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The influence of organizational factors on patient safety: Examining successful handoffs in health care

Richter, Jason P.; McAlearney, Ann Scheck; Pennell, Michael L.

doi: 10.1097/HMR.0000000000000033

Background: Although patient handoffs have been extensively studied, they continue to be problematic. Studies have shown poor handoffs are associated with increased costs, morbidity, and mortality. No prior research compared perceptions of management and clinical staff regarding handoffs.

Purpose: Our aims were (a) to determine whether perceptions of organizational factors that can influence patient safety are positively associated with perceptions of successful patient handoffs, (b) to identify organizational factors that have the greatest influence on perceptions of successful handoffs, and (c) to determine whether associations between perceptions of these factors and successful handoffs differ for management and clinical staff.

Methodology/Approach: A total of 515,637 respondents from 1,052 hospitals completed the Hospital Survey on Patient Safety Culture that assessed perceptions about organizational factors that influence patient safety. Using weighted least squares multiple regression, we tested seven organizational factors as predictors of successful handoffs. We fit three separate models using data collected from (a) all staff, (b) management only, and (c) clinical staff only.

Findings: We found that perceived teamwork across units was the most significant predictor of perceived successful handoffs. Perceptions of staffing and management support for safety were also significantly associated with perceived successful handoffs for both management and clinical staff. For management respondents, perceptions of organizational learning or continuous improvement had a significant positive association with perceived successful handoffs, whereas the association was negative for clinical staff. Perceived communication openness had a significant association only among clinical staff.

Practice Implications: Hospitals should prioritize teamwork across units and strive to improve communication across the organization in efforts to improve handoffs. In addition, hospitals should ensure sufficient staffing and management support for patient safety. Different perceptions between management and clinical staff with respect to the importance of organizational learning are noteworthy and merit additional study.

Jason P. Richter, PhD, is Assistant Professor, Graduate Program in Health and Business Administration, Army-Baylor University, Fort Sam Houston, Texas. Email:

Ann Scheck McAlearney, ScD, is Professor and Vice Chair for Research, Department of Family Medicine, College of Medicine, and Professor of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus.

Michael L. Pennell, PhD, is Assistant Professor, Division of Biostatistics, College of Public Health, The Ohio State University, Columbus.

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

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