title: Context, culture and (non-verbal) communication affect handover quality.
abstract: BACKGROUND
  Transfers of care, also known as handovers, remain a substantial patient safety risk. Although research on handovers has been done since the 1980s, the science is incomplete. Surprisingly few interventions have been rigorously evaluated and, of those that have, few have resulted in long-term positive change. Researchers, both in medicine and other high reliability industries, agree that face-to-face handovers are the most reliable. It is not clear, however, what the term face-to-face means in actual practice.
  
  
  OBJECTIVE
  We studied the use of non-verbal behaviours, including gesture, posture, bodily orientation, facial expression, eye contact and physical distance, in the delivery of information during face-to-face handovers.
  
  
  METHODS
  To address this question and study the role of non-verbal behaviour on the quality and accuracy of handovers, we videotaped 52 nursing, medicine and surgery handovers covering 238 patients. Videotapes were analysed using immersion/crystallisation methods of qualitative data analysis. A team of six researchers met weekly for 18 months to view videos together using a consensus-building approach. Consensus was achieved on verbal, non-verbal, and physical themes and patterns observed in the data.
  
  
  RESULTS
  We observed four patterns of non-verbal behaviour (NVB) during handovers: (1) joint focus of attention; (2) 'the poker hand'; (3) parallel play and (4) kerbside consultation. In terms of safety, joint focus of attention was deemed to have the best potential for high quality and reliability; however, it occurred infrequently, creating opportunities for education and improvement.
  
  
  CONCLUSIONS
  Attention to patterns of NVB in face-to-face handovers coupled with education and practice can improve quality and reliability.
authors.affiliation: Center for Implementing Evidence Based Practice, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA. rfrankel@iupui.edu
authors.forename: Richard M
authors.initials: RM
authors.lastname: Frankel
authors.forename: Mindy
authors.initials: M
authors.lastname: Flanagan
authors.forename: Patricia
authors.initials: P
authors.lastname: Ebright
authors.forename: Alicia
authors.initials: A
authors.lastname: Bergman
authors.forename: Colleen M
authors.initials: CM
authors.lastname: O'Brien
authors.forename: Zamal
authors.initials: Z
authors.lastname: Franks
authors.forename: Andrew
authors.initials: A
authors.lastname: Allen
authors.forename: Angela
authors.initials: A
authors.lastname: Harris
authors.forename: Jason J
authors.initials: JJ
authors.lastname: Saleem
mesh_terms: D001291:Attitude of Health Personnel; D019985:Benchmarking; D005149:Facial Expression; D005868:Gestures; D006801:Humans; D007196:Indiana; D007400:Interprofessional Relations; D009633:Nonverbal Communication; D015279:Organizational Culture; D062209:Patient Handoff / Q000592:standards*; D036301:Qualitative Research; D011785:Quality Assurance, Health Care; D015203:Reproducibility of Results; D014741:Video Recording / Q000592:standards