Facilitators and barriers to the use of a structured hand-off: a pediatric hospital exploratory case study

Competent communication practices among healthcare providers are a key factor in maintaining patient safety during transfers of patient care. Research shows that the majority of errors in patient care are related to communication problems, and a majority occur during patient hand-offs. This project is a qualitative study exploring the facilitators and barriers of structured hand-off at a pediatric hospital. Our data analysis indicates that while the hand-off process is facilitated by structure, clarity, and adequate time, it is hindered by lack of time, distractions, human factors, and a number of social and organizational factors that complicate physicians’ roles. Using structurating activity theory (SAT) to frame findings, analysis points to a structural tension between worker autonomy and organizational control as the primary cause of poor adherence to structured hand-off among pediatric residents. We draw on constructs of SAT to identify practical strategies for managing this contradiction at a system level.