Know Your Client and Know Your Team: A Complexity Inspired Approach to Understanding Safe Transitions in Care

Background. Transitions in care are one of the most important and challenging client safety issues in healthcare. This project was undertaken to gain insight into the practice setting realities for nurses and other health care providers as they manage increasingly complex care transitions across multiple settings. Methods. The Appreciative Inquiry approach was used to guide interviews with sixty-six healthcare providers from a variety of practice settings. Data was collected on participants’ experience of exceptional care transitions and opportunities for improving care transitions. Results. Nurses and other healthcare providers need to know three things to ensure safe care transitions: (1) know your client; (2) know your team on both sides of the transfer; and (3) know the resources your client needs and how to get them. Three themes describe successful care transitions, including flexible structures; independence and teamwork; and client and provider focus. Conclusion. Nurses often operate at the margins of acceptable performance, and flexibility with regulation and standards is often required in complex sociotechnical work like care transitions. Priority needs to be given to creating conditions where nurses and other healthcare providers are free to creatively engage and respond in ways that will optimize safe care transitions. 1. Introduction Transitions in care are arguably one of the most important and challenging safety issues in healthcare today. Transitions in care involve the transfer of duties and accountabilities from one person, or group of people, to others. Transitions are a complex business that require a high degree of context-specific coordination and communication among different people with different backgrounds and skills. Consider one family’s experience with transitions in care. Two years ago, as the time was approaching for my father to be discharged after emergency hip reconstruction surgery, and three months of non-weight bearing rehabilitation, my mother became increasingly concerned about his impending discharge. In the weeks leading up to his discharge, I had several meetings with his social worker to discuss my mother’s reluctance to take my father home and her concern about his ability to once again take care of his colostomy. The social worker arranged for a number of things to happen, prior to his discharge, which enabled a smooth transition to home. A home safety assessment was conducted and bath bars and toilet seat supports were installed a week in advance of his expected date of discharge. Arrangements were made for