Clinical handover as an interactive event: informational and interactional communication strategies in effective shift-change handovers.

Clinical handover -- the transfer between clinicians of responsibility and accountability for patients and their care (AMA 2006) -- is a pivotal and high-risk communicative event in hospital practice. Studies focusing on critical incidents, mortality, risk and patient harm in hospitals have highlighted ineffective communication -- including incomplete and unstructured clinical handovers -- as a major contributing factor (NSW Health 2005; ACSQHC 2010). In Australia, as internationally, Health Departments and hospital management have responded by introducing standardised handover communication protocols. This paper problematises one such protocol - the ISBAR tool - and argues that the narrow understanding of communication on which such protocols are based may seriously constrain their ability to shape effective handovers. Based on analysis of audio-recorded shift-change clinical handovers between medical staff we argue that handover communication must be conceptualised as inherently interactive and that attempts to describe, model and teach handover practice must recognise both informational and interactive communication strategies. By comparing the communicative performance of participants in authentic handover events we identify communication strategies that are more and less likely to lead to an effective handover and demonstrate the importance of focusing close up on communication to improve the quality and safety of healthcare interactions.