title: The key actor: a qualitative study of patient participation in the handover process in Europe.
abstract: BACKGROUND
  Patient safety experts have postulated that increasing patient participation in communications during patient handovers will improve the quality of patient transitions, and that this may reduce hospital readmissions. Choosing strategies that enhance patient safety through improved handovers requires better understanding of patient experiences and preferences for participation.
  
  
  OBJECTIVE
  The aim of this paper is to explore the patients' experiences and perspectives related to the handovers between their primary care providers and the inpatient hospital.
  
  
  METHODS
  A qualitative secondary analysis was performed, based on individual and focus group patient interviews with 90 patients in five European countries.
  
  
  RESULTS
  The analysis revealed three themes: patient positioning in the handover process; prerequisites for patient participation and patient preferences for the handover process. Patients' participation ranged from being the key actor, to sharing the responsibility with healthcare professional(s), to being passive participants. For active participation patients required both personal and social resources as well as prerequisites such as information and respect. Some patients preferred to be the key actor in charge; others preferred their healthcare professionals to be the key actors in the handover.
  
  
  CONCLUSIONS
  Patients' participation is related to the healthcare system, the activity of healthcare professionals' and patients' capacity for participation. Patients prefer a handover process where the responsibility is clear and unambiguous. Healthcare organisations need a clear and well-considered system of responsibility for handover processes, that takes into account the individual patient's need of clarity, and support in relation to his/hers own recourses.
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, B44, Karolinska Sjukhuset Huddinge, Stockholm 14186, Sweden. maria.flink@ki.se
authors.forename: Maria
authors.initials: M
authors.lastname: Flink
authors.forename: Gijs
authors.initials: G
authors.lastname: Hesselink
authors.forename: Loes
authors.initials: L
authors.lastname: Pijnenborg
authors.forename: Hub
authors.initials: H
authors.lastname: Wollersheim
authors.forename: Myrra
authors.initials: M
authors.lastname: Vernooij-Dassen
authors.forename: Ewa
authors.initials: E
authors.lastname: Dudzik-Urbaniak
authors.forename: Carola
authors.initials: C
authors.lastname: Orrego
authors.forename: Giulio
authors.initials: G
authors.lastname: Toccafondi
authors.forename: Lisette
authors.initials: L
authors.lastname: Schoonhoven
authors.forename: Petra J
authors.initials: PJ
authors.lastname: Gademan
authors.forename: Julie K
authors.initials: JK
authors.lastname: Johnson
authors.forename: Gunnar
authors.initials: G
authors.lastname: Öhlén
authors.forename: Helen
authors.initials: H
authors.lastname: Hansagi
authors.forename: Mariann
authors.initials: M
authors.lastname: Olsson
authors.forename: Paul
authors.initials: P
authors.lastname: Barach
mesh_terms: D002908:Chronic Disease / Q000534:rehabilitation; D005062:European Union; D005260:Female; D017144:Focus Groups; D058005:General Practitioners / Q000592:standards; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D062209:Patient Handoff / Q000592:standards*; D010358:Patient Participation; D061214:Patient Safety; D017060:Patient Satisfaction; D010361:Patients / Q000523:psychology*; D010817:Physician-Patient Relations; D036301:Qualitative Research; D011785:Quality Assurance, Health Care