{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T19:31:31Z","timestamp":1793302291498,"version":"4.5.0"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"vor","delay-in-days":14,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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\u2011established driver of handoffs, prior research suggests that its effectiveness varies across organizational contexts. Organizational learning\u2013continuous improvement (OL-CI)\u2014defined by routine review of work processes, testing of changes, and prevention of recurring problems\u2014may 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross\u2011sectional dataset of 394 hospital\u2011unit 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\u2011centered 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The model accounted for 50.7% of the variance in handoff quality. Teamwork demonstrated a significant positive association with handoffs (b\u2009=\u20090.416, P &amp;lt; .001), and OL-CI independently predicted better handoffs (b\u2009=\u20090.458, P &amp;lt; .001). The Teamwork\u2009\u00d7\u2009OL-CI interaction was significant (b\u2009=\u20090.223, P = .004), indicating that OL-CI strengthened the effect of teamwork on the quality of handoffs. Simple\u2011slope analyses showed a progressively stronger relationship between teamwork and handoffs at low (b\u2009=\u20090.372), median (b\u2009=\u20090.423), and high (b\u2009=\u20090.458) OL-CI levels, demonstrating that teamwork yields greater gains in units with stronger OL-CI practices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/intqhc\/mzag167","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T11:55:47Z","timestamp":1791978947000},"source":"Crossref","is-referenced-by-count":0,"title":["When teamwork is not enough: how organizational learning and continuous improvement strengthen the teamwork\u2013handoff relationship in hospitals"],"prefix":"10.1093","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9716-4241","authenticated-orcid":false,"given":"Seung-Hwan","family":"Kim","sequence":"first","affiliation":[{"name":"School of Business, Embry-Riddle Aeronautical University ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"key":"2026102914451947200_mzag167-B1","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1016\/j.jcjq.2022.04.001","article-title":"Handoffs and teamwork: a framework for care transition communication","volume":"48","author":"Webster","year":"2022","journal-title":"Jt Comm J Qual Patient Saf"},{"key":"2026102914451947200_mzag167-B2","doi-asserted-by":"publisher","first-page":"680","DOI":"10.1136\/bmjqs-2024-018385","article-title":"Use of structured handoff protocols for within-hospital unit transitions: a systematic review from making healthcare safer IV","volume":"34","author":"McCarthy","year":"2025","journal-title":"BMJ Qual Saf"},{"key":"2026102914451947200_mzag167-B3","volume-title":"SBAR Communication Tool: Situation, Background, Assessment, Recommendation","author":"NHS Improvement","year":"2018"},{"key":"2026102914451947200_mzag167-B4","doi-asserted-by":"publisher","first-page":"1803","DOI":"10.1056\/NEJMsa1405556","article-title":"Changes in medical errors after implementation of a handoff program","volume":"371","author":"Starmer","year":"2014","journal-title":"N Engl J Med"},{"key":"2026102914451947200_mzag167-B5","doi-asserted-by":"publisher","first-page":"1047","DOI":"10.1016\/j.mcna.2025.02.016","article-title":"Handoffs, care transitions, and readmissions","volume":"109","author":"Bordin-Wosk","year":"2025","journal-title":"Med Clin North Am"},{"key":"2026102914451947200_mzag167-B6","volume-title":"Hospital Survey on Patient Safety Culture Version 2.0: User\u2019s Guide","author":"Sorra","year":"2021"},{"key":"2026102914451947200_mzag167-B7","volume-title":"Advancing the Measurement of Patient Safety Culture: Development and Psychometrics of the AHRQ SOPS Hospital Survey Version 2.0","author":"Sorra","year":"2025"},{"key":"2026102914451947200_mzag167-B8","doi-asserted-by":"publisher","first-page":"155","DOI":"10.69554\/WZYM5292","article-title":"Safer together: a national action plan to advance patient safety","volume":"6","author":"Brady","year":"2021","journal-title":"MIH"},{"key":"2026102914451947200_mzag167-B9","doi-asserted-by":"publisher","first-page":"121145","DOI":"10.33940\/001c.121145","article-title":"Building a learning management framework for patient safety: lessons from a large multistate system","volume":"6","author":"Carmack","year":"2024","journal-title":"Patient Saf"},{"key":"2026102914451947200_mzag167-B10","doi-asserted-by":"publisher","first-page":"8496","DOI":"10.3390\/app14188496","article-title":"Patient safety culture in hospital settings across continents: a systematic review","volume":"14","author":"Alabdullah","year":"2024","journal-title":"Appl Sci"},{"key":"2026102914451947200_mzag167-B11","doi-asserted-by":"publisher","DOI":"10.1136\/bmjoq-2023-002506","article-title":"Effect of interventions to improve safety culture on healthcare workers in hospital settings: a systematic review of the international literature","volume":"13","author":"Finn","year":"2024","journal-title":"BMJ Open Qual"},{"key":"2026102914451947200_mzag167-B12","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1097\/TA.0000000000004285","article-title":"Handoffs and transitions of care: a systematic review, meta-analysis, and practice management guideline from the Eastern association for the surgery of trauma","volume":"97","author":"Appelbaum","year":"2024","journal-title":"J Trauma Acute Care Surg"},{"key":"2026102914451947200_mzag167-B13","volume-title":"Ensuring Safe Handoffs from the Emergency Department to the Inpatient Unit","author":"Vizient Inc","year":"2021"},{"key":"2026102914451947200_mzag167-B14","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1002\/jhm.714","article-title":"Improving teamwork: impact of structured interdisciplinary rounds on a hospitalist unit","volume":"6","author":"O\u2019Leary","year":"2011","journal-title":"J Hosp Med"},{"key":"2026102914451947200_mzag167-B15","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1002\/jhm.12979","article-title":"Implementation of the I-PASS handoff program in diverse clinical environments: a multicenter prospective effectiveness-implementation study","volume":"18","author":"Starmer","year":"2023","journal-title":"J Hosp Med"},{"key":"2026102914451947200_mzag167-B16","volume-title":"Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach","author":"Hayes","year":"2022","edition":"3rd edn"}],"container-title":["International Journal for Quality in Health Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/intqhc\/advance-article-pdf\/doi\/10.1093\/intqhc\/mzag167\/71954829\/mzag167.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/intqhc\/article-pdf\/38\/4\/mzag167\/71954829\/mzag167.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/intqhc\/article-pdf\/38\/4\/mzag167\/71954829\/mzag167.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T18:45:25Z","timestamp":1793299525000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/intqhc\/article\/doi\/10.1093\/intqhc\/mzag167\/8916739"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":16,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,10,5]]}},"URL":"https:\/\/doi.org\/10.1093\/intqhc\/mzag167","relation":{},"ISSN":["1353-4505","1464-3677"],"issn-type":[{"value":"1353-4505","type":"print"},{"value":"1464-3677","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10]]},"published":{"date-parts":[[2026,10]]},"article-number":"mzag167"}}