More on Quality and Safety

Patient input has potential to improve communication and the overall hospital experience

Physicians need to work at seeking feedback from patients and meaningfully incorporating patient preferences into treatment plans.

Jeff Lagasse, Associate Editor

American hospitals engage in continuous quality and safety improvement, but information remains scarce on what patients, families and caregivers themselves most want to change about their hospital experiences.

A lot of it boils down to one word: Communication

A new i-HOPE study, led by Dr. Luci Leykum, of UT Health San Antonio, sought to give patients, families and other stakeholders a voice in setting priorities for improving hospital care. Eight hospitalist researchers and their patient partners conducted the study, in which 499 patients, caregivers, healthcare providers and researchers stated their top unanswered questions to improve hospital care.

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Respondents included 244 patients and caregivers. Forty-seven organizations partnered with the Society of Hospital Medicine to conduct the study.


Out of nearly 800 submitted questions, 11 were identified as top priorities. Topics included shared decision-making, patient-provider communication, care transitions, telemedicine and confusion about medications.

The top-ranked question is, "What interventions ensure that patients share in decision making regarding their goals and plans of care?" Studies before i-HOPE showed that while physicians were skilled at providing health information, they were less skillful at seeking feedback from patients, assessing patients' level of understanding, or meaningfully incorporating patient preferences into treatment plans.

Communication between physician and patient is crucial throughout a patient's hospital stay, from discussing treatment options to making joint decisions to knowing who to call after discharge, the authors wrote.

The study has limitations. For example, although patients, caregivers and patient and family advisory councils were included from across the country, they may not be representative of all patients because the i-HOPE group of investigators is already engaged in improving healthcare delivery.

The study also has strengths. Questions were identified and prioritized by "a diverse group of voices and perspectives that typically are not included when prioritizing hospital research and improvement efforts," the authors wrote. The partnership between researchers, patients, caregivers and stakeholders ensures the relevance of the results.


Effectively training staff has the potential to improve care quality and the provider/patient relationship, but the efforts can sometimes be lacking. The National Association for Healthcare Quality, seeking to examine healthcare organizations' quality training and development, published its inaugural survey in February asking quality professionals which employees in their organization receive training and education on quality -- and found the numbers were pretty low.

In fact, only 33 percent of respondents said all staff receive training and education on quality within their healthcare organization.

Twitter: @JELagasse

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