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In handover

Handovers can be busy and dynamic.

Getting this time "right" for all team members can improve productivity and patient outcomes.

The RCOG e-learning module on handover gives some useful advice on how to get this right and provides 2x 5-minute video examples.

Do:

  • Show kindness and gratitude to the team who are finishing their shift.  Appreciate that they may be tired and may have had difficult situations to manage.  You could ask how they are and thank them for their work
  • Generate feelings on inclusivity by encouraging everyone at handover to introduce themselves
  • Check in on the new team before you start.  Do you know them? How are they? What are their learning needs? What are their concerns?
  • Generally avoid giving feedback in a public forum and find an alternative, more appropriate time, to deliver this.  However, there may be times where the departing team have started an unwise or unsafe plan which needs to be changed. Consider ways to address the management safely without undermining them. Phrases such as “Hindsight is a wonderful thing but I wonder if…” or “It sounds like you had an incredibly busy shift. I wonder if you had time to consider this option as an alternative given x…”

Don't:

  • Inadvertently use disrespectful gestures such as eye rolling or exchanging glances with colleagues
  • Avoid provocative expressions like “who on earth made that decision?”. It is OK to disagree with management plans but this can be discussed in a kind and respectful way. Ideally then talk to the individual about the plan after the handover (see how to give feedback).
  • Do not avoid giving feedback to the team as this is a key way for us all to learn.  However, it is important to deliver it in an appropriate and effective manner, which is rarely in the handover environment.

Poster 5: Handover (PDF 260kb)

Thumbnail for Poster 5 "Handover" in RCOG Workplace Behaviour Toolkit

Case example of inadvertent uncivil behaviour in handover:

'In my first year as a registrar in O&G I witnessed an episode of undermining in handover.  As we were running through the board our SHO was presenting a case and the actions he had taken.  Our anaesthetist started questioning the SHO on what he had done and why he had done it and went on to explain why she thought what he had done was wrong.  It was really uncomfortable to see so I chirped up in what I hoped was a friendly and neutral way to explain why the SHO’s thought process could also have made sense and moved the handover on.

'I knew the anaesthetist well enough to know that they probably had not intended on undermining the SHO in that way and just got a bit carried away.  Immediately after handover ended I asked her for a quick word and gently explained that I’m sure she didn’t mean to undermine our SHO but that it did appear that way.  She was really apologetic and quickly scooted off to find the SHO and apologise before he went home.'

Some tips and resources

  • Get to know your team and develop positive foundations.  This will mean that any feedback you deliver is more likely to be effective and be received as constructive.
  • It can be useful to have a strategy for delivering effective feedback.  The following articles are helpful for this: TOG article, BMJ article
  • Consider undertaking formal training in delivering feedback through your employer, affiliated deanery/HEE or university or through an associated organisation e.g. BMA course, BMA webinar
  • The East of England Deanery developed this interactive workshop in conjunction with the University of Bedfordshire, on strategies for difficult conversations and particularly on how to avoid undermining when giving feedback.
  • Promote learning from things that go well: eg. Learning from Excellence: resources, community
  • Use excellence reporting systems: Enable all staff within the organisation to report good and excellent practice that they experience via a quick and simple form. Here is an explanation from Learning from Excellence (link to PDF) and video
  • Introduce appreciative Inquiry: asking positively framed questions (inquiring) about a particular topic, in order to increase the value of that topic (appreciate).  Read more about Appreciative Inquiry (PDF) and watch an introductory video

Case example of poorly delivered feedback and its effect:

‘I was working as an SHO. Following an incredibly busy night shift I went home to rest. I got a call 2 hours later from the consultant who had just seen one of the patients that I had arranged follow up for. She found tubo-ovarian abscesses on ultrasound and asked why I had not taken swabs for pelvic infection. Before I could explain anything, she shouted down the phone at me for doing a bad job, not allowing me to explain that the patient had them with her GP. I couldn't rest after that and ended up coming to work exhausted with another busy night where by the end of the shift I made mistakes twice on labeling blood bottles resulting in having to redo my training. It upset me, made me unsafe. I felt unappreciated, unheard. I was merely doing my job the best I knew how. I felt the feedback could have been delivered in a better way then again, this individual is known to come down hard and has caused other individuals to go on stress leave. I did not feel at the time that I could say anything. I just avoided them like the plague.’