Navigating care transitions: A process model of how doctors overcome organizational barriers and create awareness

Brian Hilligoss, Timothy J. Vogus

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


As reforms push for improved integration across the care continuum, managers and policy makers are increasingly concerned about care transitions, such as during shift changes or when moving patients between units or institutions. The authors examined transitions from an emergency department to inpatient units through a 2-year ethnographic study of an academic medical center. Data include 48 semistructured interviews with doctors and administrators and 349 hr of observations of doctors. The authors show that organizational design poses challenges to doctors attempting between-unit care transitions, including heavy reliance on technology, separation of responsibility and control, and misalignment of routines and temporal rhythms. Each challenge threatened doctors' awareness of the current state of other units and processes. To recover awareness, doctors engaged in time-consuming workarounds. Improved awareness will likely require a mix of interventions, including standardized protocols, work redesign, advanced information technologies specifically designed to enhance awareness, and high-reliability practices, such as safety organizing.

Original languageEnglish (US)
Pages (from-to)25-48
Number of pages24
JournalMedical Care Research and Review
Issue number1
StatePublished - Feb 19 2015


  • care transitions
  • coordination
  • high reliability
  • operational failures
  • quality

ASJC Scopus subject areas

  • Health Policy


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