Shift handover in the NHS

Publication from the BMA has some useful information about shift handover that may apply to industry. (I think it ironic that a 38 page document is used to discuss good communication, but I guess that is how things work in the NHS).

It makes the point that good handover does not happen by chance. It requires work by all those involved (organisations and individuals):
* shifts must coordinate
* adequate time must be allowed
* handover should have clear leadership
* adequate information technology support must be provided.

Sufficient and relevant information should be exchanged to ensure patient safety:
* the clinically unstable patients are known to the senior and covering clinicians
* junior members of the team are adequately briefed on concerns from previous shifts
* tasks not yet completed are clearly understood by the incoming team.

Handover is of little value unless action is taken as a result:
* tasks should be prioritised
* plans for further care are put into place
* unstable patients are reviewed.


The document includes a list of handover pitfalls, including:
* Giving verbal handovers at the same time as the team taking over the patient’s care are setting up vital life support and monitoring equipment - valuable information will be lost. The importance of written handover information must be stressed.
* Roles and responsibilities are not always clear during handover and this can lead to omissions.
* Checklists and written updates are important and often under-utilised. When such information is incomplete or omitted it has a knock on effect of increasing the
workload of the staff who have taken over the patient's care because they have to spend a significant proportion of time chasing information.
* It is important that nursing staff are made aware of critical features in the medical management of a patient that will affect care during the next shift.
* Fragmentation of information at the point of handover is a major problem. It is important to avoid multiple concurrent conversations between individuals and let one person (a nominated lead) speak at a time to everyone. This reduces the opportunities for conflicting information to be given.
* Handover is a two way process. Good handover practice is characterised by the team who are taking over the patient’s care asking questions and having the opportunity to clarify points they are uncertain of. They should not be passive recipients of information.

This document gives some practical examples of how handover is being dealt with in NHS holspitals.

Failing to respond to a safety problem

According to this article on the Jishka homework website, "In 1970, psychologists Latane and Darley published their study on "bystander apathy." They found that - in order to help in a crisis - any bystander has to answer five questions. If any one of these questions is answered negatively, help will not be given."

1. Do I notice something happening? If the person is in a hurry or distracted by personal problems, they are less likely to notice what is happening around them.
2. Is the situation an emergency? Is a person lying in a doorway a homeless person resting, a drunk, or a person who has collapsed from a heart attack? Most situations have a high degree of ambiguity. It is hard to tell what is happening.
3. Am I responsible? Latane and Darley found that with more people around, there was a diffusion of responsibility - bystanders assume that others will act, so they are not personally responsible.
4. What can I do? Often people are unsure of their abilities (training or skills) to help in a given situation. They may be concerned that they might make the situation worse.
5. Will I intervene? Bystanders must weigh the costs or dangers of intervening. Will I be harmed? Will I be sued?

I was led to this link by a discussion on this forum where someone was asking what to do about a situation where a number of people violated a procedure. It seemed likely that they did that because others were without raising any concerns. Bystander apathy can certainly help in understanding that violations are often caused.

There is a good discussion on the topic on the Wikipedia

Andy Brazier

Bp Texas city - managers + supervisor blamed

According to a number of news articles, including one in the Denver Post by Juan A. Lozano on 5 May 2007.

An internal report by BP PLC about its deadly 2005 Texas City plant explosion recommended that four executives and managers be fired for failing to perform their jobs and demonstrating poor judgment.

Accountability of John Manzoni, BP's top refinery executive, should be reviewed by the company after he "failed to implement his duties" and didn't "carry out his responsibilities."

The February report singled out four managers who "failed to perform their management accountabilities in significant ways": Mike Hoffman, BP's group vice president for refining and marketing; Pat Gower, U.S. refining vice president; Don Parus, the Texas City refinery manager; and Willie Willis, a plant supervisor.

Hoffman has resigned. The others are still employed by the company, according to the report.

Interestingly, according to an article by Ed Crooks and Sheila McNulty on 4 May 2007 in the Financial Times

New BP Chief Executive Tony Hayward wants to slow the rapid circulation of BP managers. Since 2000, it has been common for BP managers to stay only 18-24 months in their jobs; Mr Hayward wants to raise that to three to four years.

Also, he wants BP to employ fewer contractors and bring more activities in house.

Andy Brazier