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Managing competing organizational priorities in clinical handover across organizational boundaries
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Sujan, Mark-Alexander, Chessum, Peter, Rudd, Michelle, Fitton, Laurence, Inada-Kim, Matthew, Cooke, Matthew and Spurgeon, Peter (2015) Managing competing organizational priorities in clinical handover across organizational boundaries. Journal of Health Services Research & Policy, Volume 20 (Supplement 1). pp. 17-25. doi:10.1177/1355819614560449 ISSN 1355-8196.
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Official URL: http://dx.doi.org/10.1177/1355819614560449
Abstract
Objectives:
Handover across care boundaries poses additional challenges due to the different professional, organizational
and cultural backgrounds of the participants involved. This paper provides a qualitative account of how practitioners
in emergency care attempt to align their different individual and organizational priorities and backgrounds when
handing over patients across care boundaries (ambulance service to emergency department (ED), and ED to acute
medicine).
Methods:
A total of 270 clinical handovers were observed in three emergency care pathways involving five participating
NHS organizations (two ambulance services and three hospitals). Half-day process mapping sessions were conducted for
each pathway. Semi-structured interviews were carried out with 39 participants and analysed thematically.
Results: The management of patient flow and the fulfilment of time-related performance targets can create conflicting
priorities for practitioners during handover. Practitioners involved in handover manage such competing organizational
priorities through additional coordination effort and dynamic trade-offs. Practitioners perceive greater collaboration
across departments and organizations, and mutual awareness of each other’s goals and constraints as possible ways
towards more sustainable improvement.
Conclusion:
Sustainable improvement in handover across boundaries in emergency care might require commitment by
leaders from all parts of the local health economy to work as partners to establish a culture of integrated, patient centred
care.
| Item Type: | Journal Article | ||||
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| Subjects: | R Medicine > R Medicine (General) R Medicine > RA Public aspects of medicine |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Social Science & Systems in Health (SSSH) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Emergency medical services , Emergency medical services--Communication systems , Communication in nursing, Medical records, Medical care--Safety measures, Patients--Safety measures | ||||
| Journal or Publication Title: | Journal of Health Services Research & Policy | ||||
| Publisher: | Royal Society of Medicine Press Ltd. | ||||
| ISSN: | 1355-8196 | ||||
| Official Date: | January 2015 | ||||
| Dates: |
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| Volume: | Volume 20 | ||||
| Number: | Supplement 1 | ||||
| Page Range: | pp. 17-25 | ||||
| DOI: | 10.1177/1355819614560449 | ||||
| Status: | Peer Reviewed | ||||
| Publication Status: | Published | ||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||
| Date of first compliant deposit: | 6 July 2016 | ||||
| Date of first compliant Open Access: | 6 July 2016 | ||||
| Funder: | National Institute for Health Research (Great Britain) (NIHR) | ||||
| Grant number: | (Project number 10/1007/26) |
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