Using Socio-Technical Systems Analysis to Understand the Enablers of Resilience in Clinical Handover in Acute Hospital Settings

Handover of patient care is the most common form of communication across hospitals. Enabling effective handover has been identified as a key priority for patient safety. This Human Factors Ergonomics socio-technical systems study aims to understand the current system of handover within departments, across departments, and at the interface of provider services, and then use this knowledge to co-design recommendations to enable resilience in clinical handover. The Systems Engineering Initiative for Patient Safety 3.0 (SEIPS3.0) framework is used to take a systems approach to observing clinical handover. Over 26 h of handover, involving 218 healthcare professionals handing over patient care across an acute hospital setting and at the interface of two external ambulance service systems, was observed. From these observations of clinical handovers, we co-designed—with the input of 41 medical, nursing, health, and social care professionals, quality and safety professionals, and patient partners—70 recommendations for enabling resilience in handover using two socio-technical systems analysis frameworks: SEIPS3.0 and the Cube. These 70 recommendations were inductively coded, and ten emergent properties that can support resilience in handover were identified, including person-centred care, multi-disciplinary team working, culture, communication, evidence-based practice, operations management, education, digitally enabled care, evidence-based design, and understanding context. This study contributes important knowledge for healthcare professionals and Human Factors Ergonomics practitioners on the systemic enablers of resilience in clinical handover in acute hospital settings.