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The ins and outs of change of shift handoffs between nurses: a communication challenge
  1. John S Carroll1,
  2. Michele Williams2,
  3. Theresa M Gallivan3
  1. 1MIT, Sloan School of Management, Cambridge, Massachusetts, USA
  2. 2Industrial and Labor Relations School, Cornell University, Ithaca, New York, USA
  3. 3Patient Care Services, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Professor John S Carroll, MIT, Sloan School of Management, 100 Main St, E62-318, Cambridge 02142, MA, USA; jcarroll{at}


Background Communication breakdowns have been identified as a source of problems in complex work settings such as hospital-based healthcare.

Methods The authors conducted a multi-method study of change of shift handoffs between nurses, including interviews, survey, audio taping and direct observation of handoffs, posthandoff questionnaires, and archival coding of clinical records.

Results The authors found considerable variability across units, nurses and, surprisingly, roles. Incoming and outgoing nurses had different expectations for a good handoff: incoming nurses wanted a conversation with questions and eye contact, whereas outgoing nurses wanted to tell their story without interruptions. More experienced nurses abbreviated their reports when incoming nurses knew the patient, but the incoming nurses responded with a large number of questions, creating a contest for control. Nurses' ratings did not correspond to expert ratings of information adequacy, suggesting that nurses consider other functions of handoffs beyond information processing, such as social interaction and learning.

Discussion These results suggest that variability across roles as information provider versus receiver and experience level (as well as across individual and organisational contexts) are reasons why improvement efforts directed at standardising and improving handoffs have been challenging in nursing and in other healthcare professions as well.

  • Safety culture
  • decision making
  • transitions in care
  • patient safety
  • significant event analysis
  • critical incident review

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  • Funding The work was supported by a seed grant for exploratory research from CRICO/RMF (part of Partners hospitals), but they had no role in the design and conduct of the studies.

  • Competing interests None.

  • Ethics approval Ethics approval was approved by Massachusetts General Hospital

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

  • Data sharing statement There are some additional data from the preobservation questionnaire that is intended to be in another paper, so it is not available at present. The only other data available from this paper are either highly redundant or not very useful. Contact John S Carroll for any requests.

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