Patient and caregiver priorities for quality improvement on general medical wards: a multicentre group concept...

Quality improvement efforts on general medical wards are often driven by organisational or clinician priorities, and little is known about patient or caregiver priorities.

To understand contributors to patients' in-hospital experience and how patients and caregivers prioritise these for improvement.

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.

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.

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.