Encourage Questions Tool 14
Encourage Questions
Overview
An essential part of achieving good health outcomes is helping patients to
understand that their role in their health care is important. But patients can
sometimes be ashamed to ask questions, fearing that they will seem foolish. In
some cultures, deference to authority figures stifles questions. Creating a shame-
free environment that encourages patients to ask questions and gives them the
confidence to take ownership of their health is crucial in this effort.
There are several strategies designed to change the dynamic of the patient/
clinician interaction. These approaches, when used over time, are aimed at
teaching patients to become more involved, but they will also help a practice to:
Decrease the number of call backs or questions after a patient leaves.
Increase patient satisfaction.
Increase patient safety.
Purpose
To give strategies for eliciting questions from patients.
Testimonial
“We decided to implement the ‘Ask Me 3’ program for 2 weeks for some of the
afternoon patients in clinic A. As part of the responsibilities of the front desk
those 2 weeks, I made copies of the brochures. As one of these patients came
in, I would give them a brochure and say, ‘Every time you see your provider
you should leave knowing the answers to these three questions. What questions
do you have for your doctor today? You can write them here…’ I point to
their brochure and hand them a pencil. I then flagged the chart with a green
sticky note, and when the nurse would take them back she would reinforce the
pamphlet and encourage them to talk about their questions. When that patient
was ready to check out I would ask them, ‘Did you get your questions answered
today?’ Most of the responses were positive, but the more amazing thing was
that fewer patients from this clinic were stopping to ask questions or calling
back in after their visit compared to clinic B.”
-community medical clinic
Encourage Questions Tool 14
Action
The following programs encourage questions. They contain brochures, posters,
and videos along with directions on how to implement them in a practice.
Although true patient activation takes much work to achieve, many practices
found these programs easy to implement and very helpful in focusing the
conversation, especially when used with Tool 5: The Teach-Back Method.
Ask Me 3: This program, designed by the National Patient Safety
Foundation, encourages patients to know three things before leaving the
encounter:
1. What is my main problem?
2. What do I need to do?
3. Why is it important for me to do this?
Questions Are the Answer: This campaign, created by AHRQ, encourages
patients to get more involved in their health care. It contains videos,
handouts, and an online question builder.
Tip
Clinicians can use the questions and strategies in these
programs to help structure patient visits.
Other considerations.
Invite questions using body language.
Sitting: Sit at the same level as your patient.
Look and listen: Look at patients when talking and listening,
as opposed to the chart or computer.
I have the time: Be conscious about presenting yourself as
having time and wanting to listen to their questions. Try not to
interrupt.
Solicit questions.
“What questions do you still have?”
“That was a lot of information. What do I need to go over
again?”
Avoid asking, “Do you have any questions?” This often leads
to a quick “no,” even if they do have questions.
Encourage Questions Tool 14
Involve the entire staff in soliciting questions.
Checkin: Have the clinical staff talk to patients while taking
vitals or checking them in about questions they want to ask the
doctor.
Ancillary staff: Use nurses, health educators, and other staff to
encourage questions.
Checkout: Ask each patient on their way out whether their
questions were answered.
Expand the scope.
Other health settings: Encourage patients to ask questions of
other physicians, pharmacists, etc.
Family and friends: Encourage patients to bring a relative or
friend to the next visit to help them remember information, and
include these people in the conversation.
Managing questions: If patients have many questions,
prioritize them with your patient and defer some to a future
visit.
Track Your Progress
Count the number of questions from patients before and after implementation.
This will provide good measurement for how well the strategies are
implemented.
Measure whether patients know the answers to the three questions as they exit.
For example, ask one patient a day at checkout if they know their main
problem, what they need to do, and why. See whether the responses change
over the course of 2 weeks. Check again after 2 months
Have all members of your team measure the number of patients that brought
or asked questions. Include questions asked by family or friends
accompanying the patient. Measure for 2 days before making changes, 2 days
after a month, and 2 days after 6 months.
Ask as patients exit, “Did you get a chance to ask all your questions?” If
patients answer no, ask whether the doctor/nurse said they would address
some questions later. Record the number of patients who answered “no” to
both questions over time.