335 - Nurturing the Communication Ecosystem: A Low-Investment Quality Improvement Bundle for Pediatric Hospital Teams

Publication Number: 4328.335

Kaylee R. Gouge, University of Kentucky College of Medicine, Lexington, KY, United States; Tariq Chaudry, University of Kentucky/Golisano Children's Hospital at the University of Kentucky, Lexington, KY, United States; Taylor Kulik, Kentucky Children's Hospital, Lexington, KY, United States; Anna Mae Flannery, University of Kentucky College of Medicine, Lexington, KY, United States; Maximo Losada-Radley, University of Kentucky College of Medicine, Lexington, KY, United States

Background: On our hospital medicine service, residents and admitted families often held mismatched expectations for patient-provider communication. This led to care team frustration and suboptimal patient satisfaction scores. We aimed to identify interventions for cultivating a healthier "communication ecosystem" by introducing physical changes to the hospital environment that could reduce barriers to effective patient-provider communication.

Objective: Using the SMART framework, we aimed to increase the percentage of parents who responded "always" to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey question, "During this hospital stay, how often did your child's doctors listen carefully to you?" from 78% to 90% by the end of a 6-month intervention period.

Design/Methods: By engaging multiple stakeholders, we identified two key drivers of communication mismatch: (1) family knowledge gaps about care team and rounding structure and (2) limited eye-level communication between providers and families. To address these, we implemented a stepped-intervention quality improvement project wherein we placed educational infographic posters in each acute care patient room and provided care teams with stools for the primary speaker to sit with families on rounds. Student observers shadowed rounds over a 6-month period to catalogue process and secondary outcome measures.

Results: We collected observational data from 409 patient encounters from January 30 to June 31, 2025. Frequency of eye level engagement, whether sitting or standing, improved from 22% to 73% of encounters, with centerline shift confirmed using Shewhart control chart methodology. We did not observe a statistically significant improvement in family understanding of team structure. Additionally, there was not a significant improvement in our primary outcome measure of "always" HCAHPS responses, (78% preintervention, 84% postintervention, p>0.05). Low HCAHPS response rates limited analysis.

Conclusion(s): In the inpatient setting, there are abundant opportunities for adjusting the built environment to improve patient-provider communication quality. By providing portable stools, we demonstrated proof of concept for a low-cost, low-risk intervention that significantly changed provider behavior and began to improve families' perception of physician communication. Local efforts are ongoing to optimize sustainability of both our stool and infographic interventions to support long-term change, with additional Plan-Do-Study-Act cycles currently in process.

Percent of Encounters Where Team Member Mirrored Caregiver Position
This control chart demonstrates a positive centerline shift in the percentage of encounters where at least one team member mirrored the family's position, averaged across five encounters. The shift occurred shortly after portable stools were made available to hospital medicine teams, as indicated by the second vertical line on the chart.

Self-Reported Parental Confidence Regarding Hospitalist Team Roles
This chart demonstrates the percentage of parents over time who responded "5 - Completely Confident" to the question, "On a scale of 1 to 5, how confident are you are that you could explain the difference between the roles of these team members: medical student, intern, upper level resident, and attending?" Responses were aggregated into groups of 5 and averaged. There was no significant centerline shift, possibly secondary to process challenges involving poor infographic visibility and engagement.

HCAHPS Top Box Responses
This graph shows the percentage of parents who responded "always" to the HCAHPS survey question,  "During this hospital stay, how often did your child's doctors listen carefully to you?" We have not yet observed a centerline shift. Notably, HCAHPS responses are supplied by a third party and are only available for aggregation every 2 weeks, creating a delay in recognition of any centerline shift.