Communicating with patients about breakdowns in care: a national randomised vignette-based survey.
communication
health services research
healthcare quality improvement
patient satisfaction
patient-centred care
Journal
BMJ quality & safety
ISSN: 2044-5423
Titre abrégé: BMJ Qual Saf
Pays: England
ID NLM: 101546984
Informations de publication
Date de publication:
04 2020
04 2020
Historique:
received:
25
04
2019
revised:
02
08
2019
accepted:
29
10
2019
pubmed:
15
11
2019
medline:
16
1
2021
entrez:
15
11
2019
Statut:
ppublish
Résumé
Many patients are reluctant to speak up about breakdowns in care, resulting in missed opportunities to respond to individual patients and improve the system. Effective approaches to encouraging patients to speak up and responding when they do are needed. To identify factors which influence speaking up, and to examine the impact of apology when problems occur. Randomised experiment using a vignette-based questionnaire describing 3 care breakdowns (slow response to call bell, rude aide, unanswered questions). The role of the person inquiring about concerns (doctor, nurse, patient care specialist), extent of the prompt (invitation to patient to share concerns) and level of apology were varied. National online survey. 1188 adults aged ≥35 years were sampled from an online panel representative of the entire US population, created and maintained by GfK, an international survey research organisation; 65.5% response rate. Affective responses to care breakdowns, intent to speak up, willingness to recommend the hospital. Twice as many participants receiving an in-depth prompt about care breakdowns would (probably/definitely) recommend the hospital compared with those receiving no prompt (18.4% vs 8.8% respectively (p=0.0067)). Almost three times as many participants receiving a full apology would (probably/definitely) recommend the hospital compared with those receiving no apology (34.1% vs 13.6% respectively ((p<0.0001)). Feeling upset was a strong determinant of greater intent to speak up, but a substantial number of upset participants would not 'definitely' speak up. A more extensive prompt did not result in greater likelihood of speaking up. The inquirer's role influenced speaking up for two of the three breakdowns (rudeness and slow response). Asking about possible care breakdowns in detail, and offering a full apology when breakdowns are reported substantially increases patients' willingness to recommend the hospital.
Sections du résumé
BACKGROUND
Many patients are reluctant to speak up about breakdowns in care, resulting in missed opportunities to respond to individual patients and improve the system. Effective approaches to encouraging patients to speak up and responding when they do are needed.
OBJECTIVE
To identify factors which influence speaking up, and to examine the impact of apology when problems occur.
DESIGN
Randomised experiment using a vignette-based questionnaire describing 3 care breakdowns (slow response to call bell, rude aide, unanswered questions). The role of the person inquiring about concerns (doctor, nurse, patient care specialist), extent of the prompt (invitation to patient to share concerns) and level of apology were varied.
SETTING
National online survey.
PARTICIPANTS
1188 adults aged ≥35 years were sampled from an online panel representative of the entire US population, created and maintained by GfK, an international survey research organisation; 65.5% response rate.
MAIN OUTCOMES AND MEASURES
Affective responses to care breakdowns, intent to speak up, willingness to recommend the hospital.
RESULTS
Twice as many participants receiving an in-depth prompt about care breakdowns would (probably/definitely) recommend the hospital compared with those receiving no prompt (18.4% vs 8.8% respectively (p=0.0067)). Almost three times as many participants receiving a full apology would (probably/definitely) recommend the hospital compared with those receiving no apology (34.1% vs 13.6% respectively ((p<0.0001)). Feeling upset was a strong determinant of greater intent to speak up, but a substantial number of upset participants would not 'definitely' speak up. A more extensive prompt did not result in greater likelihood of speaking up. The inquirer's role influenced speaking up for two of the three breakdowns (rudeness and slow response).
CONCLUSIONS
Asking about possible care breakdowns in detail, and offering a full apology when breakdowns are reported substantially increases patients' willingness to recommend the hospital.
Identifiants
pubmed: 31723017
pii: bmjqs-2019-009712
doi: 10.1136/bmjqs-2019-009712
pmc: PMC7170008
mid: NIHMS1577808
doi:
Types de publication
Journal Article
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Pagination
313-319Subventions
Organisme : AHRQ HHS
ID : K08 HS024596
Pays : United States
Organisme : AHRQ HHS
ID : R18 HS022757
Pays : United States
Informations de copyright
© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
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