title: Handoffs, safety culture, and practices: evidence from the hospital survey on patient safety culture.
abstract: The context of the study is the Agency for Healthcare Research and Quality's Hospital Survey on Patient Safety Culture (HSOPSC). The purpose of the study is to analyze how different elements of patient safety culture are associated with clinical handoffs and perceptions of patient safety.
  
  
  
  The study was performed with hierarchical multiple linear regression on data from the 2010 Survey. We examine the statistical relationships between perceptions of handoffs and transitions practices, patient safety culture, and patient safety. We statistically controlled for the systematic effects of hospital size, type, ownership, and staffing levels on perceptions of patient safety.
  
  
  
  The main findings were that the effective handoff of information, responsibility, and accountability were necessary to positive perceptions of patient safety. Feedback and communication about errors were positively related to the transfer of patient information; teamwork within units and the frequency of events reported were positively related to the transfer of personal responsibility during shift changes; and teamwork across units was positively related to the unit transfers of accountability for patients.
  
  
  
  In summary, staff views on the behavioral dimensions of handoffs influenced their perceptions of the hospital's level of patient safety. Given the known psychological links between perception, attitude, and behavior, a potential implication is that better patient safety can be achieved by a tight focus on improving handoffs through training and monitoring.
authors.affiliation: Strome College of Business, Old Dominion University, Norfolk, VA, USA.
authors.forename: Soo-Hoon
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Carey Business School, Johns Hopkins University, 100 International Drive, Baltimore, MD, 21202, USA. pphan@jhu.edu.
authors.forename: Phillip H
authors.initials: PH
authors.lastname: Phan
authors.affiliation: School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Todd
authors.initials: T
authors.lastname: Dorman
authors.affiliation: School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Sallie J
authors.initials: SJ
authors.lastname: Weaver
authors.affiliation: School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003142:Communication; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital; D015279:Organizational Culture; D062209:Patient Handoff; D061214:Patient Safety; D017751:Safety Management; D011795:Surveys and Questionnaires
keywords: Accountability; Communication; Handoffs; Patient safety culture; Personal responsibility; Staff attitudes