Patient Engagement

A Patient Experience Checklist for Pediatrics

Article · May 4, 2016

Checklists are synonymous with the airline industry and, more recently, health care, with the World Health Organization’s adoption of a Surgical Safety Checklist. More and more health care organizations are adopting a checklist mentality in the development of clinical pathways. After reading The Checklist Manifesto by Dr. Atul Gawande, we wondered if a checklist could be useful in pediatrics to create the best interactions among patients, families, and caregivers.

Clinical checklists are built upon empirical evidence of their effectiveness. Our dilemma was figuring out what, if any, empirical evidence was available to create an experience checklist for pediatrics. We sought to answer a single question: how could we determine what patients and families want during an interaction? Our answer was simple: ask them. Our research plan consisted of:

  • Asking 250 families the top three things a care provider could do for them to judge the interaction as excellent.
  • Shadowing top-performing care providers and lower-performing providers, drawn from the Care Provider section scores of the Press Ganey Medical Practice survey.
  • Interviewing the top-performing care providers to understand their philosophies and tactics.
  • Reviewing 1,700 Press Ganey survey comments from the top 30 and bottom 30 performing providers.

We focused on the non-clinical aspects of the interaction. Putting emphasis on the personal interaction does not supersede the importance of accurate diagnosis and treatment. Families expect both — diagnostic acumen and empathy and compassion in their physician visits.

The result was the following checklist:

  • Sit down so you’re eye-to-eye with the child and family.
  • Smile.
  • Greet the entire family and use their names if known. At minimum, use the child’s name.
  • If delayed, say, “Thank you for waiting for me” instead of “I’m sorry you waited.”
  • Talk about at least one non-medical topic with the child or family prior to addressing the medical issue. School, hobbies, sports, etc.
  • If the child is old enough, ask him or her questions about the medical issue.
  • Learn something you can use during future visits. Make a note of it in the EMR. For example, if a child mentions going to an upcoming sporting event, make yourself a note to ask him or her about it the next time you see the family.
  • Don’t interrupt the child or family. Listen while they talk.
  • Ask, “What questions do you have for me?” instead of “Do you have any questions?”
  • Thank the family for giving you the opportunity to care for their child.

Early feedback from physicians is positive. We are currently collecting quantitative data on the impact of the checklist. The mother of a child whose physician started using the checklist noted a “night and day” difference in the experience. Remove the word “child” and replace with “patient,” and this checklist can be applied to adult medicine. Consistent application of this list takes practice, but everything in it is common sense. Although created with a rigorous and thorough research process, the checklist was intentionally written to be simple. Sometimes the best solution is the simplest.

New Call for Submissions ­to NEJM Catalyst

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

More From Patient Engagement
Karen DeSalvo - public health population health social determinants of health expert

Moving from a Sickness Model of Health Care to One of Well-Being

The expense of the U.S. health care system is so misaligned from what we need as a country — a healthier population. A public health expert discusses how we can move toward a model that addresses social determinants of health and promotes well-being while still growing our economy.

Different Means of Initiating and Sustaining Behavior Change

Survey Snapshot: Social Support, Whether In-Person or Virtual, Is the Key to Sustained Behavior Change

NEJM Catalyst Insights Council members seek ways to create relationships with patients — but the hurdles are high.

Different Means of Initiating and Sustaining Behavior Change

Patient Engagement Survey: What Creates Behavior Change May Not Sustain It

An NEJM Catalyst Insights Council survey finds that human interaction and social support are vital for patient behavior change and employee wellness programs.

How the EpxSubstanceUse Substance Use Disorder Mobile Health Texting Program Works - Preferred Family Healthcare Epharmix Technology Assisted Care Coordination Project Opioid Abuse

Messaging System Helps Caregivers Keep Tabs on Growing Number of Patients with Substance Use Disorder

One behavioral health provider pilots cost-effective outreach to patients with SUD that checks up on their recovery, triages needs, and facilitates communication.

Gary Kaplan Head Shot

Improving Patient Involvement in Care

The CEO of Virginia Mason on facilitating and enhancing patient participation in care.

Chou01_pullquote_Time to Start Using Evidence-Based Approaches to Patient-Provider Communication

Time to Start Using Evidence-Based Approaches to Patient Engagement

Clinicians must acknowledge that there is a dramatic difference between learning a concept about patient-provider communication and learning the actual skills for effective execution.

Nash01_pullquote - A Requiem for Value-Based Care Population Health.

A Requiem for Population Health?

Despite some fits and starts for value-based care, there is abundant evidence that the concept will continue to survive and thrive.

Steps for Deploying Nudge Unit in Health Care

Nudge Units to Improve the Delivery of Health Care

Key information and important choices are constantly being presented in health care. Yet often the frames or default options used are selected without attention to strategic goals.

What Is Telehealth?

Telehealth: The delivery of health care, health education, and health information services via remote technologies. Read about telehealth technologies, services, and reimbursement issues.

Example Cost of Custom-Built PRO Collection Platform

The Cost of Patient-Reported Outcomes in Medicine

Implementation of routine PRO collection is paramount to measuring and maximizing value in health care.

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

Topics

Patient-Centered Care

210 Articles

Designing and Implementing Better Patient Experiences

An ophthalmology provider with facilities in the greater Mexico City area is using Human-Centered Design…

Survey Snapshot: Social Support, Whether In-Person…

NEJM Catalyst Insights Council members seek ways to create relationships with patients — but the…

Patient Incentives

60 Articles

Survey Snapshot: Social Support, Whether In-Person…

NEJM Catalyst Insights Council members seek ways to create relationships with patients — but the…

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now