We want to know: patient comfort speaking up about breakdowns in care and patient experience.

MedStar author(s):
Citation: BMJ Quality & Safety. 28(3):190-197, 2019 03.PMID: 30269059Institution: MedStar Health | MedStar Health Research InstituteDepartment: Market ResearchForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Patient Comfort | *Patient Satisfaction | *Quality of Health Care | Adult | Aged | Communication | Cross-Sectional Studies | District of Columbia | Female | Health Care Surveys | Hospitals | Humans | Male | Maryland | Middle Aged | Patient Safety | Retrospective StudiesYear: 2019ISSN:
  • 2044-5415
Name of journal: BMJ quality & safetyAbstract: CONCLUSIONS: Patients frequently experience problems in care during hospitalisation and many do not feel comfortable speaking up. Creating conditions for patients to be comfortable speaking up may result in service recovery opportunities and improved patient experience. Such efforts should consider the impact of health literacy and mental health on patient engagement in patient-safety activities.Copyright (c) Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ.DESIGN: Cross-sectional study.MAIN OUTCOME MEASURES: Response to the question 'How often did you feel comfortable speaking up if you had any problems in your care?' grouped as: (1) no problems during hospitalisation, (2) always felt comfortable speaking up and (3) usually/sometimes/never felt comfortable speaking up.OBJECTIVE: To assess patient comfort speaking up about problems during hospitalisation and to identify patients at increased risk of having a problem and not feeling comfortable speaking up.PARTICIPANTS: Patients hospitalised at one of eight hospitals who completed the Hospital Consumer Assessment of Healthcare Providers and Systems survey postdischarge.RESULTS: Of 10 212 patients who provided valid responses, 4958 (48.6%) indicated they had experienced a problem during hospitalisation. Of these, 1514 (30.5%) did not always feel comfortable speaking up. Predictors of having a problem during hospitalisation included age, health status and education level. Patients who were older, reported worse overall and mental health, were admitted via the Emergency Department and did not speak English at home were less likely to always feel comfortable speaking up. Patients who were not always comfortable speaking up provided lower ratings of nurse communication (47.8 vs 80.4; p<0.01), physician communication (57.2 vs 82.6; p<0.01) and overall hospital ratings (7.1 vs 8.7; p<0.01). They were significantly less likely to definitely recommend the hospital (36.7% vs 71.7 %; p<0.01) than patients who were always comfortable speaking up.SETTING: Eight hospitals in Maryland and Washington, District of Columbia.All authors: Borton JC, Fisher KA, Gallagher TH, Huang JC, Mazor KM, Smith KMFiscal year: FY2019Digital Object Identifier: ORCID: Date added to catalog: 2018-10-10
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CONCLUSIONS: Patients frequently experience problems in care during hospitalisation and many do not feel comfortable speaking up. Creating conditions for patients to be comfortable speaking up may result in service recovery opportunities and improved patient experience. Such efforts should consider the impact of health literacy and mental health on patient engagement in patient-safety activities.

Copyright (c) Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ.

DESIGN: Cross-sectional study.

MAIN OUTCOME MEASURES: Response to the question 'How often did you feel comfortable speaking up if you had any problems in your care?' grouped as: (1) no problems during hospitalisation, (2) always felt comfortable speaking up and (3) usually/sometimes/never felt comfortable speaking up.

OBJECTIVE: To assess patient comfort speaking up about problems during hospitalisation and to identify patients at increased risk of having a problem and not feeling comfortable speaking up.

PARTICIPANTS: Patients hospitalised at one of eight hospitals who completed the Hospital Consumer Assessment of Healthcare Providers and Systems survey postdischarge.

RESULTS: Of 10 212 patients who provided valid responses, 4958 (48.6%) indicated they had experienced a problem during hospitalisation. Of these, 1514 (30.5%) did not always feel comfortable speaking up. Predictors of having a problem during hospitalisation included age, health status and education level. Patients who were older, reported worse overall and mental health, were admitted via the Emergency Department and did not speak English at home were less likely to always feel comfortable speaking up. Patients who were not always comfortable speaking up provided lower ratings of nurse communication (47.8 vs 80.4; p<0.01), physician communication (57.2 vs 82.6; p<0.01) and overall hospital ratings (7.1 vs 8.7; p<0.01). They were significantly less likely to definitely recommend the hospital (36.7% vs 71.7 %; p<0.01) than patients who were always comfortable speaking up.

SETTING: Eight hospitals in Maryland and Washington, District of Columbia.

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