How Nurses Perceive Organizational Climate Surrounding Patient Handoffs in Japanese Hospitals?

Abstract

The aims of the study were to extract organizational climate factors surrounding patient handoffs, and to capture their crucial characteristics in the current Japanese hospital context. A questionnaire survey was conducted between October and December 2017. A total of 5,117 valid responses were collected from nursing staff in 31 general hospitals with a response rate of 69%. The sample collected in 2011, which had 1,462 responses, was also used for comparison with the current data. Seven handoff factors were derived by applying principal component analysis to the 2017 sample with 44% of cumulative variance accounted for. Nursing staff perceived overall handoff adequacy and its elements moderately good. Significantly different views were observed between work units for all the factors. The most negative view was exhibited to information and responsibility continuity by respondents in ED. Regarding information transfer, compared with other intra-hospital handoff cases, information was transferred well in handoffs related to OR and ICU. There were also significant hospital differences in staff perceptions of patient handoff adequacy that the largest difference was identified in training and education. Comparing to six years ago, staff views became significantly more positive, and that the largest improvement was perceived for handoff process, training and education. Sufficiency of information transfer was also improved in the six-year interval. In conclusion, nursing staff perceptions of patient handoff practices and contributing factors have been improved in Japanese hospitals for the last six years, and currently viewed them moderately well. In addition, different views were extracted across work settings.

Appendix 1. Question Items in Section 1

Q1 to Q26 are about handoffs between your department/ward and other departments/wards.

• Q1. Regarding problems discovered during patient handoffs, my department/ward always finds solutions and solves them together with other relevant departments/wards.

• Q2. My department/ward often has views different from others about what information is required for patient handoffs.

• Q3. Current information technology supports patient handoffs well.

• Q4. It is clear to me when responsibility for a patient is transferred.

• Q5. We always receive accurate and updated information in patient handoffs from other departments/wards.

• Q6. I know what role is expected of me in a patient handoff.

• Q7. In my department/ward, new staff members always receive formal training for patient handoffs.

• Q8. We have sufficient time to make an adequate patient handoff.

• Q9. In my department/ward, it is a common practice that staff read back information they received and ask questions regarding unclear parts to ensure that the information is correctly understood.

• Q10. In my department/ward, we are rarely interrupted during patient handoffs.

• Q11. In my department/ward, we sometimes talk about having received too little information in patient handoffs.

• Q12. My department/ward uses patient handoffs as an opportunity for junior staff to learn good clinical practice.

• Q13. In my department/ward, current procedures, guidelines, or instructions for patient handoffs need improvement.

• Q14. It is sometimes unclear who is responsible for a patient after a patient handoff.

• Q15. In my department/ward, patient safety has the highest priority for patient handoffs.

• Q16. In my hospital, the patient handoff process needs improvement.

• Q17. In patient handoffs, we always voice our own concerns and express our own opinions to share understanding with other handoff staff.

• Q18. In my hospital, patient handoffs could be performed more efficiently.

• Q19. We always inform our patients of their planned transfers to other departments/wards whenever they are capable of understanding this.

• Q20. In my department/ward, sometimes we are too busy to attend quickly to a newly received patient.

• Q21. In my department/ward, we always seek to obtain required information from patients themselves or their families.

• Q22. In my department/ward, we usually do not make timely follow-up and support for patient care after patient handoff.

• Q23. Sometimes, the staff conducting a handoff with me is inexperienced or less capable.

• Q24. In patient handoffs, it is a common practice that we discuss about communications with patients/families to understand their complaints.

• Q25. In my department/ward, sometimes we make deviations from procedures or guidelines of patient handoffs.

• Q26. Overall, patient handoffs between departments/wards are conducted well in my hospital.

Q27 to Q34 are about shift handoff

• Q27. In my department/ward, current procedures, guidelines, or instructions for shift handoffs need improvement.

• Q28. In my department/ward, we are rarely interrupted during a shift handoff.

• Q29. In my department/ward, we always receive accurate and adequate information about patients from departing nurses in shift handoffs

• Q30. In my department/ward, new staff members always receive formal training for shift handoffs.

• Q31. In my department/ward, we use written message for transferring important information in shift handoffs.

• Q32. In my department/ward, we have sufficient time to make an adequate shift handoff.

• Q33. In my department/ward, sometimes we make deviations from procedures or guidelines of shift handoffs.

• Q34. Overall, shift handoff is conducted well in my department/ward.