Team Performance Framework During Handoffs

TL;DR: This paper embeds the process of handoffs in a prevalent psychological model with the factors that influence them, namely the inputmediator/moderator-output-input (IMOI) model presented by Ilgen et al (2005).

Abstract: Handoffs, the transitioning care and responsibility of patients between two or more providers, are essential in almost all medical settings whether it be during shiftchange, during breaks, or transfer from one unit to another (Riesenberg, Leitzsch, & Little, 2009). More specifically, handoffs are a communication event that can include patient treatment, services, care, background, and all pertinent information (Patterson, 2010). Unfortunately, handoffs are vulnerable to communication breakdowns, which can lead to missed diagnoses (Lorinz et al., 2011), treatment delays (Horwitz, Moin, Krumholz, Wang, & Bradley, 2008), malpractice claims (Singh, Thomas, Petersen, & Studdert, 2007), patient harm (Arora, Johnson, Lovinger, Humphrey, & Meltzer, 2005; Kitch et al., 2008; Saleem, Paulus, Vassiliou, & Parsons, 2015), and mortality (American Thoracic Society, 2016). Due to criticality of these transitions as well as their inherent vulnerabilities, it is important that key information is transferred clearly, correctly, and comprehensibly between team members. Consequently, it is important to gain a better understanding regarding the factors that impact handoffs. Because handoffs are essentially a team task, we posit that literature and even practice could benefit by better understanding handoffs through a teamwork lens. Unfortunately, little research has focused on theorizing about the components that impact and surround handoffs. Due to the multitude of factors that can influence the team task of handoffs, we believe it is important to systematically organize these various factors of handoffs to foster researchers and providers in achieving safer outcomes. Therefore, this paper embeds the process of handoffs in a prevalent psychological model with the factors that influence them, namely the inputmediator/moderator-output-input (IMOI) model presented by Ilgen et al (2005). The IMOI model postulates that inputs are properties within individuals, teams, organizations, and tasks influential to a particular process or performance episode. In essence, they set the conditions for which interactions take place (McGrath, 1984). Meanwhile, mediators and moderators are the components that occur throughout the process or performance episode, and the outputs are the outcomes or consequences of the processes or performances. Finally, the second input includes the characteristics that result from previous processes and impact future performances. Within the context of handoffs, the inputs are the individual characteristics of providers and patients, the mediators/moderators are the factors or interactions that occur during a handoff, the outputs are the results of the handoff, and the final input is the team adaptation that occurs. Refer to Figure 1 for a nonexhaustive list of influential handoff factors. Depicting handoffs within this organizational framework can provide insights to lead to better teamwork by unpacking the complexities surrounding handoffs. Ultimately,