Barriers to effective communication between doctors at shift handover.

Shift handover is a process during which doctors can exchange information, authority and primary responsibility for patient care. The level of handover standardisation may vary across departments and hospitals, and handover may be affected by the context in which it occurs. If during handover communication doctors do not transfer information pertinent to a patient's care delivery, it may lead to unintended negative consequences.An explanatory, mixed-methods study, using the principles of critical realism was conducted to investigate whether or not similar barriers to effective shift handover communication between doctors identified in hospitals around the world are identified by doctors working in hospitals in the Czech Republic and to develop hypotheses regarding how various individual performance-, work environment- and system-related factors may collectively contribute to ineffective shift handover communication between doctors. In accordance with the principles of critical realism the study included theory-testing phases: (i) a critical review of literature; (ii) a cross-sectional questionnaire survey; and (iii) semi-structured interviews with doctors.The results of the study show that doctors working in hospitals in the Czech Republic identify similar barriers to effective shift handover communication between doctors identified in hospitals around the world. However, handover between the Czech Republic doctors has its own specific characteristics. The inadequacies of the social, systemic and environmental features that make up different contexts in which handover is conducted collectively contribute to ineffective shift handover communication. For example, a systemic feature (e.g. the absence of training), may lead to specific doctors' beliefs (e.g. handover is meaningless), which in turn trigger certainbehaviours (e.g. doctors go home without communicating either verbally or in writing the work carried out during the previous shift), that tend towards a particular kind of outcome (e.g. the absence of handover). Consequently, the division of barriers to handover into one-dimensional categories such as 'the individual performance', 'the system' or 'the social environment', has emerged as superficial as it does not adequately reflect the reality of the context and process of handover communication. Any interventions and programmes, which aim to enhance communication between doctors at shift handover, may need therefore to address the multidimensional nature of handover communication.