Armstrong Institute for Patient Safety and Quality

Partnering with patients and families to develop and evaluate a simulation-based program for training residents on ‘information sharing’ and ‘caring’ aspects of patient- centered communication

We partnered with patient advocates and an interprofessional team of healthcare providers and personnel to create a brief education program that uses simulation and patient feedback to advance medical residents' patient-centered communications skills. After a series of meetings and seeking broader input from patients, students and other providers, consensus was achieved on the need to focus the program on particularly challenging areas in patient-physician communication.

Those areas pertained to clear information sharing, ensuring patient understanding and handling difficult conversations. The program was pilot tested in 2013 with 16 Internal Medicine residents and nine Physical Medicine and Rehabilitation residents at Johns Hopkins School of Medicine in Baltimore, Maryland. Residents were provided with pre-simulation preparatory materials that included a short slide set with overview on patient-centered communication skills, pointers on how to handle various simulation scenarios and a select reference articles.

This project utilized Standardized Patient (SP) simulations, where SPs are carefully recruited and trained to take on the characteristics of a real patient thereby affording the student an opportunity to learn and to be evaluated on learned skills in a simulated clinical environment. Residents worked with three SPs on three scenarios.

• Breaking bad news
• Dealing with an angry patient
• Discussing therapeutic options

Feedback was provided by the SPs after each of the encounters with a scenario-specific checklist. Simulation encounters were video recorded, and the link was provided to the residents for review after the activity.

The vast majority of the residents reported that the SP feedback was helpful and that the simulation was a positive experience.

Principal Investigator: Hanan Aboumatar, M.D., M.P.H.

Project Team: Bickey Chang, Adrian Alday, Gail Berkenblit, Sanjay Desai, Carol Fleishman,R. Samuel Mayer, Pat Thomas, Zackary Berger, Mark Hughes, Paula Phurrough, Charlene Rothkopf, Peter Pronovost

Funding Agency: Picker-Gold Foundation/ACGME Challenge Grant

Project Dates: April 2012-2013

A research project to identify innovations for improving the patient experience.

Enhancing the patient experience and delivering patient-centered care is on the agenda of virtually every hospital today. Yet, while hospitals’ performance on national patient-experience surveys gains greater public attention—and is increasingly tied to financial rewards—the pathway for improvement is far from clear.

The Best Practices in Patient-Centered Care research and dissemination project sought to identify concrete innovations and promising practices of United States hospitals that are top performers in delivery of patient-centered care, or who have made remarkable strides in this area. Culminating in a conference in September 2013, it brought together hospital leaders, clinicians, patient-family advocates, researchers and policymakers to share successful strategies.

Conference Proceedings

How Top Performers Were Identified

To identify these hospitals, the Armstrong Institute for Patient Safety and Quality research team mined the comparative database of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), a validated national survey sent to patients after discharge about their hospital experiences.

Through this analysis of more than 3,000 hospitals, the team identified 176 facilities of various sizes that achieved top ranking or made major improvements in the HCAHPS domains of communication, staff responsiveness, discharge planning and pain management.

Hospital leaders from these hospitals were invited to present their work in the conference. In addition, leaders from 52 of these hospitals completed an anonymous survey about their organizations’ practices.

How Do High Performers Deliver Patient-Centered Care?

The study found several common approaches among successful hospitals.

Hourly Rounds

Nurses and other clinical staff members make rounds in the patient’s room every hour to address pain, bathroom needs and positioning and to make sure that personal items are within reach.

Communication/Care Boards in Patient Rooms

The boards list important information, such as new and existing medications, discharge goal, tests and procedures, and how to easily contact care providers.

Bedside Shift Report

Nurses conduct reports at shift change in the presence of the patient and family, giving them the chance to ask questions, understand the care plan and correct any inaccurate information.

Discharge Folder

On admission, patients receive a folder with a checklist of information they will need when they get home, such as the purpose of their medications and symptoms to look out for.

Post-discharge Phone Calls

Nurses call patients within two to three days to check on their status and answer questions about instructions and self-care.

Multi-disciplinary Rounds

Involve all members of the care team, as well as patients and families, in rounds.

Standards of Performance

Create standards for all employees to follow, such as quickly responding to patients and how to respond to patient concerns or complaints.

Resources for Improving the Patient Experience

The conference revealed many interventions for delivering patient-centered care and improving HCAHPS scores. 

• Read the conference proceedings, released in June 2015, for summaries of all keynote and best practices presentations from the two-day event.
• Review presentations and abstracts for slides from podium presentations, 30 poster abstracts and other abstracts submitted to the conference organizers.

Related Publication

Aboumatar H.J., Chang B.H., Danaf J.D., Shaear M., M.D., Namuyinga R., Elumalai S., Marsteller J.A., Pronovost P.J. Promising Practices for Achieving Patient-centered Hospital Care: A National Study of High Performing United States Hospitals. Medical Care. 2015 Jun 30.

Project Funding

Funding for this study was made possible, in part, by grant 1R13HS021921-01 from the Agency for Healthcare Research and Quality (AHRQ). The views expressed in written conference materials or publications do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices or organizations imply endorsement by the U.S. Government. Principal Investigator: Hanan J. Aboumatar, M.D., M.P.H.