Fieldset
Innovation: Let’s Make Handover Quicker and Easier

Our staff work fast-paced, high pressure jobs in medical emergencies around the world. When they start a new role, they need to get up to speed, fast. Charlotte blogs about an Médecins Sans Frontières / Doctors Without Borders (MSF) project she's working on, to help them do exactly that... 

 

MSF runs medical facilities in parts of the world where they’re needed most. This can mean a hospital in a refugee camp, the only maternity unit in a remote area, or a large-scale HIV project for people who would not otherwise be able to get treatment. Our staff work in our projects on short-term, intensive contracts, providing their expertise and management skills for up to a year at a time.

 
The nature of MSF’s work means that staff will always come and go, so a robust, well-tested handover process is vital to ensure that staff quickly settle into their roles. A good handover avoids disruption in the hospital, and in the care patients receive. I'm a service design master's student and have been working with Médecins Sans Frontières (MSF) to improve the field hospital handover processes.
 

Staying in the know

In my last post, I explained some of the research I’ve been doing to learn more about what it’s like to start a new role in an MSF hospital. 
 
In my interviews with MSF field workers, they told me that in high-pressure environments, delivering medical care in busy conditions means that there is not much opportunity for recording information. 
 
When things aren’t recorded, it means that when an experienced member of staff leaves, all the knowledge they’ve built up over their time in the job – who can get things done, how problems can be solved, which issues can be predicted and prevented – all this valuable knowledge can get lost. 
 
Ensuring that information is correctly documented and stored means it doesn’t leave with the staff member. It stays in the institution itself, becoming ‘institutional knowledge’, helping the hospital to run smoothly and continuing to benefit our patients.
 

Local knowledge

MSF employs medical staff from all over the world. The majority of our field staff work in the town, village or city they are from: we call them ‘national’ staff. 
 
However, we also employ staff from other countries to help deliver medical care where it’s needed most. These are our ‘international staff’. 
 
National staff tend to stay working at our hospitals and clinics for a longer time, as they are on home turf. International staff come and go, due to visa restrictions or commitments back home. 
 
Through the research phase of the project, chatting with staff who have experience of working for MSF in the field, we identified that strengthening the link between the national and international staff could improve the handover process, and help to conserve institutional knowledge. 
 
National staff often stay in their role for a long time so international staff can learn a lot from them. 
 

A new approach

In collaboration with MSF field and headquarters staff, we have designed a quicker, easier hospital handover process. The new handover process improves institutional knowledge and strengthens the link between national and international staff. It does this through a series of solutions. 
 
 

Living organogram

 
The organogram is made up of many small pieces of paper, each with the details of one staff member, and stuck on the wall in an order reflecting the organisational hierarchy
Photo: Charlotte Fountaine / MSF
 
The vast majority of field staff we spoke to said that having an organogram would greatly improve their experience. They mentioned that not knowing who to speak to about what meant they wasted time during their role, which would have a negative impact on the patient care they were able to provide. 
 
So, we created a template which means staff can print out people’s names, photos and roles and stick them on the wall somewhere communal in the hospital. Having the organogram on the wall means is it accessible to all and easy to update. 
 
 
 

Flexible template

 
A laptop with the flexible handover template on screen

Photo: Charlotte Fountaine / MSF

A written handover document is vital so that information isn’t lost. Field staff mentioned that writing a handover report was time-consuming because they didn’t know what to put in it. This template will be kept on a central system, and updated every time a new staff member leaves. A member of staff who is leaving simply takes their predecessor’s handover document, updates the information and links, and shares it with their successor and line manager. 
 
 
 

National staff buddies 

 
Two women in MSF jackets talk in front of a health centre
Staff members in Papua New Guinea consult. Photo: Basia Asztabska
 
The buddy system means that information can be shared verbally and there’s a chance to ask questions and get clarity. When a staff member arrives, they’ll be partnered up with an experienced member of national staff for a tour and to understand their role. A buddy system will strengthen the important link between the national and international staff.  
 

Get involved!

After May 2018 the new handover process will have been researched, designed and tested, so that it is ready to be implemented for people in the field. The aim is to improve the hospital handover process for smoother transitions between staff and therefore more time to deliver the best medical care we can. 
 
Currently, we are still testing the new process and welcome feedback. All of these new solutions can be downloaded and tested from the MSF handover website: msfhandover.org.uk
 
If you're an MSF field worker, we encourage you to try them out, and let us know how it goes. Give feedback by emailing: charlotte.fountaine@london.msf.org