Table 3 Stages of resilience (adapted from Hollnagel et al1) applied to the three key handover elements
Resilience stageExplanationKey handover elements
1. Information2. Responsibility/accountability3. System
1. “Reactive (or brittle with no resilience)This is about response and knowing what to do to respond to failuresFor example, standardised but not tailored formats (ie, reducing flexibility)For example, wide acceptance of not completing handovers after pagers interrupt handover updatesFor example, absence or incomplete staff rotas for handover
2. “Interactive (or robust with partial resilience)This is about attention and knowing what to look forFor example, provide easy access to extra information, if neededFor example, provide an opportunity for receiving team to seek clarificationFor example, designated handover times and areas
3. “Proactive (or resilient with full resilience)This is about anticipation and knowing what to expect before it disrupts systemFor example, triage or clinical review (ie, cross-check decision, not just transfer)For example, official sign-off and escalation policies for common understandingFor example, designing the system so that the incoming person in a handover has to update the incoming supervisor while the outgoing person listens to ensure accuracy