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Improvement of Hand-off Communication in Hospital Settings


The paper represents a proposal on the ways to improve hand-off communication in hospital settings. The paper consists of background and literature review, which investigates the degree of the problem and essential tendencies in hand-off communication. The literature review analyzes the key ideas of the most recent investigations on the topic of hand-off communication and shows how it can be applied in the medical care organizations by the health care actors (such as patients, doctors, and medical personnel in general).

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The investigation will involve both patients' and doctors' opinions. The sample will comprise 40 doctors and 160 patients who are expected to answer the questions from questionnaires and interviews to give feedback. The study will show how the improved version of the hand-off communication in hospital settings can change the treatment process and its outcomes to the best. The questionnaires will be built in accordance with the basic rules for questionnaire construction. Thus, the questions will appear from general to ones that are more complex. This will permit objectively to assess the result and interpret the obtained data. The only limitation of the study is the insincerity of the respondents.

Keywords: patient, hand-off communication, doctors, medical care personnel, investigation


The relations between a doctor and a patient are generally and the most frequently defined as asymmetrical. When participating in the medical interview, firstly, the patient considers it as an act of social interaction, and not as a technical method of extracting information for diagnosis. At the same time, the physician's medical interview goes beyond communication with a specific patient. The doctor is obliged to maintain the status in the presence of colleagues. It is expected that doctor stops to manifest his/her personality, wanting to act primarily as a source of medical knowledge, defending him/herself from emotional experiences for the sake of objectivity. This is generally done as a means of combating the disease.

Such expectations are valid as long as they do not spread on private medical practice. Research in this area suggests that the relative autonomy of the physician, his/her financial interest and the desire to keep favorable patients have a tendency to change their behavior. It is necessary to remember that in the information society, the patient is less passive in the decision-making process. Model of communication between doctors and patients get new connotation. The dominant position of the doctor, which previously seemed natural, is currently losing its relevance. The doctor and patient's positions are aligned to each other.

Thus, the aim of this paper is to investigate hand-off communication between a patient, on the one hand, and the health care personnel, on the other hand. It is assumed that health care security and the patient's condition are to be improved along with the enhancement of the hand-off communication between all actors of the medical care process.


The term “interaction” is often interpreted as “interconnection,” or “communication.” Western researchers have long been using these terms as synonyms. These concepts have similar features. The existence of many different definitions is associated with different approaches to the implementation of hand-off communication. Therefore, it is necessary to point out the specificity of general hand-off communication problems in social psychology. The term 'communication' has no exact equivalent in the traditional (Western) social psychology.

This situation has resulted in the fact that the study of the problems of hand-off communication is considered a range of issues, such as the ratio of communication and activities, mapping of communication, interaction, determination of the kind of relationships (subject-object, subject-subject) and others. It is important to recognize the relevance of these lines of research.

In western medicine, communication with the patient implies a greater involvement of a patient in the treatment process, which corresponds to a model of informed decision-making. The anthropocentric approach to language has allowed expanding the scope of the dialogic communication study, which is a basic form of interpersonal communication and is the basis for the hand-off communication. This dialog assumes the special linguistic cooperation of individuals based on mutual interest. These individuals are patients, doctors, and all medical personnel in general.


The essential aim of this proposal is to evaluate the level of implementation of the hand-off communication in the hospital setting between all actors of the medical process. Additionally, it is possible to single out the following aims:

  1. To develop a holistic view of the patient and their condition in the bio-psycho-social model, cultural and existential aspects of life, which are likely to manifest in the hand-off communication between the medical care participants;
  2. To develop knowledge on the scientific foundations of clinical manifestations of the diseases and their diagnosis, therapy, and prognosis, epidemiology and decision theory, preventive medicine using the hand-off communication;
  3. To deepen the understanding of the medical and social care problems of patients by using the hand-off communication during the secondary and tertiary prevention;
  4. To develop the ability to cooperate with other health care professionals working in primary care, as well as with specialists from hospitals;
  5. To develop health care skills that correspond to the patient's interests.

In order to achieve these aims, it is necessary to regard the most recent findings in the field of hand-off communication in the hospital setting and observe the key tendencies in its implementation. Furthermore, the literature review provides an analysis of the unsuccessful approaches to the communication between a patient and medical staff.

Literature Review

At present, science, and society as a whole face the problem of information overload. Every day large and small discoveries occur, every year dozens of new medical devices and instruments are developed. This is definitely a good thing. However, a person begins to sink in this rising sea of information. This process greatly affects the communication between a doctor and a patient. This literature review aims to show and analyze the most recent investigations on the use of communication in hospital settings as well as to investigate the role of hand-off communication improvement in hospital settings.

Thus, when regarding the overall role of the hand-off communication, Reilly Marcotte, Berns, and Shea (2013) state that the position of a physician (as well as of any other doctor) during the interaction with a patient is mainly determined by their professional status. The duty and desire to cure the patient based on the medical knowledge is the basis of the medical profession. It is important for a physician (as well as of any other doctor) to possess the professional socialization skills, which rely on the norms of relationships with patients, as well as the communication strategy. Belonging to a certain occupational group influences the behavior of the physician.

For example, such a parameter as the degree of openness determines the extent to which the doctor seeks to comply with regulatory requirements in his/her daily activities. As a consequence, Watkins and Patrician (2014) and Reilly et al. (2013) conclude that in the hospital the doctor(s) is (are) constantly forced to comply with all professional standards, confirming his/her role in front of colleagues, while the examinations, which are often conducted in the office of the doctors, are less formal. The standards currently include hand-off communication.

When defining the phenomenon of hand-off communication, Friesen, White, and Byers (2008) state that it is mainly represented by “the transfer of information (along with authority and responsibility) during transitions in care across the continuum; to include an opportunity to ask questions, clarify and confirm” (Friesen, White, & Byers, 2008). In addition, the authors believe that it is important to pay attention to the problem of medical ethics in the process of professional hand-off communication when establishing the relations between a health care worker and a patient, a health professional and the public, and the relationships among health workers (between each other).

The relationship between the nurse and the patient covers a number of issues, including ethical, psychological, and moral, when finding a solution or compromise. Therefore, the nurse is required to not only learn the technical side of the profession, but also have a special ability to communicate with people, respond to the problems of the patient, and have a sense of compassion.

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This idea is strongly supported by Abraham et al. (2016) who state that psychological characteristics of the patient in a therapeutic relationship and interaction come into contact with the psychological characteristics of a health professional in hospital settings. The therapeutic activity forms a special relationship between health professionals and patients. Authors believe that this relationship is established between a doctor and a patient, a nurse, and a patient. According to Abraham et al. (2016), it is organized in a triangular way, more specifically as a “doctor-nurse-patient” relationship. The daily therapeutic activity is associated with many psychological and emotional factors.

Psychological research on medical ethics, social hygiene, public health organizations studies the impact of communication activities of a doctor and a patient. In accordance with the investigation conducted by Koenig, Maquen, Daley, Cohen, and Seal (2013) as well as Colvin, Eisen, and Gong (2016) the hand-off communication play a major role, since the communication serves as a mean of treatment. The importance of a personal approach and trusting contacts is paramount in hand-off communication (even excluding the patient's figure).

There are not many researches, which are aimed at the study of professional communication between a nurse and a patient; however, due to the nature of their activities, a nurse spends much more time with the patient than the doctor. The behavior of a nurse influences the process of treatment, physical, and emotional condition of the patient. Staggers and Blaz (2013) state that professional communication of a nurse develops in conjunction with professional activity, directly affecting the patient.

For example, sanitary and anti-epidemic regime, therapeutic and diagnostic procedures are important components of the nurse's work and necessary activities during the treatment process. If nurses lack knowledge, abilities, and professional communication skills, their actions, and words may be ineffective or even sometimes dangerous. The hand-off communication, in Staggers and Blaz’s (2013) point of view, can restore the humanistic orientation of medicine, lost because of medical specialization. This idea is supported by Park, Weaver, Mejia-Johnson, Vukas, and Zimmerman (2015).

Research Methods

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Research Design

The study design incorporates the methods of medical sociology. This choice is determined by the theme and research materials. Social research uses both qualitative and quantitative methods. These methods involve different research tools and are based on different theoretical foundations and platforms. Such sociological methods as questionnaires, a simple interview, case studies, the focus groups will be used to obtain the necessary data.

The primary sociological information may be obtained through case studies. As it is known, case analysis is a technique that studies objects or processes, using the description of the real economic, social, health, and other situations. These studies, after the analysis of the situation and determination of the nature of the problem, suggest possible solutions. Cases will be based on factual data close to real facts. In the medical sociology, this method is very effective, as it allows giving a sociological evaluation of the clinical situation. The purpose of this method consists of an analytical review of the interpersonal interaction of medical staff and patients. Description of clinical cases performed by applying well-known clinical methods of objective research is widely used in the practice of medical care staff – physical, laboratory, and instrumental.

The mutual relations among all medical process actors in the hospital setting (in the doctor-patient system) will be characterized by the contract type relations model.

Doctors as well as patients consider a technical model type as the least rarely used, however, doctors with little (less than 10 years) experience will probably use the model of technical experience.

The analysis of the data from the surveys filled by doctors will show whether doctors believe that patients provide a sufficient amount of information. At the same time, this opinion is expected to be largely different from their own assertions on the completeness of patients’ awareness. The positions of doctors and patients on the issue of the need for information are expected to not coincide since doctors will believe that the information is provided in sufficient quantities, while the patients deny it and resort to all sorts of information sources (primarily, to the media) and the subsequent self-healing. Declaring the commitment to the collegiate model of interaction between doctor-patient, a number of doctors will be focused on the paternalistic model of interaction, which serves as a basis for the hand-off communication.

When creating a questionnaire and interview questions, it will be necessary to involve the following insights. First, it will review if a doctor is perceived as an attentive listener who correctly assesses the situation, creates a conversation atmosphere. Secondly, it will evaluate if a doctor is a passive listener and how he/she regards the external and internal indifference to the conversation, which makes the interlocutor apathetic and unwilling to continue the dialog (in format doctor-patient; doctor – medical care staff; medical care staff-patient).

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When making a conversation with the patient it will be important to account the success factors of interpersonal communications and compliance with certain other

features such as the most comfortable environment for conversation (confidentiality, lack of physical discomfort in the patient); tactful handling (by name, for example); the usage of positive nonverbal symbolism; the usage of information obtained records; providing initiatives to the patient, the use of the promotion, reflection, explanation, empathy. In addition, approach in dealing with certain categories of patients will be observed, for example, with terminally ill, blind, aggressive, excited, or depressed.


The study of health workers' opinions on relations with the other medical staff members and patients will be conducted through a simple questionnaire and interview. Basic communication skills between doctors/nurses and patients are developed in the process of acquiring medical experience. Therefore, 40 doctors will be questioned on the topic of hand-off communication. According to the data analysis, the same doctors will be interviewed in order to clarify key points (get feedback). It is planned to use a simple interview to expand the understanding of the options of medical workers.

Additionally, 160 patients hospitalized will be interviewed to compare the feedbacks of doctors and patients. The survey will be conducted in a hospital within one working day to prevent the reintroduction of the same respondents in the survey.

Inclusion Criteria

Doctors and patients who used to collaborate less effectively before the hand-off communication have been an improvement.

Exclusion Criteria

Patients and doctors who are not sincere in their answers to the questions provided in the questionnaire and interview.


To study the social aspects of the interaction between a doctor-patient-medical staff it will be important to first ask questions, which will bear a neutral character, then more complex questions, and, finally, the socio-demographic questionnaire will comprise the end block of the questionnaire.

There are two obvious behavior samples in hand-off communication, which will be taken into account when conducting the investigation. The first group consists of the people who use a collegial approach; while the second group is represented by people to rely on a personal approach. The difference, which is important to consider when collecting and analyzing the results of the questionnaires and interviews, consists of the opinion orientation. The personal group will tend to respond to the questions from their own point of view. The collegial group will tend to provide the answers, which are based on other people's opinions. At the same time, the usefulness of communication in the format doctor-patient-medical staff-patient (i.e. the hand-off communication) can be seen in each group's orientation.

Data Collection Procedures

In order to collect information, it will be necessary to question both doctors and patients on how the communication has transformed and how the relationship between the doctors and patients has changed with the implementation of the hand-off communication. The interview and questionnaire data will be recorded and analyzed in accordance with the rules of social questioning. The patients and the medical care process actors will know the aim of the investigation and they will be asked to fulfill the task with utter sincerity.

Data Analysis

In order to analyze the acquired data, it will be necessary to use the essential rules of meta-analysis, which will help gain objective results based on the opinions of both patients and medical care personnel. In addition to this, meta-analysis will help determine the key advantages and disadvantages (in case if they are) of hand-off communication.

Potential Limitations

The essential limitation of the investigation is the insincerity of the respondents. This can be caused by personal opinion towards the issue of hand-off communication and the lack of desire to improve the already existing system of communication.

Implications for Nursing Practice

The theoretical significance of the research is determined by its contribution to the study of hand-off communication in hospital settings. The theoretical significance of peer-reviewed studies is determined by the fact that the paper undertook a comprehensive analysis of communication strategies and tactics of professional hand-off communication of medical staff, from different specialties.

These strategies and tactics are discussed in terms of communication objectives and interaction goals with the different categories of patients. Established types of hand-off communication strategies of medical personnel contribute to the development of communicative problems among the medical care personnel: expanding knowledge of the laws and professional communication methods' analysis. The results of the research can be used in the educational process as well as can be implemented in the ordinary medical practice in order to sustain the care of patients at an appropriate level.

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Doctor and patient, however being equivalent participants in the diagnostic and treatment process, are unequal. The specificity of the doctor-patient relationship is determined by the fact that one of them is sick, while another one is not; one of them is independent in their desire to recover from the other. The doctor has a significant expert authority, which is called by the powerful influence of tradition. Medicine as a social institution should be seen as a set of common roles for all health care actors. The social role of the doctor is initially higher in the hierarchy than the role of the patient; together these roles form the 'vertical' communication.

According to the medical and sociological studies, doctors mostly implement an event-driven model of hand-off communication, when, after the evaluation of the patient, a doctor informs them on the diagnoses and prepares a treatment plan. The same information is shared with other members of medical personnel. Thus, the implementation of hand-off communication in a hospital setting is a long process of improving the information exchange, which should happen at all times during the doctor's (or any other health care institution member) interaction with the patient.

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