150: Social Impediments to Implementation of Structured Handoff in a Professional Context: A Qualitative Study of I-Pass Implementation
Bibliographic record
Abstract
Literature on high reliability organizations suggests that structured communication can reduce errors. The I-PASS Handoff Bundle aims to improve resident handoff and consists of teamwork training, structured verbal communication using a mnemonic, and an electronic written handoff tool. The program was implemented as part of a nine-site study. This qualitative study examines the implementation of structured handoff in the context of residency training programmes. This study examined to what extent I-PASS was adopted amongst residents, what factors facilitate and impede adoption, and in particular the impact of social factors. Focus groups were conducted with residents (n=54) at eight of nine IPASS sites. The data were analysed using grounded theory techniques to generate insight into how adoption of structured communication could be facilitated in health care. The results were very consistent across sites, and resident perspectives fell into four main themes. Residents expect communication to be efficient. Time is universally regarded as a scarce resource and it is expected that communication should cover only the information necessary for on-going quality patient care. The perception that the I-PASS mnemonic requires that the same information be covered regardless of the professional's level or knowledge of the patient and for all patients regardless of complexity was seen as violating this norm. Residents expect communication to respect professional competence. The standardized nature of the information communicated to colleagues can be seen as insensitive to the requirements of residents at different stages of professional competence. Junior residents were more receptive to comprehensive information while the same information was felt redundant by senior residents. Residents expect allowance for professional judgment and autonomy. The standardized format of IPASS communication, particularly the Synthesis by Receiver step (read back) was seen as limiting professionals' right to exercise judgment in communication. Residents expect informal communication among peers: The standardized format of IPASS was seen as more suited to demonstrating skill to a superior rather than for use among colleagues of the same hierarchical level. These data must be interpreted in the context of residency training. Residents who have varying levels of professional identity formation may vary in their ability to adopt new structured communication practices. Acknowledgement of these norms in the training and ongoing reinforcement phases could lead to more positive attitudes and greater receptivity to ongoing efforts to improve communication, which will be required to bring about transformative change.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.022 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.008 | 0.009 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".