• Beryl Göbel, Dorien Zwart, Gijs Hesselink, Loes Pijnenborg, Paul Barach, Cor Kalkman, and Julie K Johnson.
• Patient Safety Center, University Medical Centre Utrecht, Utrecht, The Netherlands.
• BMJ Qual Saf. 2012 Dec 1;21 Suppl 1:i106-13.

BackgroundMuch of the research on improving patient handovers has focused on enhancing communication within the hospital system, but there have been relatively few efforts aimed at addressing the challenges at the interface between the hospital and the primary care setting.MethodsA qualitative thematic analysis using a clinical microsystems lens applied to 28 semi-structured key stakeholder interviews in the Netherlands. Data were organised into seven 'virtual' clinical microsystem datasets composed of patients, hospital-based physicians, hospital-based nurses and community-based general practitioners.ResultsFive themes that contributed to effective or ineffective handovers emerged from our analysis: (1) lack of adequate information; (2) healthcare professionals' availability and opportunity for personal contact; (3) feedback, teaching and protocols related to handovers; (4) information technology facilitated communication solutions; and (5) the role and responsibility of patients. Our analysis suggests that each healthcare professional attempted to provide the best care possible, but did this largely in isolation, and without the benefit of the knowledge and expertise of the other members of the microsystem.ConclusionsThe microsystem approach offers an innovative organisational construct and approach to assess the gaps in 'hospital to community' patient handovers, by viewing the hospital to the community interface as a clinical microsystem continuum. Our application of the microsystem approach confirms and extends earlier findings about the impact of barriers on the continuity and safety of patient transitions and their impact on the quality of patient care.

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