How Asking Patients a Simple Question Enhances Care at the Bedside: Medical Students as Agents of Quality Improvement

摘要

Medical students have traditionally played a passive role in the delivery of health care. The Institute for Healthcare Improvement Open School members and leaders initiated the Ask One Question project in December 2011. Through a commitment to the project, students are learning to assume a unique position in health care settings, as both learners and caregivers. They are improving care at the bedside by asking a simple question: "How can I improve your stay today?" Using the Model for Improvement to adapt the Ask One Question concept for local use, medical students at Cardiff University (United Kingdom) asked 120 patients. A content analysis of those responses identified 89 issues across 4 broad areas for improvement, including communication issues (uncertainty about their care management and desire for more time with their health care professional); practical issues (assistance with tasks made difficult because of ill health); wider organizational and National Health Services requests; and medical needs (requiring medical or nursing intervention). A medical student, a clinical colleague, or the hospital organization could act on those issues. Actions ranged from attending to simple tasks (eg, finding spectacles) or basic care needs (eg, giving a drink) to suggestions requiring wider institutional change. On a simple but effective level, Ask One Question reflects good manners and is a demonstrable competency of patient-centered practice. It is a vehicle for enabling students to seek improvements in health care and initiate relevant actions to improve the patient experience at the bedside. Introduction Patients all too often feel ignored and report that their health care has been fragmented and not holistic.1 The quality of patient care has raised considerable political and public concern in the UK,2 fueling efforts to achieve a patient-centered culture within the National Health Services (NHS). The recent Francis Inquiry in the UK revealed that patients and their caregivers were failed at many levels and, among many recommendations, called for better health care leadership and patient-centered care.3,4 These are qualities that can be exhibited by medical students, who are an untapped resource for improving health care quality.5 Medical students have more flexibility and time to spend with patients than employed staff. However, medical students in the UK typically interact with patients for learning purposes onlya??for example, they obtain medical histories, perform physical examinations, and observe encounters between patients and more senior health care staffa??and often assume a passive role in health care delivery and its improvement.6 Moreover, the effects of the "hidden curriculum," defined as "a set of influences that function at the level of organizational structure and culture," can shape the moral and ethical attitudes of medical students during their professional training.7 As a result, students in the early stage of their courses are reportedly more empathic and patient-centered than those in the later stages of their training.6,8,9 The Institute for Healthcare Improvement (IHI) Open School is an interdisciplinary community that has a mission to advance health care improvement and patient safety competencies in the next generation of health professionals.10 It encourages the set-up of chapters where students, supported by faculty, engage with each other about issues related to quality improvement in health care. The Ask One Question project was initiated by IHI Open School members and leaders in December 2011, challenging students to ask patients, "What can I do to improve your stay?" Pilot work undertaken by early adopters of the project in Denmark, Wales, and the US suggests the majority of patients responded to this question with basic care requests, for example hydration, nutrition, and comfort.11,12 This article describes work undertaken by medical students at the IHI Open School chapter at the School of M