It has long been speculated that a patient’s (or their family’s) disappointment with the care they receive in the healthcare system is a key driver for complaints and sometimes even litigation. An important risk control measure to counter this potential effect is to ensure that patients and their families have appropriate education about what to expect. This will help develop realistic expectations about the care they will receive and the possible outcomes.

Communication with families is not simply good practice in general. It is required by F-Tags 151, 152, and 154. Several interventions have been designed to encourage and facilitate more family involvement.

In an article in Psychology Today titled “The Danger of Having Unrealistic Expectations,” author Alex Lickerman, M.D. (3/1/2010) describes four basic scenarios regarding expectations and experience:

  1. Low expectations and a poor experience – the low expectations can lessen any disappointment if there is actually a less than positive experience or outcome.

  2. Low expectations, but a good experience – a “pleasant surprise.”

  3. High expectations and a good experience – an experience that actually lives up to one’s expectations and is therefore satisfying.

  4. High expectations, but a poor experience – the individual ends up highly disappointed and oftentimes angry and traumatized.

The idea of establishing realistic expectations has been used in the acute care setting, particularly as it relates to surgical procedures. In a 2009 article, S. Jay Jayasankar, M.D. states, “The expectation model of patient education, with its focus on developing realistic expectations, is good medical practice and a risk management tool….leading to increased trust and an enhanced patient-physician relationship. The latter, in turn, improves quality and risk management. It is all about expectations!”

This “expectation education” model can be translated into other healthcare settings. A patient’s expectations depend not only on the material they receive upon admission, but also on the way they take that information and transfer it into a personal belief. That may depend on their past experiences, input from friends and family, and even the marketing materials they have seen from your organization or other healthcare entities. 

First impressions are often the most important, so introductory visits and the admission process may be the best opportunity you have to set the expectations of the patient/resident and their family. Take time to communicate realistic expectations for the course and eventual outcome of treatment.

Involving patients and their family members in goal setting increases their awareness of what functional improvements (if any) can be expected during the course of treatment and what interventions are best suited for goal achievement. By working with the patient and family to set realistic goals, the team can help shape those expectations, beliefs and perceptions to match what is reasonable and attainable.

Setting realistic expectations starts with an explanation of what services the organization can and cannot provide and what staff can and cannot do. In most cases the resident is moving into a supervised setting because they are no longer able to live independently.  It is helpful to have a dialog with the resident and their family regarding the changes they may see as a result of the aging process.

Best Practices for Establishing Realistic Expectations

  • Establish clear guidelines on services provided,  levels of care and any limitations based on that level

  • Provide a mechanism to educate and inform patients/residents and their families/caregivers

  • Open communication lines between staff and families; ones that encourage questions and allow for honest answers about changes in health status and abilities

  • Build a foundation of trust and mutual respect

Betty Norman is the Director of Risk Control Services GHP at Glatfelter Insurance Group.