Don’t Drop the Baton

By Dr. Jonathan Ware  /  07 Oct 2014

The difference between a handover and a handoff sounds minor—it’s just a few letters. But in healthcare, the way we think of that patient transition process can make a world of difference to our patients. Picture runners in a relay race: When a runner hands-off a baton to the next runner, what happens? The first runner has completed their part of the race. They’re finished with the process. But often enough, that baton falls to the ground. A handover is more akin to passing someone a hot plate full of home-cooked food; before you let go, you want to be sure that the person has the hot plate firmly in their hands. You’re invested in the process, and want to make sure it gets safely to the dinner table without crashing down.

Too often in healthcare we miss this distinction, and instead of safely handing over our patients, we hand them off. Patients come into the hospital, their immediate needs are addressed, and often they are handed off to a skilled nursing facility (SNF). But the hospitalist doesn’t speak to the SNF doctor, and the SNF doesn’t talk to the primary care physicians—and in many cases, the hospitalist never told the primary care physician that their patient had even entered the hospital in the first place. And then once the patient leaves the facility, there’s no real communication with the patient over who is going to be treating them, and how.

At Orlando Health, we’re aiming for a handover every time. We’re coordinating a demonstration project for a patient-centered medical neighborhood that joins together non-affiliated providers who are committed to working together to ensure their healthcare delivery has a strong focus on putting the patient first. A big focus of this demonstration project is making sure that all of these providers are able to communicate with each other at any time, especially during patient transitions. We’re opening the lines of communication so that a provider can call or text one another to better coordinate patient care. We’re doing so on a secure platform that takes into consideration each clinician’s individual workflow needs. And it’s working.

Getting clinicians to communicate with each other more frequently isn’t something that happens overnight. We knew it would take more than a blast email saying “Communicate more!” to make the habit stick. Instead, we created a detailed plan to spread awareness by reaching our clinicians with multiple, repeated messages through many different modalities. We tried emails, and posters, and in-person meetings. Then we held targeted webinars and developed tailored approaches to reach certain subsets of clinicians. And when we thought we had near 100 percent compliance, we hit them with another round of messages.

Investing so much time and resources into getting clinicians to communicate more might seem unnecessary on the surface. But if you were the patient who was treated like a baton—would you still agree?

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