Tools to Help Patients Engage in their Healthcare

The Joint Commission’s “Ask” Campaign has been discussed previously. The idea of engaging with patients as while they are in the hospital setting (and elsewhere) is important, but difficult. I have had concerns about the “Ask” campaign, not because it isn’t important, but rather because it can seem to place the burden of engagement on the patient or their family. Patients and their families can be overwhelmed by the medical jargon and the difficulty trying to understand all the things happening in a hospital. Patients are really visitors in a strange land with people speaking a foreign language. People already feel vulnerable and then we ask them to push through the fear and the positions of power that physicians and nurses have over them. The idea of the “Ask” campaign is important, but maybe we could do a better job of giving patients a better way to get engaged.

Enter the VA National Center for Patient Safety’s program called The Daily Plan. This program provides patients with a daily itinerary that outlines expected activities and treatments during their hospital stay or outpatient visit. This document may include details such as planned diagnostic tests, medications, nutrition plans, appointments, and known allergies. Now the patient has a “roadmap” of the things that are meant to happen over the course of a day. If they have not gotten the x-ray that is on their Daily Plan, they can ask the nurse to check on it. If someone comes and tries to give them a medication, they can check to be certain it is on their Daily Plan. Further, the act of reviewing information with patients allows the nurses to be more aware of what is supposed to happen with their patients during the day. Thus, this tool helps prevent errors and helps things get done.

This program was initially piloted in 2007/2008 at five VA facilities, receiving positive feedback from both patients and staff. Subsequent evaluations indicated that nearly 75% of patients felt The Daily Plan® made it easier to ask questions and increased their understanding of their hospital stay. Additionally, 47.5% of patients reported identifying and inquiring about discrepancies in their planned care. 

The challenge for nursing staff is to find a convenient way to print out the document with the list of expected tests, procedures, medications, etc. Nurses may also find it difficult to manage the time it takes to go over the plan with patients, though the downstream impacts can reap rewards in time recovery.

For a brief description with additional details about this program listen to this podcast.