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Detecting, Addressing, and Learning from Patient-Perceived Breakdowns in Care: We Want To Know (WWTK)

HSS Investigators: Kathleen M. Mazor, Kimberly A. Fisher
Funding Agency: Agency for Healthcare Research and Quality (AHRQ)
Status: Complete

Project Overview: There is increasing recognition that patients have critical insights into care experiences, including about breakdowns in care. Harnessing patient perspectives for hospital improvement requires an in-depth understanding of the types of breakdowns patients identify and the impact of these events. The major goals of this project were to develop, implement, disseminate and evaluate a program for detecting, addressing and preventing patient-perceived breakdowns in care. Implementation included a unique, proactive multimodal We Want to Know campaign, encouraging patients to report if they perceive a breakdown in their care; a We Want to Know Specialist who coordinated real-time responses to these care breakdowns. Using the RE-AIM framework, we examined program reach, adoption, and implementation, of the WWTK program across the 10 hospitals within the MedStar Health organization.

Main Findings: When asked directly, almost 4 out of 10 hospitalized patients report a breakdown in their care. The most common reported breakdowns involve information exchange, medications, delays in admission, team communication, providers’ manner, and discharge. Of patients reporting a breakdown in care, more than 3 in 10 feel they have experienced harm related to the breakdown, such as distress, pain, damage to their relationship with providers, a prolonged hospital stay, or life disruption. Hospitals that effectively encourage patients and their family members to speak up about perceived breakdowns will identify many opportunities to address patient concerns, potentially leading to improved patient safety and experience. However, further work is needed to develop sustainable methods to overcome patients’ reluctance to report breakdowns in care.  Read more about our findings here.

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