Few doctors, nurses report asking patients about what they expect in their care

By Chelsea Conaboy, Globe Staff

While a majority of doctors and nurses think it is important to check in with patients about what they expect to get from their care during a hospitalization, few have the training or awareness needed to ask the right questions, a team led by researchers at Brigham and Women’s Hospital found in a study released today in BMJ Quality & Safety.

The use of patient satisfaction surveys as a measure of hospital quality has grown in recent years. And some studies have shown that patients, such as those who suffer heart attacks, may have better health outcomes if they report being happier with the care they have received.

That’s in part because patients are good judges of the quality of care that they get, but also because they may be more likely to adhere to a doctor’s advice if they trust that they are getting good care.

In a survey of 1,004 doctors and nurses in four academic centers, about 89 percent said it was important to ask patients what they expect from their care but only about 16 percent reported actually asking. The authors dubbed this a “blind spot” in physician efforts to improve overall satisfaction.

“If you don’t ask people about their expectations it’s very hard to meet them,” said Dr. David W. Bates, Brigham and Women’s senior vice president for quality and safety.

Among the participants, who were at the Brigham and three other academic medical centers in Denmark, Israel, and the United Kingdom, only about 20 percent said they had enough training to address those expectations. Nurses were more likely to ask patients about expectations than physicians were.

“It’s something that we have to change, something in our attitudes,” said Ronen Rozenblum, lead author and a researcher in the Brigham and Women’s Department of Medicine. “The bottom line is that clinicians really think that it’s important, so we are really willing to make the change.”

Bates and Rozenblum have developed a program called the PatientSatisfactive Model to guide doctors and nurses to ask the right questions about what a patient is expecting and to respond. The model is being tested in a multi-site study.

Rozenblum gave this simple example: A patient being admitted to the hospital wants a single-occupancy room but the hospital does not have single rooms. If that patient gets put into a double room, they may feel disgruntled. But if a nurse learns this by asking the right questions and is able to explain that there are no single rooms but that the staff will do what they can to make the person comfortable, the patient may adjust expectations, Rozenblum said.

“Just the feeling that somebody is taking care of them, caring about their concerns makes all the difference,” he said.