Human factors in clinical handover: development and testing of a 'handover performance tool' for doctors' shift handovers

Objective. To develop and test a handover performance tool (HPT) able to help clinicians to systematically assess the quality and safety of shift handovers. Design. The study used a mixed methods approach. In the development phase of the tool, a review of the literature and a Delphi process were conducted to sample five generic non-technical skills: communication, teamwork, leadership, situation awareness and task management. Validity and reliability of the HPT were evaluated through direct observation and during simulated handover video sessions. Setting. This study was conducted in the Paediatrics, Obstetrics and Gynaecology wards of a UK district hospital. Participants. Thirty human factor experts participated in the development phase; 62 doctors from various disciplines were asked to validate the tool. Main Outcome Measures. Item development, HPT validity and reliability. Results. The tool developed consisted of 25 items. Communication, teamwork and situation awareness explained, respectively, 55.5, 47.2 and 39.6% of the variance in doctors rating of quality. Internal consistency and inter-rater reliability of the HPT were good (Cronbach's alpha = 0.77 and intra-class correlation = 0.817). Conclusions. Communication determined the majority of handover quality. Teamwork and situation awareness also provided an independent contribution to the overall quality rating. The HPT has demonstrated good validity and reliability providing evidence that it can be easily used by raters with different backgrounds and in several clinical settings. The HPT could be utilized to assess doctors' handover quality systematically, as well as teaching tool in medical schools or in continuing professional development programmes for self-reflective practice.