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Article Title

Implementing a Program to Encourage Patients to Report Breakdowns in Care: Do We Really Want to Know?

Publication Date

8-10-2017

Keywords

program evaluation, communication, patients, providers, hospitals, dissemination and implementation of innovations, patient experience/satisfaction, patient safety, quality improvement

Abstract

Background: Patients and family members have critical insights into care experiences, including information about adverse events. However, many patients are reluctant to speak up when they suspect a breakdown in communication or medical care. We therefore designed the We Want to Know (WWTK) program to encourage patients to speak up about concerns and to enable an effective response when they do. In preparation for widespread implementation of the program in a large health care system, we sought to identify the multilevel barriers and facilitators to full-scale implementation of the program.

Methods: We conducted semi-structured interviews with hospital leaders and unit leaders at two pilot hospitals, as well as system-level leaders. Interviews focused on: 1) perceived value and potential benefits of the program, 2) barriers to implementation, and 3) strategies for overcoming barriers and achieving systemwide implementation.

Results: Preliminary analysis of the interviews revealed facilitators and barriers unique to each stakeholder level with regards to implementation of the WWTK program. Unit and hospital leaders appreciated the value of a WWTK specialist who was not part of the care team to conduct active outreach with patients and assist with problem resolution, but were concerned about resource constraints and difficulties addressing problems in the absence of a WWTK specialist. Hospital leaders found the detailed and timely feedback elicited by the WWTK specialist to be useful, but raised concerns about overlap with similar activities to elicit patient perspectives. System leaders were supportive of the program and deemed it consistent with organizational values and goals, but reiterated resource constraints especially with regards to competing initiatives. Ultimately, system leaders identified an opportunity to integrate WWTK into a current, high-priority initiative that will be implemented throughout the system.

Conclusion: Efforts to achieve systemwide implementation of a program to encourage patients to speak up about breakdowns in care and respond to the concerns raised by patients will need to consider both the benefits and barriers noted by multiple levels of stakeholders. Integrating the program into an existing initiative may overcome a major barrier to systemwide implementation; additional efforts are needed to address unit- and hospital-level barriers.

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