National Clinicians Network
Queensland Forum 2013 - Report of outcomes
‘Clinical Handover – Strengthening Patient Care’
CONTENTS
1. Executive Summary ............................................................................................. 2
2. Background and Purpose .................................................................................... 4
3. Clinical Handover – Critical Issues and Interfaces ............................................... 4
3.1. Panel discussion ........................................................................................... 4
4. Clinical Handover – Issues and Barriers .............................................................. 5
4.1. Small Group-Work Session 1 ........................................................................ 5
4.2. Plenary Discussion – Critical Issues ............................................................. 8
5. Developing Solutions for Improving Clinical Handover in Specific Settings ......... 8
5.1. Small Group-Work Session 2 ........................................................................ 8
5.2. Plenary Discussion ...................................................................................... 13
7. Appendices ........................................................................................................ 16
7.1. Appendix 1 – National Lead Clinicians Group Membership ........................ 16
7.2. Appendix 2 – QUEENSLAND National Clinicians Network Program .......... 18
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1. EXECUTIVE SUMMARY
The Queensland National Clinicians Network (NCN) forum was co-hosted by the National
Lead Clinicians Group (National LCG), the Queensland Clinical Senate and Queensland
Health on 19 April 2013.
The purpose of the forum was for participants to share their perspectives on the issues they
face in the transfer of care as patients journey between different care settings, and to identify
potential solutions to improve transfer of care.
The forum commenced with overview addresses from both the National and Queensland
perspectives. The Minister for Health, the Hon Tanya Plibersek MP, provided a video
address and spoke about the challenges facing the healthcare system and the need to
better integrate patient care across health disciplines and sectors. Minister Plibersek noted
the Personally Controlled Electronic Health Record (PCEHR) as a useful tool in managing
patient information and integrating care, particularly given the increasing incidence of chronic
conditions.
Ms Kirstine Sketcher-Baker, Executive Director Patient Safety, Queensland Health,
discussed some of the evidence around clinical handover and demonstrated the significance
of the impact of ineffective clinical handover through a stand-up survey of participants’
experiences.
Ms Sketcher-Baker also spoke about the results of a 2011 Queensland survey on shift to
shift handover. The survey identified that the quality of information handed over is generally
poor; handover skills are learned on the job and not addressed through undergraduate or
post-graduate training; and patient and carer involvement occurs infrequently.
A panel discussion then explored some of the critical issues related to clinical handover,
drawing on a case study, to set the context for the forum. Small group work sessions
provided participants the opportunity to further discuss critical issues and identify a number
of solutions to improve clinical handover:
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for patients and carers
in shift to shift medical handover
in shift to shift nursing handover
in handover to and from on call and night staff
in hospital to community handover.
Key outcomes
Participants identified a number of issues and solutions to improve clinical handover
with an emphasis on achieving consistency across the state. Key themes included:
 Work to create an organisational and clinical culture that values clinical handover
 Identify local clinical champions to drive and provide leadership for effective
clinical handover and expand on existing good practice
 Establish good governance, including senior executive leadership and regular
transparent audit and reporting against key performance indicators
 Expand on the National Standard for Clinical Handover to develop consistent,
practical, measurable tools and processes for clinicians to use on the ground
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 Explore strategies to improve care coordination, as clinical handover between
sectors is often poorly coordinated with key information lost and the patient is
often not included in the decision-making process
 Ensure clinicians and consumers are “PCEHR ready”. Integrating and improving
access to information systems such as PCEHR will improve access to
comprehensive patient information by all clinicians involved in care
 Empower consumers to be active participants in care, rather than passive
recipients. Patients should be equipped with the skills and knowledge that will
assist them to navigate the health system and be engaged in decisions about their
care.
The National LCG will consider follow up actions to progress the outcomes of this
forum. This will include continued engagement with Queensland Health and the
Queensland Clinical Senate.
Outcomes from this forum, along with other state and territory forums, were provided
as input to the National NCN forum in June 2013, and will be considered by the
National LCG in their broader work. It is expected that the solutions identified will
ultimately flow through to systemic changes that result in improved outcomes for
patients.
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2. BACKGROUND AND PURPOSE
The National Clinicians Network (NCN) has been established by the National LCG, a clinical
advisory committee to the Federal Minister for Health (see Appendix 1 for membership).
Commencing in 2012, the NCN is an annual series of interlinking state and territory forums,
culminating in a national forum, to enhance clinical leadership and engagement in health
reform.
Co-hosted by the National LCG and state or territory clinical structures, the NCN brings
together clinicians from all disciplines and sectors to tackle issues affecting patients as they
journey through the Australian health system.
The Queensland NCN forum was held on 19 April 2013 at the Brisbane Convention and
Exhibition Centre. It was co-hosted by the National LCG, the Queensland Clinical Senate
and Queensland Health. The theme for discussion was ‘Clinical Handover – Strengthening
Patient Care’. There were over 330 registrations from a range of backgrounds including:
 medical, nursing and allied health practitioners
 acute and primary care sectors
 consumers
 representatives from the National Lead Clinicians Group (LCG), Queensland Clinical
Senate and Queensland Health.
The forum was facilitated by Ms Lynette Glendinning of Tempo Strategies.
The Minister for Health, the Hon Tanya Plibersek MP, provided a video address, and Ms
Kirstine Sketcher-Baker, Executive Director Patient Safety, Queensland Health, discussed
the context for clinical handover in Queensland.
The purpose of the forum was for participants to share their perspectives on the issues they
face in the transfer of care as patients journey between different care settings, and to identify
potential solutions to improve transfer of care.
3. CLINICAL HANDOVER – CRITICAL ISSUES AND INTERFACES
Panel discussion
A panel of clinicians and a consumer representative discussed their personal perspectives
on clinical handover, to set the context for further conversations in the small group-work
sessions. The panel drew upon a case study about the patient journey of an older person
with multiple co-morbidities through the primary and acute care sectors. The patient
experienced several adverse events related to a breakdown in the clinical handover process.
Professor Wendy Chaboyer – Director, National Health and Medical Research Council
National Centre for Research Excellence in Nursing noted that clinicians tend to give clinical
handover based on their own world view, rather than considering the handover receiver’s
information needs. She also spoke of the need to understand the degree to which each
patient wishes to be involved in the clinical handover discussion, as this can vary
considerably. The key issue Professor Chaboyer encouraged participants to think about was
what the role of nurses was, or could be, in discharge planning.
Dr Georga Cooke – Registrar, Medical Administration Executive Services, Princess
Alexandra Hospital discussed how communication is often quickly abandoned in favour of
completing clinical tasks when a clinician or system is under pressure, and that critical
communication with the primary sector is often left to the most junior medical staff. The key
change Dr Cooke saw necessary was to ‘make communication part of the professional
identity, just as much as technical skills’.
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Mr Mark Tucker-Evans – Chair, Health Consumers Queensland and Chief Executive,
Council on the Ageing Queensland spoke about the need to include the patient and family in
transfers of care from the very beginning of the patient journey and to have frank discussions
about how the patient wishes to be treated as their condition progresses. Mr Tucker-Evans
urged clinicians to include consumers when designing frameworks for clinical handover and
encouraged consumers to be active in their health care.
Dr David Cavalucci – Visiting Medical Officer, Wesley Hospital discussed the need to
access up-to-date patient information and how electronic records could assist with this. Dr
Cavalucci identified a need for senior staff to supervise and educate junior staff on how to
effectively communicate among the health care team, and with patients and families, and to
recognise clinical handover as an important part of continuity of care.
4. CLINICAL HANDOVER – ISSUES AND BARRIERS
4.1.
Small Group-Work Session 1
Forum participants divided into five groups to consider the critical issues to address in
improving clinical handover in different settings. The key issues from each of the groups are
below.
1. For patients and carers
Patients are not empowered to be involved in clinical handover.
 Patients are generally not equipped with the skills and knowledge they need to
effectively engage with clinicians.
 Patients are not given the tools they need to navigate the health system and
make informed decisions.
 Clinicians often don’t work to understand the degree to which each patient wants
to be involved in clinical handover and often don’t invite their participation.
 Clinicians may see confidentiality requirements as a barrier to involving patients
in clinical handover.
Lack of consistent communication/language used by clinicians.
 Different clinicians use different language and often do not tailor their language to
meet the needs of the patient, taking into consideration their health literacy, level
of education or use of English.
 Clinicians often use medical jargon or language that is unclear or ambiguous.
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Clinicians often choose inappropriate times to discuss key issues, such as when
the patient is stressed or fatigued.
Lack of coordination of care
 Clinical handover between sectors is often poorly coordinated with key
information lost. The patient’s needs are frequently not sought and the patient is
not included in the process.
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The patient’s primary care provider, such as the General Practitioner, who usually
has the best understanding of the patient and their needs, is not included in
decision making within the acute care sector.
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2. In shift to shift medical handover
Lack of standard concepts and processes.
 Different doctors across different units and hospitals hand over patients
differently. This is compounded as there is no standard training in clinical
handover in undergraduate or post-graduate training. In addition, there are
different perspectives on what the key purpose or principles for clinical handover
are.
 The quality and comprehensiveness of information provided in clinical handover
varies considerably.
 There are many shifts within a 24 hour period leading to multiple handovers
where information is lost, and there is duplication between different disciplines.
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Multidisciplinary handovers are difficult as each discipline has its own ‘language’.
The current culture does not support good handover and there is unclear ownership.
 The medical structure is strongly hierarchical and junior staff are not confident or
supported to engage with senior staff and in particular, are not empowered to ask
questions.
 There is a culture of ‘this is how we do it’ which makes improvements difficult to
implement and a culture of ‘blame’.
 Handover time is frequently interrupted by colleagues, pagers and phone calls.
 It is not clear who should lead the handover, leading to poor direction.
3. In shift to shift nursing handover
Handover is not valued by organisations or individuals.
 Other priorities are assigned a higher value than clinical handover. This is
reflected in the lack of consistent, sufficient and dedicated time, without
interruptions, across all shifts for handover to occur.
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Compliance or performance of clinical handover is not measured or reported.
Lack of a standard approach and process.
 Handover occurs in different ways (phone, face to face) and in different settings,
however there needs to be a consistent approach.
 The quality and accuracy of information given in handover varies considerably as
does the extent to which patients and carers are involved in the process.
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Information in clinical handover is not made accessible across the health care
team and often does not include multidisciplinary input.
Lack of education and training
 Nursing students do not receive enough training on how to do effective clinical
handover and this is compounded by a lack of standard tools to support good
practices.
 There is a lack of common language across professions and this acts as a barrier
to effective handover communication. In addition, clinicians generally do not
understand the information requirements of handover across different settings.
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Patients and carers also require education in order to understand the purpose
and their role in clinical handover.
4. In handover to and from on-call and night staff
Capacity due to time and workload pressures
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There are generally significantly fewer staff on duty at night and they tend to be
more junior and less experienced. Consequently, staff with reduced confidence
and competence are required to take on a high volume of information from a
number of staff at the beginning of their shift, and then be able to continue this
communication back to a large number of staff at the end of their shift.
Clinical handover to on-call staff is often not planned and tends to occur during a
crisis situation, such as acute deterioration, which limits the time for
comprehensive, patient focused communication. The clinician also has a low
level of familiarity with the patient.
There is generally a high workload and many competing priorities outside of
normal business hours and this can decrease the value placed upon clinical
handover. Fatigue is also a contributing factor.
There is insufficient time allocated for clinical handover for on-call and night staff,
resulting in reduced quality or clinicians working beyond their shift. Handover time
is also frequently interrupted.
There is a lack of training on how to lead effective clinical handover.
Patients are frequently not included in clinical handover with night staff, as it often
occurs when patients are sleeping.
Culture does not support effective clinical handover
 Clinical handover is not recognised as a priority and is not highly valued.
 Devoting time for training, education and mentoring is seen as less of a priority
than completing clinical work.
Lack of consistency
 There is a lack of standard tools and methods for documenting clinical handover.
 There are different communication skills among clinicians and across disciplines,
as well as inconsistency in the amount and quality of information communicated.
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There is a siloed approach to clinical handover, making multidisciplinary
communication difficult.
5. In hospital to community handover
Current discharge communication is inadequate
 Communication between sectors around the time of discharge, including through
discharge summaries, does not provide adequate information for ongoing care.
Information provided is generally not multidisciplinary, holistic, patient centered, fit
for purpose and/or provided in a timely way.
 Discharge communication is not supported by good access to quality information.
This occurs as records across different sectors are not integrated or accessible to
the multidisciplinary team. In addition, information sharing can be curtailed due to
concerns about breaching confidentiality requirements.
Lack of coordination and discharge planning
 Discharges often seem to occur in a rush, without communication and planning
between sectors. There is a lack of a clearly identified coordinator or contact
officer to guide the flow of information.
Lack of understanding between sectors
 There is generally a poor understanding of the scope of services available in the
community and a reluctance of the acute sector to transfer care to other
providers, particularly for complex patients. This is related to a lack of trust and
poor understanding of the capabilities and pressures of each sector.
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4.2.
Plenary Discussion – Critical Issues
Following the small group-work session, participants refined the critical issues as a plenary
group and identified common themes.
Key issues identified included:
Frequency – The more frequent clinical handover occurs within a 24 hour period, the more
opportunity there is for key information to be lost, presenting an increase in risk to the
patient.
Information – Information must be provided in a timely way and be functional and fit for
purpose, meeting the needs of the recipient. There is a lack of consistent tools and language
to guide this process.
Patient empowerment – Patients are not empowered to be fully engaged in clinical
handover. This is related to inadequate health literacy, lack of skills to navigate the system
and inadequate support from clinicians and systems to be involved. This is compounded in
vulnerable patient populations such as culturally and linguistically diverse groups.
Capacity and resources – Clinicians have high workloads and time pressures, impacting on
their ability to practice effective clinical handover.
Education and training – Clinicians are not taught the importance of effective clinical
handover or how to do it.
Standardised framework – There is a lack of a practical and measurable standard state or
national framework for effective, patient focused, multidisciplinary clinical handover.
Value – Effective clinical handover is not seen as important by clinicians or organisations
when compared with other high priorities.
Coordination – Transfer of care is generally not well planned or coordinated, with a lack of a
central contact person and enabling technologies.
Poor understanding between sectors – Clinicians and managers do not understand the
business and capacity of other disciplines and sectors.
5. DEVELOPING SOLUTIONS FOR IMPROVING CLINICAL
HANDOVER IN SPECIFIC SETTINGS
5.1.
Small Group-Work Session 2
Following identification of the critical issues, participants went back to their groups to
consider potential solutions to address these issues. The key solutions from each of the
groups are below.
1. For patients and carers
Issue: Patients are not empowered to be involved in clinical handover.
Empower patients to be involved in clinical handover
 Orient patients to the clinical environment and care, including the purpose and
process of clinical handover, and clearly identify the health care team and
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individual roles. This may include developing patient education packages and
posters for display in hospitals, and commissioning community resources.
Clinicians must seek the patient’s input on how they would like to be involved and
how they would like their family/carer involved in clinical handover.
Patient advocacy groups should work to assist patients to be more involved in
clinical handover.
Provide education for clinicians at the undergraduate, post graduate and
organisational level on how to communicate, involve and empower patients.
Work to build a culture that values patient input. Senior staff must model
appropriate practices.
Improve access for patients to their medical records and other patient
information.
Issue: Lack of consistent communication/language used by clinicians.
Improve the way clinicians communicate with patients
 Clinicians must be able to provide clear, concise information to patients, checking
understanding and encouraging questions. Standard terminology must be used to
limit misunderstanding.
 Communication, including language, needs to be tailored to the individual patient,
taking into account their background and needs.
 Different methods of communication should be used to convey key issues and
support decisions. This may include verbal, written and visual media.
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Trained health interpreters must be used wherever possible, instead of relying on
family members to interpret clinical information as information can be
misunderstood.
Issue: Lack of coordination of care.
Improve the coordination of care as the patient moves through the health system
 Develop a standard process and framework across Queensland for coordination
of care and involve consumers in the development process.
 Care should be planned by the multidisciplinary team, with clear definition of roles
and accountabilities, with a central coordinator.
 The patient’s needs and preferences must be understood and the relevant
stakeholders then involved.
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Decisions and plans must be clearly documented in integrated records that are
accessible by all involved in care.
2. In shift to shift medical handover
Issue: Lack of standard concept and process.
Develop a standard process for clinical handover
 An agreed purpose and set of principles to guide clinical handover must be
settled to enable the development of a standard process.
 Adopt a standard framework to guide clinical handover, with flexibility to adapt to
different clinical areas. Existing tools such as ISBAR (Introduction, Situation,
Background, Assessment, Recommendation) or SHARED (Situation, History,
Assessment, Risks, Expectations, Direction) should be used. The opportunity for
two-way communication, including asking questions must be included.
 Agree on a minimum data set that meets the basic information needs of all
clinical areas. Additional information can be included as is relevant in each area.
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Review rostering practices to align shifts where possible to minimise the number
of handovers in a 24 hour period.
Implement multidisciplinary team handovers with one clear leader to avoid
duplication and enhance the team approach to care planning.
Nominate one clear leader for each handover session to use the available time
more effectively and efficiently.
Work to adopt a common language across professions to improve clarity in
handovers.
Support clinical handover with IT systems that improve access to patient
information and incorporate the PCEHR into acute care.
Issue: Culture and ownership
Work to build a culture that supports effective clinical handover
 Develop strategies to make the medical hierarchy more accessible to enable
junior staff to engage with senior staff. This may include senior staff supervision
and mentorship of junior staff around clinical handover and adopting a more
supportive model, moving away from a culture of ‘blame’.
 Agree to work towards best practice and do not accept a culture of ‘this is how we
do it’ where practices are not supported by evidence.
 Nominate clinical champions (either medical or from another profession) to
promote and lead implementation of effective clinical handover in each area.
Clinical champions will need to be of sufficient social competence and seniority to
influence their colleagues.
 Support implementation of effective clinical handover with evidence from the
literature on adverse outcomes resulting from poor handover. Follow up with audit
and transparent reporting of progress.
 Quarantine handover time to minimise avoidable interruptions such as phone
calls and pages.
 Consultants must model effective clinical handover.
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Instigate performance management processes for staff who do not practice
effective clinical handover.
Education
 Include simulation training in clinical handover in undergraduate training.
Education should include the purpose and reason for effective clinical handover,
including consequences of poor handover. Include competency in this training as
a requirement for professional registration.
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Include training in clinical handover in orientation for new medical officers,
particularly interns.
3. In shift to shift nursing handover
Issue: Handover is not valued by organisations or individuals
Commitment to effective clinical handover as an organisation
 The senior staff and executive within the organisation must provide leadership in
order to improve culture. This may include their presence from time to time at
handovers. Clinical handover should be included in Key Performance Indicators
at executive level meetings as a standing agenda item, and there should be
transparent reporting throughout the organisation on auditing and adverse events
related to handover.
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Organisation leaders should direct a review of rostering practices to minimise the
number of clinical handovers within a 24 hour period and ‘quarantine’ dedicated
handover time to reduce interruptions so far as is possible.
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Nominate clinical champions to lead and drive effective clinical handover and
influence culture at the unit level.
Issue: Lack of standard approach and process
Standard state/national framework
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Develop a standard framework and include input from all stakeholders. The
framework should build on work already undertaken by the Australian
Commission on Safety and Quality in Health Care (ACSQHC) and provide more
practical and measurable steps for clinicians and organisations to follow,
including tools (such as ISBAR or SHARED). The framework should provide
consistency between clinical areas and organisations while retaining a degree of
flexibility for adaptation for the local context.
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Implementation of the standard framework must be supported by education and
followed with regular audit and transparent reporting.
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Forms, whether paper or electronic, should be standard across Queensland to
streamline communication and decrease duplication. Examples include care
plans and discharge referrals.
Issue: Lack of education and training
Undergraduate education
 Develop a national curriculum for clinical handover with consistency across
disciplines for undergraduate medical, nursing and allied health courses.
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Include undergraduate education in clinical handover as a requirement for
professional registration.
Mandatory annual training
 Include annual training in clinical handover as a mandatory requirement for all
clinical staff.
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Education may be supported by competency based training, or followed by
regular audits of performance/compliance. Clinical handover should form part of
individual staff Performance Appraisal and Development Plans (PADPs).
4. In handover to and from on-call and night shift
Issue: Capacity due to time and workload pressures
Develop strategies to increase capacity for clinical handover
 Review rostering practices to standardise handover times across a
24 hour period, both within and between disciplines, to assist multidisciplinary
handover.
 Provide for senior clinician attendance at handovers to establish role models and
provide support for junior staff.
 Schedule handovers away from other peak activity periods to reduce
interruptions.
 Develop an agreed framework with practical tools to assist clinicians to give,
receive and document handover.
 Provide training in clinical handover, including how to involve the patient.
 Improve access to real time information across the organisation. This may include
electronic ‘journey boards’ displaying where a patient is in their care.
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Issue: Culture does not support effective clinical handover
Work to build a culture that supports effective clinical handover
 Cultural change to support effective clinical handover will require a dedicated,
funded improvement program.
 The executive, at the state and organisational level must support clinical
handover, and measure and report on performance.
 Senior clinicians must model appropriate practices for junior staff.
 All clinicians should receive training in clinical handover as undergraduates and
in continuing education.
 Implementation of a clinical handover framework should be supported by
evidence and followed with audit and transparent reporting.
Issue: Lack of consistency
Develop a standard framework
 Develop a standard framework for clinical handover including purpose, minimum
standards and direction on when clinical handover should occur, for example,
hand hygiene uses the ‘5 Moments for Hand Hygiene1’ to guide clinicians as to
when hand hygiene should occur. The framework must also include practical
tools and a requirement to involve the patient.
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A standard framework for clinical handover must be supported by improved
access to integrated patient information.
5. In hospital to community handover
Issue: Current discharge communication is inadequate
Develop a standard set of principles and framework
 Develop a standard set of principles at the state level to provide guidance on
clinical handover from the hospital to the community, including a strong emphasis
on multidisciplinary input and patient involvement. A framework, including
practical tools such as a checklist and a mechanism for ‘flagging’ patients at risk
of readmission, should be included to assist clinicians to work to the principles.
While a statewide standard is needed, flexibility for local adaptation must be
retained.
 Development of these principles and framework should be driven and ‘owned’ by
clinicians. Implementation should be supported by multidisciplinary education
across the acute, primary and community sectors.
 Performance against the principles and framework for clinical handover should be
measured through regular auditing and reporting.
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This standard approach should be supported by access to a single,
comprehensive health record across Queensland.
Issue: Lack of coordination and discharge planning
Support coordination of care
 Discharge coordination positions need to be supported and funded. The
coordinator can drive the planning process for transfer of care, ensuring a
multidisciplinary approach and inclusion of the patient. Specially trained
coordinators should be available for vulnerable populations, for example,
Indigenous or older people.
Hand Hygiene Australia (2013). ‘5 Moments for Hand Hygiene’. Retrieved from
http://www.hha.org.au/home/5-moments-for-hand-hygiene.aspx.
1
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Each patient should have a ‘medical home’, which may be a general practice or
other primary care provider. This would be the coordinator’s first stakeholder
(after the patient) for planning and communication towards transfer of care.
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The coordinator should also ensure there is a clear plan for follow-up care, to
provide the General Practitioner with a starting point and clear understanding of
current expectations and treatment goals.
Issue: Lack of understanding between sectors
Understand the local context
 Local areas should explore ways to improve the understanding, respect and trust
between sectors. Clearly defined roles should be part of this process. Strategies
may include developing local level partnership agreements or co-locating
services where possible. Joint education and training sessions could also be of
value.
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5.2.
Common health problems should have locally agreed pathways of care for
transition between the acute and primary/community sector, based on the
services locally available.
Plenary Discussion – Solutions
Following the small group-work session, participants discussed common themes in a plenary
session.
Key solutions identified included:
Issue: Frequency
Reduce the number of handovers occurring within a 24 hour period to help preserve the
integrity of information and reduce risk to the patient.
Strategies may include:
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Review rostering practices to align shift changes, both within disciplines and
across the organisation. Common handover times will:
 enable multidisciplinary handover, reinforcing the multidisciplinary model of
care
 decrease interruptions including phone calls, pages and meetings.
Issue: Information
 Develop and agree upon a minimum data set for handover communication.
Information should include social and cognitive as well as physical components.
 Referral information should include clear goals and expectations for the referral.
For example, the expectation for a patient transferred from a residential aged
care facility (RACF) to an Emergency Department (ED) with a suspected hip
fracture may require diagnostic testing to rule out the fracture, and then return to
the RACF for medical management of other health problems, avoiding admission
to the hospital.
 Develop and implement electronic information systems that allow real-time
sharing of patient information. For example, real-time ‘journey boards’ that display
information about the patient as they move between the ED, operating theatres
and the ward.
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Enable clinicians to access electronic information systems through personally
held electronic devices such as tablets and smart phones.
Issue: Patient empowerment
Work to empower patients to be more involved in handover and decisions about their care.
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Consumers need to be aware of their right to ask questions throughout their
health care journey. This could occur through broader health literacy programs.
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Patients should be able to access user-friendly, evidence based information
about their condition. This would enable them to better navigate the health
system and be more assertive and engaged in decisions about their care. This
type of information, for example, about the management of their diabetes, would
be able to be included on the PCEHR.
Issue: Standardised framework
Expand upon the existing national framework for clinical handover, National Safety and
Quality Health Service Standards, Standard 6, Clinical Handover. Areas to address include:
 Developing and agreeing upon standard practical, measurable tools and
frameworks for clinicians to use in daily practice that emphasise a
multidisciplinary, patient focused approach. Queensland Health has undertaken
significant work on this front, available at
http://www.health.qld.gov.au/psq/handover/html/ch_homepage.asp. This may be
best achieved by a national level working group.
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Providing a standard approach while retaining flexibility for local adaptation.
Issue: Value
Work to improve the value clinicians and organisations place on effective clinical handover.
This is a large process that will require careful planning and implementation in order to
change the current culture. Strategies may include:
 Identifying local clinical champions to drive and lead effective clinical handover.
Clinical champions should be known and well regarded in their area of practice, in
order to influence their colleagues. Champions will have a role in implementing
standard frameworks and tools, and influence culture at the local level, including
through role-modeling.
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Strengthening governance and accountability at the senior leader level. Senior
leaders within the state and organisations must demonstrate commitment and
interest in achieving effective clinical handover by role modeling, engaging with
clinicians and developing policy that enables clinicians to practice in this way.
Promoting and recognising existing good practice.
Partnering areas who perform well in clinical handover with those who require
improvement to provide mentorship and peer-learning.
Organisations must monitor performance in relation to effective clinical handover
through regular audit and transparent reporting and work to continuously improve
performance. A functioning model to draw upon is the ‘5 Moments of Hand
Hygiene2’ initiative.
Participating in effective clinical handover should form part of every clinician’s
Performance and Development plan.
Issue: Education and training

All clinicians should have regular training in effective clinical handover. Training
should be available through the ‘iLearn’ portal and be linked to Performance and
Development plans.
Issue: Poor understanding between sectors
Develop strategies to improve the understanding between sectors. This may include:
 Working at the Local Hospital Network/Medicare Local level to enable General
Practice in-reach to the acute sector.
2
http://www.hha.org.au/home/5-moments-for-hand-hygiene.aspx
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

Supporting short term ‘swapping’ of staff between sectors
Engaging all stakeholders in developing patient pathways for specific health
problems.
Issue: Coordination
Support effective coordination of care transfers. Strategies include:
 General Practitioners, or others referring into the acute sector, to provide clear
communication of reason and goals for referral, ensuring the patient is aware of
their situation.
 Funding discharge coordination officers to drive the planning process, ensure
good communication and inclusion of all relevant stakeholders and act as a
central point of contact.
 Connecting existing services and information systems by:
 improving understanding of services available at the local level
 working to build understanding, trust and respect between different services
and professions
 integrating and improving access to existing information systems both within
the acute sector and across sectors, particularly electronic. This may include
promoting the use of the PCEHR to improve access to comprehensive patient
information by all clinicians involved in care.
 Developing a ‘flagging’ system across sectors to notify clinicians of patient
movements, particularly complex or vulnerable patients and those at risk for
multiple admissions.
6. NEXT STEPS
The National LCG will consider follow up actions to progress the outcomes of this forum.
This will require the Group’s engagement with other stakeholders across the health system,
and its use of networks and partners to ensure the solutions identified ultimately flow through
to systemic changes that result in improved outcomes for patients.
The National LCG will also discuss other options to progress implementation and develop a
matrix of solutions and implementation partners to provide a framework for action.
This forum was part of a series of state and territory forums held in 2012-13 on transfer of
care issues. Suggestions from this forum and other state/territory forums were provided as
input to the National forum in June 2013, and will be considered by the National LCG in their
future work.
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7. APPENDICES
7.1.
Appendix 1 – National Lead Clinicians Group Membership
Adjunct Professor Dr Russell Stitz, AM RFD (Chair) is Commissioner at the Queensland
Health Quality and Complaints Commission, senior surgeon at the Royal Brisbane and
Women’s Hospital and previously Professor of Clinical Surgery and Head of the Discipline of
Surgery for the University of Queensland. He is a past President of the Royal Australasian
College of Surgeons and past Chairman of the Committee of Presidents of Medical
Colleges. He is also a former Director of the Australian Medical Council.
Adjunct Associate Professor Melissa Locke (Deputy Chair) (until 29 April 2013) is a
practising specialist paediatric physiotherapist (Fellow of the Australian College of
Physiotherapists), holding an adjunct associate professorship at Griffith University and
Immediate Past National President of the Australian Physiotherapy Association.
Mr Tim Benson is an experienced senior health consumer representative and a member of
both the national and state peak consumer health bodies, as well as the WA North
Metropolitan Health Service Area Executive.
Dr Mark Bowman is a practising dentist in Victoria, federal and state councillor of the
Australian Dental Association and Immediate Past President of the Australian Society of
Periodontology.
Professor David Clarke is Clinical Director of Primary Care and Consultation-Liaison
Psychiatry at Monash Health in Victoria and Professor of Psychological Medicine in the
Faculty of Medicine, Nursing and Health Sciences at Monash University.
Mr Christopher Cliffe is a registered nurse who has worked extensively in remote, rural,
indigenous and international health. He is the Executive Director of Nursing and Midwifery
for the Cape York Hospital and Health Service, National President of CRANAplus, Deputy
Chair of CoNNO (Coalition of National Nursing Organisations) and a member of the
Prevention and Community Health committee of the NHMRC.
Professor Nicholas Glasgow is a practising palliative medicine specialist and General
Practitioner in the ACT, and Dean of the Australian National University Medical School.
Ms Helen Gosby is a nurse practitioner in the emergency department at the Children’s
Hospital at Westmead, NSW, and President of the Australian College of Nurse Practitioners.
Dr Alasdair MacDonald is the Director of Medicine, Clinical Integration, Reform and Stroke
Care within the Tasmanian Northern Area Health Service and active in Education and Policy
within the Royal Australasian College of Physicians.
Dr Jennifer May is a practising general practitioner in rural NSW, GP Academic at the
University of Newcastle Rural Clinical School, immediate past Chair of the National Rural
Health Alliance and the Chair of the Rural Doctors Association Female Doctor’s Group.
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Professor Tracey McDonald AM FACN is a professor at the Australian Catholic University,
with wide experience in nursing, health services, education and management. This supports
her leadership of clinical practice and research in ageing; clinical and practice development;
clinical outcomes benchmarking; leadership and governance; and social and health policy.
In 2012, she was invested as a Member of the Order of Australia.
Dr Ameeta Patel is a General Practitioner, Member NT Board of the Medical Board of
Australia, Board Member Rural Health Workforce Australia, Director Northern Territory
Medicare Local.
Dr Andrew Pesce is a practising obstetrician and gynaecologist, currently appointed as
Clinical Director in Women’s Health in Western Sydney Local Health District and a member
of the Local Health District Board, as well as the immediate past President of the Australian
Medical Association.
Ms Toni Riley is a practising pharmacist in a regional Victorian pharmacy providing opiate
replacement, primary care services and services to residential care facilities.
Winthrop Professor Christobel Saunders is a Professor of Surgical Oncology, academic
surgeon, cancer researcher and teacher of surgery at the School of Surgery, University of
Western Australia since 2002. She has been closely involved in strategic planning and
management of health cancer services in Australia for the last decade as Board member
and Advisory Council member of Cancer Australia, President of the Cancer Council WA, and
locally as author of the WA Health Cancer Services Framework and first A/Director Statewide Cancer and Palliative Care Network.
Dr Mark Wenitong is a founder and past President of the Australian Indigenous Doctors
Association, and the senior medical officer for Apunipima Cape York Health Council, an
Aboriginal community-controlled health service delivering primary care to remote Cape York
communities.
Associate Professor Craig Whitehead is a practising geriatrician at Repatriation General
Hospital SA and the Regional Clinical Director for Rehabilitation and Aged Care, as well as
an Associate Professor at the Flinders University Medical School.
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7.2.
Appendix 2 – QUEENSLAND National Clinicians Network Program
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