{ "abstract": "Importance Quality improvement efforts on general medical wards are often driven by organisational or clinician priorities, and little is known about patient or caregiver priorities.Objective To understand contributors to patients’ in-hospital experience and how patients and caregivers prioritise these for improvement.Methods We recruited inpatients or their caregivers from the general medical wards of 10 hospitals across Canada from November 2023 to February 2025 to participate in a group concept mapping study. Group concept mapping is a participatory multistep mixed method used to understand how a group views a particular topic. We used a targeted recruitment strategy to ensure inclusion of individuals who identified as non-white, preferred a non-English language, were unhoused, had a history of a mental health condition or who had dementia. An open-ended prompt elicited narratives about the inpatient experience. These were iteratively summarised into statements, which subsequent participants thematically sorted and rated in response to two rating questions: (1) extent of negative impact on well-being and (2) prioritisation for quality improvement.Results 302 participants (230 patients, 72 caregivers) responded to the open-ended prompt. These were synthesised into 935 ideas, summarised into 42 unique statements, which were then rated (N=203 participants) and sorted (N=50), generating a concept map with six clusters: Environment & Facilities, Personal Support, Delays, Communication, Nutrition, Inclusivity & Engagement. There was no correlation between rating results for impact to well-being versus prioritisation for quality improvement. The ‘Delays’, ‘Communication’ and ‘Inclusivity & Engagement’ conceptual clusters contained many of the highest-rated improvement priorities. Prioritisation was consistent across participant subgroups, despite variation in how these groups rated items on impact to well-being.Conclusion This study provides a ranked list of priorities, setting an agenda that is grounded in the patient experience. Overall, patients’ and caregivers’ own negative inpatient experiences had little bearing on overall prioritisation for quality improvement.", "authors": [ { "affiliations": [ "Department of Medicine, University of Toronto, Toronto, Ontario, Canada", "Department of Medicine, University Health Network and Sinai Health System, Toronto, Ontario, Canada", "Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada", "Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada" ], "name": "Lauren Lapointe-Shaw" }, { "affiliations": [ "Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada" ], "name": "Christine Salahub" }, { "affiliations": [ "Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada" ], "name": "Minkyung Lee" }, { "affiliations": [ "Department of Medicine, University of Toronto, Toronto, Ontario, Canada", "Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada", "Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada" ], "name": "Amol A. Verma" }, { "affiliations": [ "Department of Medicine, University of Toronto, Toronto, Ontario, Canada", "Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada", "Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada" ], "name": "Fahad Razak" }, { "affiliations": [ "Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada", "Department of Medicine, University of Calgary, Calgary, Alberta, Canada" ], "name": "Anshula Ambasta" }, { "affiliations": [ "Hematology and Thromboembolism, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada", "Oncology (Hematology & Thrombosis), Niagara Health System, St. Catharines, Ontario, Canada" ], "name": "Mohammad Refaei" }, { "affiliations": [ "Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada", "Department of Medicine, St. Joseph's Health Centre, Toronto, Ontario, Canada" ], "name": "Travis Carpenter" }, { "affiliations": [ "Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada" ], "name": "Brian Moses" }, { "affiliations": [ "Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada" ], "name": "Nabha Shetty" }, { "affiliations": [ "Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada" ], "name": "Ashley P. Miller" }, { "affiliations": [ "Department of Medicine, Western University, London, Ontario, Canada" ], "name": "Erin Spicer" }, { "affiliations": [ "Department of Medicine, University of Toronto, Toronto, Ontario, Canada", "Department of Medicine, University Health Network and Sinai Health System, Toronto, Ontario, Canada" ], "name": "Shail Rawal" }, { "affiliations": [ "Department of Medicine, University of Toronto, Toronto, Ontario, Canada", "Department of Medicine, University Health Network and Sinai Health System, Toronto, Ontario, Canada", "Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada" ], "name": "Christine Soong" }, { "affiliations": [ "Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada", "Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada" ], "name": "Kerry Kuluski" }, { "affiliations": [ "Department of Medicine, University of Toronto, Toronto, Ontario, Canada", "Department of Medicine, University Health Network and Sinai Health System, Toronto, Ontario, Canada", "Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada", "Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada" ], "name": "Karen Okrainec" }, { "affiliations": [ "Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada" ], "name": "G. Ross Baker" }, { "affiliations": [ "Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada", "Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada", "Emergency Department, University Health Network, Toronto, Ontario, Canada" ], "name": "Lucas B Chartier" }, { "affiliations": [ "Department of Medicine, University of Toronto, Toronto, Ontario, Canada", "Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada", "Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada" ], "name": "Irfan A. Dhalla" }, { "affiliations": [ "Department of Medicine, Western University, London, Ontario, Canada" ], "name": "Radha Joseph" }, { "affiliations": [ "Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada", "Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada" ], "name": "Walter P. Wodchis" }, { "affiliations": [ "Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada", "Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada" ], "name": "Laura Desveaux" }, { "affiliations": [ "Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada" ], "name": "Wendy Wu" }, { "affiliations": [ "Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada" ], "name": "Marisa Granieri" }, { "affiliations": [], "name": "GIM Priorities Group" } ], "title": "Patient and caregiver priorities for quality improvement on general medical wards: a multicentre group concept mapping study", "uid": "1f289440-bb6c-5900-979b-2350f7a24187" }