Medical team communication

Shift handover: why important information gets lost between crews

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TL;DR: A good shift handover isn’t a list of everything that happened over the last eight hours. It answers the question of what the incoming crew needs to know and do in order to take over responsibility safely. What matters most are deviations from normal, unfinished work, risks and priorities. It’s worth combining a face-to-face conversation with a short written record and confirmation of the key information.

  • Saying “the machine’s running” isn’t enough when a fault has only been fixed temporarily.
  • The written record captures the facts, while the conversation lets people ask questions and clear up anything unclear.
  • Confirmation should be about the next action, not just the words “all clear”.

How does Empatyzer help improve the conversation at shift handover?

Em can help foremen develop a way of handing over unfinished business and responding to questions without blaming each other. It takes into account differences in how people communicate.

Features that will help you:

  • Talk to Em about your team: Preparing rules for exchanging information and questions between shifts.
  • Talk to Em about a specific person: Tailoring the conversation with the foreman you most often have misunderstandings with.
  • Personalised micro-lessons: Building the habit of clarifying and closing off agreed actions.

What gets lost in the last few minutes of a shift

The last minutes of a shift can be the most hectic: you have to clean the workstation, complete the paperwork and get to the changing room in time. Meanwhile, the crew starting work is trying to work out what lies ahead. If the handover boils down to “everything’s running normally”, it’s precisely the information that isn’t obvious at first glance that gets left out: an unfinished order, an unusual alarm, a temporary workaround for a fault or a scheduled service.

The UK’s Health and Safety Executive (HSE) identifies three elements of an effective shift handover: preparation by the person finishing work, a two-way exchange of information, and a check of the information by the person taking over. It’s an important distinction. Simply having two foremen in the same place doesn’t yet mean responsibility has been handed over. Preparation should happen before they meet, rather than relying on a rushed reconstruction of the shift from memory. At the end, the person taking over needs to know not only what happened, but also what needs to be done now.

An experienced worker doesn’t always know what their successor doesn’t know yet

An operator who has run the same machine for years may assume certain things are obvious. “Everyone knows what that noise means.” But a new person might associate it with a completely different situation, and a colleague from another department may not know the machine’s fault history. The problem doesn’t have to come from carelessness or bad intent. It’s a gap in knowledge that neither side noticed. The person handing over should, for a moment, look at the process through the eyes of someone who wasn’t there for the last few hours.

Instead of “you know what I mean”, it’s better to say: “After start-up the temperature alarm came on again. Maintenance checked the sensor, but what we do next depends on the result of the inspection.” The person taking over then has three pieces of information: the fact, what has been done so far and the decision that needs to be made. It also helps to say where the agreed actions have been recorded and who can explain the details. For critical issues, tacking on “if anything comes up, give me a call” isn’t enough.

Hand over exceptions and unfinished business first and foremost

If everything went according to procedure, it’s enough to record that conditions were normal. More attention is needed for situations that change the risk or the order of actions: a disconnected component, a pending measurement, a changed parameter, the wrong material, a missing part, or work that was started but not finished. This isn’t a list of curiosities from the last shift. It’s a map of the decisions the next team is about to make.

One standing question helps: “What does the person taking over the shift need to know before they make their first move?” For one task, that will be whether the equipment has been made safe; for another, the order number, the person responsible and the expected completion date. If three minor faults have come up and one of them could stop the line, they shouldn’t be presented as equally important. Priority should follow from the risk and the next action, not from whichever story stuck most in the mind of the person telling it.

The written record and the conversation complement each other

A shift log is necessary because memory can be unreliable, and the status of an issue must also be available to people who weren’t present for the conversation. On the other hand, an entry like “fault to be monitored” can mean different things to different people. That’s why HSE recommends combining written and verbal communication and treating the handover as a two-way conversation. Good practice is simple: first a completed log, then a short conversation about anything unusual, and finally confirmation of the handover.

However, don’t create a second information channel alongside the safety system already in place. If the site has a formal log, a permit-to-work system, an energy isolation procedure or a separate fault register, these remain the basis for technical decisions. The verbal conversation is there to help people interpret them correctly, not to replace the written record. Private messaging apps are also risky: an important agreement can get lost in them or be unavailable to the next shift.

Check understanding by asking about action

It’s very easy to answer “yes” to the question “Is everything clear?” All it takes is a nod, even when the person doesn’t understand what they need to do first. A better question refers to something concrete: “What will you check before start-up?” or “If the alarm comes on again, what’s the agreed course of action?” The point isn’t to test your colleague. It’s to spot a difference in understanding before it turns into a mistake.

If the person taking over the shift gives a different answer from the one expected, the person handing over shouldn’t react with: “I’ve told you this so many times.” It’s better to check which wording was unclear, correct it and only then ask the question again. This way of closing the communication loop is a practical adaptation of techniques for checking understanding used in other settings. There are no grounds for promising that simply repeating information will eliminate breakdowns. What it does is allow a misunderstanding to be caught straight away, before it causes an error.

When the handover starts with a complaint

“You’ve left us with problems again” is a sentence that usually increases the number of excuses, not the amount of useful information. If a handover starts with mutual accusations, the manager should separate two issues: what needs to be done safely right now, and how to analyse the cause of the recurring problem later. A good message would be: “Let’s first establish the state of the equipment and the next step. We’ll come back to what happened earlier once the process is up and running, with the records from both shifts.”

If similar situations keep happening, it’s worth arranging a short meeting between the foremen and asking which piece of information didn’t get through, why, and how to pass it on next time. A meta-analysis by Tannenbaum and Cerasoli showed beneficial effects of well-run debriefs, but that doesn’t make them a ready-made recipe for every site. What matters is that the meeting leads to a change in a specific habit, not yet another signature under the statement that “communication needs to improve”.

A shift handover is only complete when the next crew knows the state of the process, the exceptions, the decisions still to be made and their own first step. Good practice combines a prepared written record, a two-way conversation and confirmation of critical information. That way, settling old grievances doesn’t crowd out the more urgent task: taking over responsibility safely.

How Empatyzer supports understanding between shifts

A foreman can talk to Em before meeting a colleague from the other shift, especially if recent handovers have ended in accusations about missing information. They describe a specific incident, sample entries in the log and how both sides reacted. Em helps them separate facts from judgements, turn a complaint into a question about the status of a task and prepare a short opening for the conversation: “Let’s work out what the next shift needs to know before we go back to the causes.” If relationship tips are available for both foremen, the tone and level of detail of the message can be better matched. In a conversation about the team, Em can help assess whether one shift needs more clear-cut agreements and the other more room for questions. Em doesn’t replace the site’s registers or technical procedures. It helps people work out how to talk about unusual situations, ask questions and accept correction without losing face. Short, personalised micro-lessons linked to everyday collaboration challenges help to reinforce these habits.

Sources

  1. Health and Safety Executive (b.d.). Shift handover. Health and Safety Executive (UK). https://www.hse.gov.uk/humanfactors/topics/shift-handover.htm Shift handover
  2. Tannenbaum SI; Cerasoli CP (2013). Do Team and Individual Debriefs Enhance Performance? A Meta-Analysis. Human Factors. https://pubmed.ncbi.nlm.nih.gov/23516804/ 10.1177/0018720812448394
  3. Edmondson AC (1999). Psychological Safety and Learning Behavior in Work Teams. Administrative Science Quarterly. https://journals.sagepub.com/doi/10.2307/2666999 10.2307/2666999