Decision-aid tool helps patient communication

Outcome measurement leads to patient education

Outcome measurement at University of Washington Medical Center in Seattle typically is tied in some way to quality improvement office initiatives. Therefore, to improve patient education, staff recently looked at the quarterly patient satisfaction reports the medical center receives from a vendor.

Several questions on the survey pertain to communication- and education-related aspects
of the patient’s care experience. "We honed in on one of our lower-performing areas, which was getting answers to your questions in a way you could understand,’" says Cezanne Garcia, MPH, CHES, manager of Patient and Family Services at the hospital.

To help patients get the information they need, a committee developed a decision-aid tool titled "About Your Visit." The pamphlet suggests questions for patients or family members to ask when they come for their visit with their health care provider, she reports.

It covers all medical areas, prompting questions on everything from medications to equipment, and it has space for patients to write answers. "We really wanted a tool that would
be useful across the continuum," says Garcia. Patients are encouraged to select two or three questions from the list that reflect their main concern. This method for using the tool is suggested because clinicians were concerned about patients coming in for an appointment armed with 20 questions, she explains.

To determine if the new pamphlet would be effective, it first was reviewed by 20 patients for readability and to determine if the questions gleaned from similar tools found in the literature and at other institutions represented the main concerns of patients at the University of Washington Medical Center.

Once the pamphlet was perfected, it was pilot-tested in two waves during the course of a month. About 150 patients during each test period were given the pamphlet when they came in for their appointment and asked to fill out a survey before they left. They were given the option to mail the survey back, but most completed it before leaving the clinic.

The questions on the survey were modeled after those the vendor asked patients on its quarterly patient satisfaction survey. In addition, a few questions about the pamphlet’s usefulness were added. The questions were designed to determine if the patient’s main concerns were addressed during their visit and their questions answered in a way that they understood.

The front desk staff distributed the pamphlet at the time that patients checked in for their appointment. They handed the pamphlet to the patient and said: "Your questions are important to us. At this visit, be sure to write them down. Here is a tool to help you with that."

Also, at a clinical staff meeting clinicians were encouraged to ask patients during the pilot test
if they had written down questions they wanted answered. Extra copies of the pamphlet were placed in the room so the clinician could point to it and ask the patients if they had any questions from the handout they were given that they wanted addressed, says Garcia.

The rapid-process, quality-improvement initiative provided enough data to launch the pamphlet systemwide. There were small margins of change revealed during the pilot test that were significant enough for the methodology used, says Garcia. However, the real test came when results from the next quarterly patient satisfaction survey were released from the vendor. "We have seen significant changes. In all areas, we hit the median, and some areas we went beyond that," she adds.

While many other factors could have affected the results, there clearly was a change during the first quarter after releasing the tool to all clinical areas, says Garcia. Regardless of how many patients come into the exam room with the tool completed, it helps staff remember to ask at the beginning of the visit what the patient’s main concerns are. "It’s currently a way to trigger communication," she says.

The brochures are distributed in clear plastic holders in all areas of the clinic. Many outpatient areas also send the brochure with patient appointment notices. During the pilot, many patients
said it would be helpful to receive the brochure before their visit. While inpatient areas can use the brochure, its greatest impact has been in the outpatient area, says Garcia.

The brochures were created with the aid of a Microsoft Word template that Patient and Family Services uses to produce patient education materials. It costs the medical center 18 cents to create each brochure.

There are similar decision-aid tools that can be purchased, but the last two pages of the brochure created for use at University of Washington Medical Center lists resources such as education kiosks in waiting room areas and small resource centers on some floors and clinics. It also encourages people to look at a few select web sites.

"It was a way to encourage the concept that we welcome and encourage their self-directed learning," says Garcia. However, the first resource for patients listed on the brochures is the clinicians, and the brochure copy emphasizes the importance of partnering with the health care team.

"We continue to score well in this area [communication and education], and we know from our stocks and materials management that the brochures are being used," she says.

Need More Information?
  • Cezanne Garcia, MPH, CHES, Manager, Patient and Family Education Services, 1959 N.E. Pacific St., Box 356052, Seattle, WA 98195-6052. Telephone: (206) 598-8424. E-mail: