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Quality Update - The wisdom of patients

Winter 2011

The wisdom of patients

By: Peter Pronovost
Date: January 20, 2011

An eye-opening conversation with a patient solidifies the connection between service excellence and patient safety.


Peter Pronovost
Peter Pronovost
Photo by Keith Weller

For all of the work that we’ve done at The Johns Hopkins Hospital to improve communication among caregivers, there’s one member of the care team that we too frequently leave out—the patient.

So during one of my monthly safety rounds as the executive champion of Weinberg 4C, a surgical oncology unit at the hospital, I decided to try something different. In addition to meeting with caregivers to discuss safety problems and solutions on their unit, I invited patient safety coordinator Paula Kent to join me, and together we went to a patient’s room to learn about her experiences. Had this patient seen anything that might pose a risk to herself or others?

What I expected to be a 10-minute chat ended up being an eye-opening, 45-minute conversation that reinforced my belief that patients see risks that clinicians may not and that improving patient satisfaction can also have benefits in safety.

The patient had been in the hospital for more than a month, including several weeks in an intensive care unit. Although she believed that her care in the ICU was technically excellent, she felt like “a piece of meat.” Every day, she said, when doctors and nurses visited her for rounds, they stood in the doorway and spoke about her lungs, heart and ailments, but they never spoke a word to her. Not only was this humiliating, she said, but she felt that it compromised her care, by closing the lines of communication that would encourage her to raise concerns. As an intensivist myself, I realized that I could have been one of the physicians she was referring to; I too had sometimes neglected to address patients and seek their input.

She went on to say that, one day, she was sitting on the commode when a staff member from Patient Transport walked into the bathroom—without knocking first—to take her to a diagnostic test. She was not only embarrassed, but one could see how a similar situation might lead a patient to hurriedly get off the commode and possibly fall.

She also described how, as an Infectious Disease specialist was visiting her for a consult, a resident walked in and began yelling at the other physician that the consult wasn’t needed. The appalled patient asked them, “Is this the way you normally treat each other?”  

The characteristics that allow a patient to receive high quality service—by organizing work around their needs rather than those of clinicians—are the same that can help keep them safe. I could see from this conversation that work wasn’t always structured in this way.

I’ve used this personal story to engage clinicians in a way that is more meaningful than providing them with patient satisfaction statistics and nothing else. For instance, in the ICU where I see patients, we’ve adopted a new protocol that requires physicians and nurses to introduce themselves each time they make rounds and to invite the patient to share their own experiences.

We also relayed the woman’s comments about the feuding physicians to the residency program and her experiences with transport staff to that service.

Perhaps just as important as any actions, this patient was elated to have the chance to share her experiences—something that she had never expected. She actually became tearful telling us that she couldn’t believe that a hospital would actually listen to patients as Paula and I had.

If I have my way, these kinds of interactions will become a routine on our safety teams. We’re working to determine the types of questions that will elicit the best patient responses. But perhaps what is more important than what we say, is that we stay quiet and listen.

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