"Changeovers can bring dividends," he said. "They offer opportunities to catch mistakes. If you handle them badly, however, things can fall through the cracks. You can have a discontinuity of care. But the problem isn't the changeover itself, it's just that you need new techniques to do the changeover better."
One dividend: the incoming employee often has a fresh perspective. "The outgoing person may have been working on a problem for a while, and they've fixated on only one possible solution. One way to break that fixation is to bring in a new person," Patterson said.
"So these strategies can do more than just make shift changes possible, they can also improve operations overall," she continued.
The researchers were surprised by two findings.
First, even though experts have suggested that incoming employees should read back information that was given to them to prevent misunderstandings, none of the businesses in the study followed this practice.
And second, rather than discuss a standard list of items during every changeover -- to make sure nothing was missed -- the employees preferred to pick and choose topics depending on what they deemed most important.
Technology may help hospitals adopt some of these strategies, Patterson said. Some medical residents now carry personal digital assistants (PDAs). Nurses could benefit from a similar system, with outgoing nurses passing PDAs with audio and text notes to incoming nurses. The PDA would then be a clear signal of who was on or off-duty -- fulfilling another one of the strategies for good shift changes.
The study was sponsored by the Department of Veterans Affairs (VA). Patterson was supported by a VA Health Services Research and Development Merit Review Entry Program award. Other co-authors on the paper included Emilie Roth of Roth Cognitive Engineering in
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Contact: Emily Patterson
Patterson.150@osu.edu
614-688-3938
Ohio State University
15-Apr-2004