Table 1 12 Steps of the Vancouver School method

1.

Selecting dialogue partners (the sample).

Emergency medical technicians (EMTs) (n = 6: 1 EMT, 3 advanced EMTs, and 2 paramedics), nurses (n = 7), and physicians (n = 4) who were experienced in patient handovers to emergency departments (EDs) were selected as a purposive sample. Variations in work experience, level of education, and service area were ensured.

2.

Preparing the mind (silence before entering a dialogue).

Before each interview, the interviewer (the first author) examined and wrote down his preconceived ideas about the issue. Because he had been working as a paramedic for years, it was especially important to consciously push aside ideas that might influence the interviews and to open his mind to hearing something new.

3.

Participating in a dialogue (data collection).

One semi-structured, individual interview was conducted with each participant (n = 17). An interview guide was used to guide but not dictate the interview.

4.

Sharpened awareness of words (data analysis).

The data gathering and analysis were conducted concurrently (constant comparison). Interviews were transcribed verbatim and then read and reread to get a comprehensive impression of the whole.

5.

Beginning consideration of essences (coding).

By finding key phrases and identifying their meanings, significant statements were extracted from the transcript. Next, the themes of key statements were identified and coded. An attempt was made to continuously answer the following question: What is the essence of what this participant is saying?

6.

Constructing the essential structure of the phenomenon for each case (single-case constructions).

The main themes in each participant’s narrative were highlighted and grouped. The most important ones were presented in a single-case analytical-model (see an example in Fig. 1).

7.

Verifying the single-case construction with relevant participants (verification).

A single-case analytical model verification was sought from each participant, who verified that the results described their experiences correctly and that they had no further suggestions or comments.

8.

Constructing the essence of the phenomenon from all cases (metasynthesis of all case constructions).

Individual analysis models were compared internally, searching for “common threads” and differences. Then, one overall analytical model was constructed from the single-case analytical models (see Table 2). All the researchers participated in this process and made sure that the analytical model was based on the data.

9.

Comparing the essential structure with the data.

To ensure that the overall analytical model was adequate, the interviews were read again and compared with the model.

10.

Identifying the overarching theme that describes the phenomenon (interpreting the meaning of the phenomenon).

During this work, the essence of the phenomenon was shaped, and the overarching theme was put into words: Professional patient handover through clear patient responsibility, structured communication procedures, and quality teamwork.

11.

Verifying the essential structure (the findings) with some research participants (verification).

The overall analytical model was discussed with all the participants, all of whom agreed upon the outcome of the analysis.

12.

Writing the findings.

Care was taken to quote all the participants and to shed light on their experiences regarding the research material. This was done to increase the study’s credibility and show that the results were based on the experiences of all the participants.