Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
Meyers Primary Care Institute, a joint endeavor of the University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA.
BMJ Qual Saf. 2020 Apr;29(4):313-319. doi: 10.1136/bmjqs-2019-009712. Epub 2019 Nov 13.
Many patients are reluctant to speak up about breakdowns in care, resulting in missed opportunities to respond to individual patients and improve the system. Effective approaches to encouraging patients to speak up and responding when they do are needed.
To identify factors which influence speaking up, and to examine the impact of apology when problems occur.
Randomised experiment using a vignette-based questionnaire describing 3 care breakdowns (slow response to call bell, rude aide, unanswered questions). The role of the person inquiring about concerns (doctor, nurse, patient care specialist), extent of the prompt (invitation to patient to share concerns) and level of apology were varied.
National online survey.
1188 adults aged ≥35 years were sampled from an online panel representative of the entire US population, created and maintained by GfK, an international survey research organisation; 65.5% response rate.
Affective responses to care breakdowns, intent to speak up, willingness to recommend the hospital.
Twice as many participants receiving an in-depth prompt about care breakdowns would (probably/definitely) recommend the hospital compared with those receiving no prompt (18.4% vs 8.8% respectively (p=0.0067)). Almost three times as many participants receiving a full apology would (probably/definitely) recommend the hospital compared with those receiving no apology (34.1% vs 13.6% respectively ((p<0.0001)). Feeling upset was a strong determinant of greater intent to speak up, but a substantial number of upset participants would not 'definitely' speak up. A more extensive prompt did not result in greater likelihood of speaking up. The inquirer's role influenced speaking up for two of the three breakdowns (rudeness and slow response).
Asking about possible care breakdowns in detail, and offering a full apology when breakdowns are reported substantially increases patients' willingness to recommend the hospital.
许多患者不愿主动指出护理失误，导致错失改善医患关系和医疗体系的机会。因此，我们需要寻找一些有效的方法鼓励患者积极反馈问题。
确定影响患者反馈的因素，并研究发生问题时道歉的效果。
采用基于情景描述的问卷调查法，参与者需对 3 种护理失误（对呼叫铃响应慢、医护人员态度粗鲁、未回答患者问题）进行评价。调查人员身份（医生、护士、护理专家）、问题询问程度（邀请患者分享顾虑）和道歉程度会有所不同。
全国性在线调查。
共有 1188 名年龄≥35 岁的成年人参与了这项在线调查，该调查样本是从 GfK（一家国际调查研究机构）建立和维护的全美在线样本库中随机抽取的，该样本库具有全国代表性，应答率为 65.5%。
对护理失误的情感反应、反馈意愿、医院推荐意愿。
与未收到详细问题询问的参与者相比，收到详细问题询问的参与者（很可能/肯定）会更愿意推荐该医院（18.4%对 8.8%，p=0.0067）。与未收到道歉的参与者相比，收到完整道歉的参与者（很可能/肯定）会更愿意推荐该医院（34.1%对 13.6%，p<0.0001）。感到沮丧是增强反馈意愿的重要决定因素，但仍有相当一部分感到沮丧的参与者不会“肯定”进行反馈。更详细的询问并不会增加反馈的可能性。调查人员的角色对其中两种护理失误（粗鲁和响应慢）的反馈意愿有影响。
详细询问可能发生的护理失误，并在发生失误时提供完整的道歉，这会显著提高患者推荐医院的意愿。
