michael cohen’s last research
Like most of us in the world of organization studies, I was saddened to hear of Michael Cohen’s passing. I only met him once and he was very gracious. In the spirit of his work, let me me draw your attention to his last research project – an analysis of “handoffs.” The issue is that doctors can’t continuously watch patients. Whenever a doctor leaves to go home, a new doctor comes in and there is a “handoff.” Cohen wrote a nice summary for the Robert Wood Johnson Foundation website:
1. To be effective, a handoff has to happen.
It may seem incredibly commonplace, but all too often preventable injuries or even deaths trace back to handoffs that were abbreviated, conducted in awkward conditions, or downright skipped. The easy cases to identify are things like leaving before handoff is done, or rushing the handoff in order to get out the door.
Unfortunately, many other causes are also in play. Some major examples derive from schedule or workload incompatibilities. If patients are sent from the PACU (post-anesthesia care unit) to a floor unit during its nursing report, the nurses accepting the patients will necessarily miss out on the handoff of existing patients. If a patient is moved from the Emergency Department (ED) before her doctor or nurse has time to complete phone calls to the destination unit, the patient endures some period of having been transferred without benefit of handoff. If there is a shift change in the ED just before a patient moves, the handoff is conducted by a doctor or nurse who has only second-hand familiarity with the events. To improve handoffs, we may need to teach participants to think about the organizational structures that make it hard to do them well.
2. An effective handoff is not a telegram.
Even if a mnemonic, checklist or computer report is used in an effort to assure transmission of key data, that is far from fulfilling one of the central functions of a handoff. As colleagues and I have argued recently, a handoff is not a telegram. The correct transmission of routine data about patients can be useful, but handoffs also function to establish for the receiving party a working mental model of the trajectory of the patient’s illness and treatment. They highlight what is unusual about the patient (co-morbidities, family decision making, personality or cultural traits that may affect treatment options). Good handoffs answer the question “what does the next caregiver need to know about this patient to do a good job?” Often the data transmitted are of secondary importance, or have value mainly as they support the development of the next caregiver’s “big picture” of the patient. To improve handoffs, we may need to provide training in taking the other party’s perspective in order to discern what they really need to understand.
Simple, but important.