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Structuring flexibility: the potential good, bad and ugly in standardisation of handovers

Correspondence to:
E S Patterson, Getting at Patient Safety (GAPS) Center, Veterans Administration, Institute for Ergonomics, Ohio State University, Columbus, Ohio, USA; patterson.150@osu.edu

The first 150 words of the full text of this article appear below.

Few strategies routinely used during shift change handovers in high-reliability organisations (HROs) are used in healthcare.¹ The findings from the paper in this issue by Borowitz et al² (see page 6) add to the growing empirical evidence that patient handovers in all healthcare settings are highly variable in content and process. Similar to other highly respected healthcare researchers, the authors recommend reducing this variability, in this case by standardising sign-out protocols. However, similar to other human factors researchers, I am concerned about the potential unintended consequences from this well-intentioned approach.

A natural experiment is already underway in the USA to standardise patient handovers. This experiment will likely be shaped by these repeating patterns from human factors research in complex socio-technical settings:

• all decisions require making trade-offs on competing goals;
  
• imposing a simple standard on a complex process does not result in simplicity;
  
• local actors must tailor a distant . . . [Full text of this article]

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