Abstract / Summary
• Responsibility closure shifts handover assessment to each unfinished obligation. • Five conditions distinguish nominal transfer from executable continuity. • Communication improvements often outpace evidence on follow-through and safety. • Work-system capacity is part of credible responsibility transfer. • The framework is provisional and requires prospective validation. Healthcare shift handovers are commonly evaluated as information-transfer events, yet patient safety also depends on whether unfinished work is understood, assigned and executable within the receiving system. We systematically reviewed empirical studies of real healthcare shift-boundary handovers and developed a provisional SEIPS 2.0-informed integrative framework for analysing this operational endpoint. PubMed/MEDLINE, Web of Science Core Collection and OpenAlex were searched through 13 July 2026, supplemented by backward and forward citation searching. Screening, eligibility assessment, extraction, MMAT appraisal and synthesis were conducted by the primary reviewer, with independent verification of prespecified samples across review stages. From 2,876 identified records, 172 reports representing 167 independent studies were included. Best-fit framework synthesis identified five analytically distinguishable conditions relevant to credible responsibility closure: visibility of unfinished work; active reception and shared understanding; actionability and priority; explicit ownership; and operational capacity. Intervention studies more consistently reported improvements in communication completeness and documentation, whereas ownership, subsequent action and patient-safety outcomes were less frequently and less robustly evaluated. Responsibility closure describes the obligation-level state in which consequential unfinished work has an identifiable receiving location, a feasible next action and sufficient capacity for action or escalation. It therefore extends beyond information completeness or nominal transfer of accountability by requiring operational executability. The evidence was heterogeneous, predominantly healthcare-based and did not directly validate the construct or its candidate indicators. Responsibility closure offers a provisional systems-oriented framework for designing and evaluating handovers around the continuation of unfinished work. Prospective studies should test its association with follow-through, delay, escalation and harm.