organization of handover: example of 3 unitsPattern in organization of handover: example of 3 units
• General surgery: - Daily: 2 * patient discussion, final check- Weekly: 4 * MD meeting, 3 * education/research meetings, closing
the week, indication meeting- Patient record: additional, supportive
• Lung diseases:- Daily: ward round, 2 * patient discussion- Weekly: 3 * MD meeting, large ward round, release discussion,
outpatient discussion- Patient record: additional, supportive
• Special Dentistry and Oral Surgery:- Patient record most important- Daily: 2 * ward round- Weekly: referee meeting, patient discussion
![Page 12: Co-ordination of clinical handover: a contingency approach Manda Broekhuis and Tanja Lips University of Groningen, University Hospital Groningen The Netherlands](https://reader036.vdocuments.site/reader036/viewer/2022062308/56649f0c5503460f94c1f652/html5/thumbnails/12.jpg)
Different departments and unitsDifferent departments and units
General surgery
Lung disease Special dentistry and oral surgery
Large unit (in terms of beds and staff)
Small unit Small unit
Many sub-specialties
Many sub-specialties
Medium number sub-specialties
Medium turnover
Low turnover High turnover
Mix inpatients and outpatients
More inpatients More outpatients
Life threatening and not life threatening
Both Not life threatening
![Page 13: Co-ordination of clinical handover: a contingency approach Manda Broekhuis and Tanja Lips University of Groningen, University Hospital Groningen The Netherlands](https://reader036.vdocuments.site/reader036/viewer/2022062308/56649f0c5503460f94c1f652/html5/thumbnails/13.jpg)
Pattern in organization of handoversPattern in organization of handovers
• The ‘intensity’ in pattern of daily and weekly handovers meetings: substantial confirmation of propositions
• Size (unit level) seems less important than other contingency factors (more patient level)
• Different patient and flow characteristics influence intensity and degree of formalization: seriousness of illness, routine level, level of uncertainty and unpredictability
• Some differentiation to particular patient groups within a department
![Page 14: Co-ordination of clinical handover: a contingency approach Manda Broekhuis and Tanja Lips University of Groningen, University Hospital Groningen The Netherlands](https://reader036.vdocuments.site/reader036/viewer/2022062308/56649f0c5503460f94c1f652/html5/thumbnails/14.jpg)
Additional findingsAdditional findings
- Contingencies seem to be more important than accountability: not always tension
- Objective to transfer and to develop knowledge (patient level and patient group level)
- Importance of ‘soft’ contingencies: quality of the handover instances, motivation to learn, atmosphere, crafting of tasks, age, relevance attached to clinical handovers, trust
- Problem: how to organize handovers if specialization increases
![Page 15: Co-ordination of clinical handover: a contingency approach Manda Broekhuis and Tanja Lips University of Groningen, University Hospital Groningen The Netherlands](https://reader036.vdocuments.site/reader036/viewer/2022062308/56649f0c5503460f94c1f652/html5/thumbnails/15.jpg)
FormalizationFormalization
• Confirmation of propositions
• Accountability: aware, yet hard to put in practice
• Especially patient records used to formalize (pre-fab constructions, tailoring to patient characteristics)
![Page 16: Co-ordination of clinical handover: a contingency approach Manda Broekhuis and Tanja Lips University of Groningen, University Hospital Groningen The Netherlands](https://reader036.vdocuments.site/reader036/viewer/2022062308/56649f0c5503460f94c1f652/html5/thumbnails/16.jpg)
Other finding: organizing supervision of handoversOther finding: organizing supervision of handovers
- Large number of in- and outpatients: free scheduled supervisor
- * Turnover low: weekly schedule* Turnover high: daily schedule
- Large number of subspecialties: how to organize the best supervision? more need for joint meeting, “transactive memory”, good relationships
- Seriousness of illness: more active supervision- Job crafting: physical and psychological accessibility
![Page 17: Co-ordination of clinical handover: a contingency approach Manda Broekhuis and Tanja Lips University of Groningen, University Hospital Groningen The Netherlands](https://reader036.vdocuments.site/reader036/viewer/2022062308/56649f0c5503460f94c1f652/html5/thumbnails/17.jpg)
ConclusionConclusion
• Organizing handovers depends on several variables. Dominant seem to be:
- patient characteristics - flow characteristics- number of subspecialties
• However: organizing handovers is a matter of hard and soft contingencies
• Research used to improve clinical handovers• Next project: developing organization of
handovers in a MD with a patient oriented grouping