Neil Gulsvig

In our last blog, we discussed the first driver of successful patient transitions: early and active patient engagement. As we continue our series and look to the next driver, identification of expectation gaps, it is critical for short-stay providers to take a close look at what can be done to ensure successful management of patient transitions, from admission to discharge and beyond. To minimize post-transition failures, short stay providers need to direct their attention toward implementing patient-centered care practices that examine the patient’s expectations for recovery and ensure they align with reasonable and realistic outcomes.

Research suggests the most reliable prediction of improved patient outcomes is when expectations are identified and aligned. This concept ensures patient needs are adequately addressed increasing the likelihood for post-transition success.

What is meant by patient expectations?

It is not uncommon for short-stay patients and families to underestimate the impact a recent illness can have on a patient’s ability to manage their care following the transition. An exacerbation of a chronic condition or onset of a newly acquired illness can impair a patient’s physical, cognitive and emotional health making daily routines more challenging if not impossible. Patients’ expectations may be driven by past experiences or a lack of understanding for how much time and effort it takes to recover from a set-back. They may assume they will be able to quickly and fully resume normal activity despite the change in health status. As a result, patients may develop wishful thinking about their capacity to return to their prior daily activities that does not match what their current state of health will allow. If patient expectations are not identified and addressed, the patient’s ability to manage post transition may be compromised.

Identifying the expectation gap

Healthcare teams can sometimes overlook the fact that patient expectations are a critical component of improved post-transition outcomes. When expectations are not acknowledged or understood, patients and healthcare teams are at risk for not being on the same page and working toward the same goals. In effect, patients may feel their needs are not being addressed, causing dissatisfaction in the healthcare team’s ability to adequately prepare them for a successful transition.

When a patient’s expectations are unrealistic, they can experience frustration and disappointment when recovery outcomes are less than anticipated. These factors may contribute to prolonged patient stays, inadequate preparation for transition and ultimately poor post-transition outcomes.

To gain better insight into patient expectations, the healthcare team needs to carefully examine patient perceptions early in the patient stay and then compare them to the team’s assessment of the patient’s actual abilities to perform required daily activities. Asking the patient and family where they intend to live, what activities of daily living will they need to take part in, and how they intend to perform them will aid your team in gaining a clear understanding of the patient’s perceptions, needs and goals for transition. Performing patient assessments that evaluate the patient’s ability to complete daily living tasks while in your facility will provide insight into whether or not the patient’s perceptions match their actual abilities. If a discrepancy is found between patient and family perceptions and what the team deems as realistic, an expectation gap exists. 

Bridging the gap for post-transition success

Defining gaps in expectations lays the foundation for care planning and goal setting, helping to guide the interdisciplinary team toward implementing patient specific recovery interventions intended to bridge the expectation gap. An important first step in bridging expectation gaps is open and honest communication between the patient, family and healthcare team that includes conversations about realistic guidelines for recovery. Educating patients and families about their condition plays an important role in helping them understand activity limitations, recovery timeframes and how these may change due to complications or unanticipated delays. Developing care plans based on patient expectations early in the patient stay affords your team the time to effectively address patient needs while in your care and ensures timely and appropriate arrangements for services and support are in place for post-transition success.

In addition, involving patients in goal setting increases awareness for what functional improvements can be expected during the course of recovery 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. Research supports that encouraging patient input in setting realistic goals gives patients a greater sense of ownership in their own recovery. Recovery interventions are more meaningful and relevant to patient needs. This leads to greater patient motivation and compliance resulting in a greater likelihood of goal attainment and ultimately better post-transition outcomes.

Take action: Best practices for understanding patient expectations

Understanding patient expectations and working to align them is imperative to patient post-transition success. A few best practices to consider:

  • Begin by engaging your patients and families in direct dialogue early in their stay to identify their expectations for recovery and transition. Once identified, your team can compare patient perceptions to the team’s assessment of what the patient is actually able to do. If there is an expectation gap, work together with the patient and family on developing care plans and setting realistic rehab goals that implement specific interventions best suited to address patient’s needs and properly prepare them for transition.
  • Provide patient education to help patients understand realistic recovery timelines based on their condition and the impact this may have on their ability to manage post-transition.  
  • Involve your patients and families as you guide them toward setting goals that align with what is reasonable and realistic. Working collaboratively to align expectation gaps brings patients, families and your healthcare team in agreement with recovery potential and sets the stage for working on common goals that effectively meet the patient’s needs.

By actively managing these practices, you can maximize patient participation, minimize patient disappointment and diminish the risk of failure, ensuring your patients have smooth and successful transitions.

Neil Gulsvig, CEO of Align, has more than 35 years of experience in the field of senior healthcare and extensive knowledge in human resources, communications and operations. Align is focused on developing integrated solutions that help providers reimagine patient experiences through engagement and successful discharge and transition planning.