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Critical Access Hospital Use of TeamSTEPPS to Implement Shift-Change Handoff Communication

Natafgi, Nabil MPH, CPH; Zhu, Xi PhD; Baloh, Jure MHA; Vellinga, Kelli BSN, RN; Vaughn, Thomas PhD; Ward, Marcia M. PhD

doi: 10.1097/NCQ.0000000000000203

Implementation of handoff as part of TeamSTEPPS initiatives for improving shift-change communication is examined via qualitative analysis of on-site interviews and process observations in 8 critical access hospitals. Comparing implementation attributes and handoff performance across hospitals shows that the purpose of implementation did not differentiate between high and low performance, but facilitators and barriers did. Staff involvement and being part of the “big picture” were important facilitators to change management and buy-in.

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Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City.

Correspondence: Nabil Natafgi, MPH, CPH, Department of Health Management and Policy, College of Public Health, Bldg N277, University of Iowa, 145 River Side Dr, Iowa City, IA 52241 (

This research was supported by grant number R18HS018396 from the Agency for Healthcare Research and Quality (AHRQ). The content is solely the responsibility of the authors and does not necessarily represent the official views of the AHRQ. The authors thank Abby Powell, Erik Jorgensen, Jenna Lovaas, and Madhana Pandian for assistance with coding for this article.

The authors declare no conflict of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Accepted for publication: April 10, 2016

Published ahead of print: June 6, 2016

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