BMJ Qual Saf 20:941-946 doi:10.1136/bmjqs.2010.050450
  • Original research

Barriers and strategies for improving communication between inpatient and outpatient mental health clinicians

  1. Richard C Hermann5,6
  1. 1HSR&D Center for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Healthcare System, Sepulveda, California, USA
  2. 2UCLA Semel Institute Center for Health Services and Society, University of California Los Angeles, Los Angeles, CA, USA
  3. 3Mental Health and Behavioral Science, Miami VA Healthcare System, Miami, Florida, USA
  4. 4Psychiatry and Behavioral Science, University of Miami, Miami, Florida, USA
  5. 5Institute for Clinical Research & Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
  6. 6Center for Organization, Leadership & Management Research (COLMR), VA Boston Healthcare System, Boston, Massachusetts, USA
  1. Correspondence to Dr Susan E Stockdale, HSR&D Center for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Healthcare System, 16111 Plummer Street, Building 25, Room A-103, Sepulveda, CA 91343, USA; susan.stockdale{at}
  • Accepted 23 April 2011
  • Published Online First 23 May 2011


Objectives To explore hospital leaders' perceptions of organisational factors as barriers and/or facilitators in improving inpatient–outpatient (IP–OP) communication.

Design Semistructured in-person interviews.

Analysis Constant comparative method of qualitative data.

Setting Inpatient psychiatry units in 33 general medical/surgical and specialty psychiatric hospitals in California and Massachusetts (USA).

Participants Psychiatry chair/chief, service director or medical director.

Variables Importance to leadership, resources, organisational structure and culture.

Results A majority of hospital leaders rated the IP–OP communication objective as highly or moderately important. Hospitals with good IP–OP communication had structures in place to support communication or had changed/implemented new procedures to enhance communication, and anticipated clinicians would ‘buy in’ to the goal of improved communication. Hospitals reporting no improvement efforts were less likely to have structures supporting IP–OP communication, anticipated resistance among clinicians and reported a need for technological resources such as electronic health records, integrated IT and secure online communication. Most leaders reported a need for additional staff time and information, knowledge or data.

Conclusions For many hospitals, successfully improving communication will require overcoming organisational barriers such as cultures not conducive to change and lack of resources and infrastructure. Creating a culture that values communication at discharge may help improve outcomes following hospitalisation, but changes in healthcare delivery in the past few decades may necessitate new strategies or changes at the systems level to address barriers to effective communication.


  • Funding This research was supported by grants from the National Institute of Mental Health (R34 MH074788, PI: R. Hermann; P30 MH082760, PI: K. Wells; P30 MH068639, PI: K. Wells).

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the UCLA and Tufts University-New England Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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