Background: There is no standardized, consistent method for providing and receiving personalized feedback on patient care amongst hospitalists at our institution. The result is that physicians are not aware of areas they could improve in clinical care until either a sentinel event occurs or at the time of their annual review with division leadership. Additionally, based on institution-wide engagement survey results, there is dissatisfaction with the quality of handoffs at transitions of care. Both these conditions lead to less-than-optimal patient care. In general, among hospitalist groups, reviews of clinical performance are usually performed after a sentinel event and thus are associated with being punitive as opposed to being a learning opportunity. In contrast, anonymous peer feedback on a more consistent basis is less likely to be construed as punitive (Martin, 2018). Peer feedback allows us to learn from our mistakes and correct our behavior before a severe event occurs, leading to improved clinical care (Kitay, 2005), and the nature of hospital medicine being based on shift work lends itself well to peer feedback at times of transitions of care (Rosenthal, Sharpe and Haber, 2020). We believe that implementing a standardized method of providing feedback on clinical care will lead to improved satisfaction with the feedback process. We believe that by improving the feedback loop at our institution, providers can improve overall communication and reflection on ways to improve clinical care.
Methods: We surveyed hospitalists at our institution in 3/2023 and determined there was not a standardized method of providing feedback. We performed a root cause analysis for why there is not a culture of feedback at our institution. Based on these results, we created a novel feedback tool for providers in multiple areas of patient care. The feedback tool was deployed in 8/2024 to all non-teaching service providers and use of the tool was expanded in 10/2024 to include teaching service hospitalists. We also developed a smartphrase in our EMR that linked to the feedback tool in 9/2024. Hospitalists on service were given reminders to submit feedback upon starting service. We will be assessing the number of individual providers submitting feedback weekly, the total number of weekly feedback responses, and the percentage of providers who are submitting and receiving feedback. We will perform follow-up surveys to assess perceived improvement in the feedback process and improvement in quality of handoffs at times of transition of care. We will also perform a retrospective analysis on event reports submitted for our providers to determine change in the number of events with deployment of the feedback tool.
Results: Hospitalists at our institution, numbering 158 in total, were educated on the feedback intervention. Since implementation of the feedback tool, there have been an average of 5 responses per week, out of an average of 74 physicians on service and 109 physicians working in any clinical capacity. At time of submission, analyses are pending for the following: percentage of hospitalists receiving feedback, follow-up surveys to assess degree of satisfaction with the feedback process, and change in number of event reports submitted for our providers. We expect hospitalists to report improvement with the feedback process after deployment of the feedback tool.
Conclusions: A standardized method for providing feedback can improve satisfaction with the feedback process and allow for improved reflection on clinical care.