Clinical Handover as Craft, Not Checklist

Handover is one of the most studied elements of clinical care and its importance to the good continuity of care and patient outcomes is well-accepted. Unfortunately, efforts to improve the quality of clinical handovers have led to an environment of compliance exemplified by mnemonics, templates and audits that assume or suggest handovers to be stable, reproducible processes that can be judged by conformity to checklists. However, handovers are highly heterogenous, personalised and nuanced events that do not easily fit into tightly structured models. We draw on observational work in a 2-year, ongoing collaboration between a large emergency department and a human-centred design research team, and argue that handover is essentially a craft: a skilled practice shaped by timing, uncertainty, recipient needs and jurisdictional boundaries. We suggest that standardisation of handovers can work against quality, and that simple checklists threaten to flatten rather than enhance their true craft or value. Shifting how clinical handover is understood, taught, assessed and supported, by emphasising the importance of craft over completeness may be the secret to ensuring quality.