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Original research
We want to know: patient comfort speaking up about breakdowns in care and patient experience
  1. Kimberly A Fisher1,2,
  2. Kelly M Smith3,4,
  3. Thomas H Gallagher5,
  4. Jim C Huang6,7,
  5. James C Borton8,
  6. Kathleen M Mazor2
  1. 1 Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  2. 2 Meyers Primary Care Institute, a joint endeavor of the University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA
  3. 3 MedStar Health Research Institute, Hyattsville, Maryland, USA
  4. 4 System Quality and Patient Safety, MedStar Health, Columbia, MD, USA
  5. 5 Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
  6. 6 Department of Biostatistics and Biomedical Informatics, MedStar Health Research Institute, Hyattsville, Maryland, USA
  7. 7 Center for Clinical and Translational Science, Georgetown-Howard Universities, Washington, D.C., USA
  8. 8 MedStar Health, Columbia, Maryland, USA
  1. Correspondence to Dr Kimberly A Fisher, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA; kimberly.fisher{at}umassmemorial.org

Abstract

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.

Design Cross-sectional study.

Setting Eight hospitals in Maryland and Washington, District of Columbia.

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

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.

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.

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.

  • healthcare quality improvement
  • health services research
  • hospital medicine
  • patient-centred care
  • patient satisfaction

https://doi.org/10.1136/bmjqs-2018-008159

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    Footnotes

    • Contributors KAF contributed to the conception of the work, the acquisition, analysis and interpretation of the data and drafted the manuscript. KMS contributed to the conception of the work, the acquisition, analysis and interpretation of data and revised the manuscript critically for important intellectual content. THG contributed to the conception of the work, interpretation of data and revising the manuscript critically for important intellectual work. JCH contributed to the acquisition, analysis and interpretation of data and revised the manuscript critically for important intellectual content. JCB contributed to the acquisition of data and revised the manuscript critically for important intellectual content. KMM contributed to the conception of the work, the acquisition, analysis and interpretation of data and revised the manuscript critically for important intellectual content.

    • Funding The research was funded by Agency for Healthcare Research and Quality (AHRQ) (grant numbers: #4R18HS022757 and 1K08HS024596).

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval MedStar Health Research Institute Institutional Review Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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