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Promising Practices for Achieving Patient-centered Hospital Care

A National Study of High-performing US Hospitals

Aboumatar, Hanan J., MD, MPH*,†,‡; Chang, Bickey H., MHA*; Al Danaf, Jad, MD, MPH*; Shaear, Mohammad, MD*,§; Namuyinga, Ruth, MD, MPH*,∥; Elumalai, Sathyanarayanan, BTech, MS*,¶; Marsteller, Jill A., PhD, MPP*,#; Pronovost, Peter J., MD, PhD*,#,**

doi: 10.1097/MLR.0000000000000396
Patient-Centered Care

Background: Patient-centered care is integral to health care quality, yet little is known regarding how to achieve patient-centeredness in the hospital setting. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey measures patients’ reports on clinician behaviors deemed by patients as key to a high-quality hospitalization experience.

Objectives: We conducted a national study of hospitals that achieved the highest performance on HCAHPS to identify promising practices for improving patient-centeredness, common challenges met, and how those were addressed.

Research Design: We identified hospitals that achieved the top ranks or remarkable recent improvements on HCAHPS and surveyed key informants at these hospitals. Using quantitative and qualitative methods, we described the interventions used at these hospitals and developed an explanatory model for achieving patient-centeredness in hospital care.

Results: Fifty-two hospitals participated in this study. Hospitals used similar interventions that focused on improving responsiveness to patient needs, the discharge experience, and patient-clinician interactions. To improve responsiveness, hospitals used proactive nursing rounds (reported at 83% of hospitals) and executive/leader rounds (62%); for the discharge experience, multidisciplinary rounds (56%), postdischarge calls (54%), and discharge folders (52%) were utilized; for clinician-patient interactions, hospitals promoted specific desired behaviors (65%) and set behavioral standards (60%) for which employees were held accountable. Similar strategies were also used to achieve successful intervention implementation including HCAHPS data feedback, and employee and leader engagement and accountability.

Conclusions: High-performing hospitals used a set of patient-centered care processes that involved both leaders and clinicians in ensuring that patient needs and preferences are addressed.

*Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine

Department of Medicine, General Internal Medicine Division, Johns Hopkins University School of Medicine

Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

§Ain Shams University, School of Medicine, Cairo, Egypt

General Preventive Medicine Program, Johns Hopkins Bloomberg School of Public Health

Carey Business School, Johns Hopkins University

#Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health

**Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD

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Supported by grant number R13HS021921 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

The authors declare no conflict of interest.

Reprints: Hanan J. Aboumatar, MD, MPH, The Johns Hopkins University School of Medicine, 750 East Pratt Street 15th Floor, Baltimore, MD 21202. E-mail:

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