When Teamwork Is Not Enough: How Organizational Learning and Continuous Improvement Strengthen the Teamwork–Handoff Relationship in Hospitals

BACKGROUND: Hospital handoffs, including shift changes and transfers across units, are vulnerable points in care delivery where communication failures may lead to information loss and preventable adverse events. Although teamwork is a well‑established driver of handoffs, prior research suggests that its effectiveness varies across organizational contexts. Organizational Learning and Continuous Improvement (OL-CI)-defined by routine review of work processes, testing of changes, and prevention of recurring problems-may strengthen the degree to which teamwork translates into more reliable handoff processes. This study examines whether OL-CI moderates the relationship between teamwork and handoffs in a hospital. METHODS: A cross‑sectional dataset of 394 hospital‑unit observations was analyzed using validated composites from the Hospital Survey on Patient Safety Culture Version 2.0 (HSOPS 2.0). Handoffs and Information Exchange served as the dependent variable, Teamwork as the independent variable, and OL-CI as the moderator. All focal variables were mean‑centered and entered into a moderation model using the PROCESS macro (Model 1). Conditional effects were evaluated at low, median, and high levels of OL-CI. RESULTS: The model accounted for 50.7% of the variance in handoff quality. Teamwork demonstrated a significant positive association with handoffs (b = 0.416, p < .001), and OL-CI independently predicted better handoffs (b = 0.458, p < .001). The Teamwork × OL-CI interaction was significant (b = 0.223, p = .004), indicating that OL-CI strengthened the effect of teamwork on the quality of handoffs. Simple‑slope analyses showed a progressively stronger relationship between teamwork and handoffs at low (b = 0.372), median (b = 0.423), and high (b = 0.458) OL-CI levels, demonstrating that teamwork yields greater gains in units with stronger OL-CI practices. CONCLUSION: The findings indicate that teamwork contributes to higher-quality handoffs, with greater benefits in organizations that support continuous learning and improvement. To promote reliable handoffs, hospitals should combine teamwork development and structured handoff tools with established practices for process review, recurring feedback, and the prevention of repeated communication failures. Longitudinal research is recommended to clarify these relationships and determine which organizational practices are most effective in sustaining high-quality handoffs over time.