Generic Handover Investigation (GHandI)
Lead Research Organisation:
City, University of London
Department Name: Centre for HCI Design
Abstract
Handover of responsibility for a system from one individual or team to another makes a vital contribution to the safety and effectiveness of the work. Poor handovers have been identified as contributory causal factors in high profile disasters such as the Piper Alpha Disaster. Recently, handovers in the healthcare sector have come under scrutiny with the implementation in 2004 of the European Working Time Directive, which resulted in the introduction of shift working for junior hospital doctors in order to reduce their working hours. This saw a corresponding increase in the frequency of shift changeovers and made effective clinical handover all the more imperative. Yet current practice is highly variable: it varies from ward to ward and hospital to hospital. Handovers are often impromptu, informal and supported by ad hoc artefacts such as paper-based notes. This is a reflection of the fact that there has been surprisingly little research into this crucial aspect of patient safety.While there have been small-scale studies of clinical handover in specific settings, including our own study of a paediatric ward on the ACE project, there is a lack of basic research. We will address this shortcoming in the GHandI project with an extensive investigation of handover as it is only by achieving a clear understanding of the 'work' that handover accomplishes that we will be able to improve the practice. For example, there is evidence that handover contributes to patient safety by accomplishing work other than the immediate transfer of responsibility for care of the patient. It is within this context that the current proposal is situated, the overall aim of which is to conduct a detailed investigation of clinical handover and its contribution to patient safety by developing and evaluating a generic theoretical model of handover and deriving detailed recommendations and prototypes for innovative handover support technology. This is decomposed into the following objectives:1. To develop a generic model of clinical handover from a socio-technical system perspective that will capture its many commonalities and variations. This will be achieved at both practical and theoretical levels.2. To design and evaluate prototypes for innovative handover support technologies, integrating results from 1 and 3.3. To investigate the role of simple codes and graphic languages in improving communication and reducing ambiguity in information resources used in clinical handover.4. To investigate the nature of an effective handover and determine how this can be measured.In order to ground the modelling and design activities in a genuine understanding of the work, we will undertake a detailed study of clinical handover in a range of very different settings. With the support of our collaborators, we plan to study handovers in ten clinical settings, ranging from ambulance 'retrieval' services to inter-specialty transfers to shift handovers in paediatric intensive care units. This in itself will be an important contribution from GHandI.The outcomes of this research will be of direct benefit to the healthcare sector, both the field study settings and the NHS more generally. They will benefit from an improved understanding of handover, from guidance on effective practice and from the prototype handover technologies. Improved handovers will enhance patient safety, and therefore the quality of life, and improved working practices will be of benefit to clinical staff. The results, particularly the modelling work, will also be of relevance to other critical domains where handovers between operators make an important contribution to the safety and effectiveness of the work, e.g. the continuous process industries. Finally, the HCI and CSCW academic communities will benefit from the theoretical modelling work, from the detailed study of this particular form of collaborative work and from the investigation of graphical communication tools.
Publications
Galliers J
(2011)
Safe use of symbols in handover documentation for medical teams
in Behaviour & Information Technology
Randell R
(2011)
The importance of the verbal shift handover report: a multi-site case study.
in International journal of medical informatics
Randell R
(2010)
Variations and Commonalities in Processes of Collaboration: The Need for Multi-Site Workplace Studies
in Computer Supported Cooperative Work (CSCW)
Randell R
(2010)
Editorial - Evaluating New Interactions in Health Care: Challenges and Approaches
in International Journal of Human-Computer Interaction
Randell R
(2011)
The ConStratO model of handover: a tool to support technology design and evaluation
in Behaviour & Information Technology
Randell R
(2009)
Evaluating new interactions in healthcare
Randell R
(2010)
Beyond handover: supporting awareness for continuous coverage
in Cognition, Technology & Work
Description | The GHandI project focused on an important area of healthcare practice: the collaboration and communication activities that constitute clinical handover. The overall aim was to conduct a detailed investigation of clinical handover and its contribution to effective patient care. GHandI undertook an ambitious and successful programme of work, with a particularly strong focus on field work and on developing technology to support handover. The project achieved the following outcomes: • Field studies of clinical handover were undertaken in nine healthcare settings, ranging from an ambulance transport service, to an emergency assessment unit, and a post-natal ward. Cognitive landscapes and conceptual models of handover were developed for each of the main settings; these highlighted the distribution of information, the roles and affordances of handover artefacts (e.g. paper notes, whiteboards) and details of local practice. • Handover has tended to be regarded as a baton-passing activity in which there is a single point of transfer of responsibility and information. Drawing on the field work, we reconceptualised handover as a process and its attendant information sharing as an on-going activity that promotes good clinical situation awareness (Wilson et al, 2009). • A generic, conceptual model of handover (the ConStratO model) was synthesised to describe the commonalities and variations in handover across settings (Randell et al, 2011). The model reveals how variations in handover are grounded in the context and identifies the trade-offs inherent in various handover strategies. • We designed, implemented and evaluated PaperChain, a novel ICT system to support handover (Wilson et al, 2010). PaperChain uses a combination of digital pens/paper and shared displays to provide light-weight data capture and sharing of information in (almost) real-time across geographically distributed clinical staff. PaperChain was deployed in August 2009 at the Children's Acute Transport Service (CATS) and later at the Cardiac Paediatric Intensive Care Unit at Great Ormond Street Hospital for Children and remained in routine daily use until the project concluded in April 2010. We are now licensing the software to CATS. Sponsorship for the digital pens / paper was provided by Digital Field Solutions Ltd. • A qualitative analysis was undertaken of the use of graphic symbols and codes in handover. This was extended with an experimental study to investigate ambiguity and understanding of the symbology (Galliers et al, 2011). • Recommendations for good practice in handover were synthesised from the project results. Galliers J, Wilson S, Randall R, and Woodward P (2011) Safe use of symbols in handover documentation for medical teams, Behaviour and Information Technology, 30(4), pp. 499-506. Randell R, Wilson S, Woodward P and Galliers J (2011) The ConStratO model of handover: a tool to support technology design and evaluation, Behaviour and Information Technology, 30(4), 489-498. Wilson S, Woodward P and Randell R (2010) PaperChain: A Collaborative Healthcare System Grounded in Field Study Work,. Proc. WISH 2010. Wilson S, Randell R, Galliers J and Woodward P. (2009) Reconceptualising Clinical Handover: Information Sharing for Situation Awareness, Proceedings European Conference on Cognitive Ergonomics, ECCE 2009, 315-322. |
Exploitation Route | Briefly, the findings might be taken forward in the following ways: • The reconceptualisation of handover might influence standards and procedures locally and nationally. • Findings regarding the symbols used in handover documentation might be exploited in local and national protocols for handover. • Recommendations for handover might influence standards and protocols. • New technology to support handovers in distributed healthcare settings might be exploited in the specific setting that we worked with, as well as more widely. |
Sectors | Digital/Communication/Information Technologies (including Software) Healthcare |
Description | 1. The project delivered a robust prototype system called PaperChain for supporting handover at one of the research sites. 2. The modelling and reconceptualisation findings formed the basis for subsequent research commissioned by NHS Connecting for Health (CfH) and contributed to guidance issued by CfH. |
First Year Of Impact | 2009 |
Sector | Digital/Communication/Information Technologies (including Software),Healthcare |
Impact Types | Societal |
Description | An investigation of the impact of novel hardware solutions on the interaction between clinicians and patients in health care consultations |
Amount | £5,000 (GBP) |
Organisation | City, University of London |
Sector | Academic/University |
Country | United Kingdom |
Start | 11/2008 |
End | 12/2009 |
Description | Safer Handover |
Amount | £39,150 (GBP) |
Organisation | NHS England |
Department | Connecting for Health (CFH) |
Sector | Public |
Country | United Kingdom |
Start | 01/2009 |
End | 07/2009 |
Description | Collaboration with CATS |
Organisation | Great Ormond Street Hospital (GOSH) |
Department | Children's Acute Transport Service (CATS) |
Country | United Kingdom |
Sector | Hospitals |
PI Contribution | Technical expertise. PaperChain software application. |
Collaborator Contribution | Clinical expertise. Opportunities to collect data in clinical settings. Evaluations of software prototypes. |
Impact | Outputs: PaperChain Software application; models of clinical handover; guidance on use of symbols in handover documentation. Multi-disciplinary. |
Start Year | 2007 |
Description | Collaboration with DFS |
Organisation | Digital Field Solutions |
Country | United Kingdom |
Sector | Private |
PI Contribution | PaperChain software application for sharing information between distributed healthcare teams. Specifically the web-based interface. |
Collaborator Contribution | Digital paper technology and infrastructure. |
Impact | PaperChain handover software application |
Start Year | 2009 |
Description | Handover Workshop at ECSCW 2007 |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Postgraduate students |
Results and Impact | Workshop to share latest research developments regarding effective clinical handover. |
Year(s) Of Engagement Activity | 2007 |
Description | Pan Thames PICU Commissioning Consortium Meetings |
Form Of Engagement Activity | A formal working group, expert panel or dialogue |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Professional Practitioners |
Results and Impact | Shared information. n/a |
Year(s) Of Engagement Activity | 2007,2008 |
Description | Research Presentation: Healthcare Events 2011 |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | Interest and new contacts. New research contacts. Profile raising. |
Year(s) Of Engagement Activity | 2011 |
Description | Research Presentation: National Patient Safety Agency |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | Sparked questions and discussion. Raised profile. Disseminate information about research findings. |
Year(s) Of Engagement Activity | 2009 |
Description | Royal College of Physicians Workshop on Records Standards for Clinical Handover and Discharge |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | Discussion on handover standards. n/a |
Year(s) Of Engagement Activity | 2007 |
Description | Workshop: Evaluating New Interactions in Healthcare |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Other audiences |
Results and Impact | A workshop at the international CHI 2009 conference. |
Year(s) Of Engagement Activity | 2009 |