Organizational climate for safe and effective inter-unit handoffs in Japanese hospitals

To extract the organizational climate factors that contribute to safe and effective inter-unit patient handoffs, as well as to capture their crucial characteristics in the context of current Japanese hospitals.

A questionnaire survey was conducted among nursing staff in 31 general hospitals, collecting a total of 5117 valid responses (69% response rate).

A five-factor model was established to determine the inter-unit handoff climate within hospitals. This comprised information and responsibility-related risk, role understanding, communication, handoff environment, and guidelines and process. Based on nursing staff perceptions, the inter-unit handoff climate in Japanese hospitals were generally found to be moderate or moderate-to-high levels across all five of the factors. Nursing staff's perceptions of all five climate factors differed significantly across hospitals and work units, rather than working conditions (full-time vs. part-time) or professions (nurse vs. nurse assistant). All five handoff factors were verified their significant impacts on patient safety awareness and handoff quality. Furthermore, in hospitals where staff perceptions of handoff climate were more positive, information was transferred more effectively.

An inter-unit handoff climate structure was extracted and verified its impact on handoff quality and safety. Due to moderate climate levels in Japanese hospitals, as well as background factors such as low risk awareness among staff and busy situations, promoting a more positive organizational culture is suggested for creating safer and more effective inter-unit handoffs. Improving the current handoff guidelines and processes in hospitals and using non-licensed assistive staff more effectively are also recommended.