Health Literacy Universal Precautions Toolkit, 2nd Edition

Encourage Questions: Tool #14

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Overview

Patients are sometimes embarrassed to ask questions and, in some cultures, deference to authority stifles questions. Creating a shame-free environment that encourages patients to ask questions is an important way to engage patients as active partners in their health care and is crucial in promoting patient safety and good health outcomes. It also can increase patient satisfaction and reduce the number of callbacks after a patient leaves.

Practice Experiences
"We decided to implement the "Ask Me Three" program. As 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.' I point to their brochure and hand them a pencil. When the nurse would take them back she would reinforce the pamphlet and encourage them to talk about their questions. When the 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 were stopping to ask questions or calling back in after their visit."

—Community clinic

Action

Invite questions.

  • Encouraging patients to ask questions can be as simple as saying, "What questions do you have?" This specific wording creates the expectation that they should ask questions.
  • Do not ask patients, "Do you have any questions?" because most patients will respond to this wording by saying "no," even if they do have questions.
  • Ask patients what questions they have several times during an office visit.

Other ways to elicit questions.

  • "We discussed a lot of information. What can we review again?"
  • "[Diagnosis] may be new to you, and I expect that you have some questions. What would you like to know more about?"

Use body language to invite questions:

  • Sit, don't stand: Sit at the same level as your patient.
  • Look and listen: Look at patients when talking and listening, as opposed to looking at the chart or computer.
  • Show that you have the time: Be conscious about presenting yourself as having time and wanting to listen to their questions. Try not to interrupt.

Help patients prioritize questions.

  • If patients have a long list of questions, help them decide which ones are most important to address at this visit. Have them schedule another visit to address the rest of their questions.

Encourage all staff to make sure questions are asked and answered.

  • Check-in and rooming staff can encourage patients to ask their clinicians any questions they have during the visit.
  • Check-out staff can ask patients whether all of their questions were answered. Make sure you have a plan for how to respond if a patient says "no."

Remind patients to bring questions with them.

  • Appointment reminders can suggest patients bring a written list of questions with them.
  • Check-out staff can suggest patients write down questions that occur to them after they leave so they can ask them at the next visit.

Encourage patients to ask questions in other health settings.

  • For example, when giving a patient a new prescription, you might say "Be sure to ask the pharmacist if you think of any additional questions about your medicine."

Track Your Progress

Over the course of a week, have check-out staff ask patients at the end of each visit, "Did you get a chance to ask all your questions today?" Record the number of patients who answered "yes" over time. Check before implementing this Tool and again after 2 months, 6 months, and 12 months.

Over the course of a week, record the percentage of patients who call the practice with questions within 48 hours after their office visit. Check before implementing this tool and again after 2 months, 6 months, and 12 months.

Before implementing this tool, collect patient feedback using the Brief Patient Feedback Form. Administer the questions 2, 6, and 12 months later to determine if there's been an improvement in response to the item on encouraging questions. If you field questions from the Health Literacy Patient Survey, calculate what percentage of patients responded "Always" to questions #7 and #8.

Resources

Practices found the following programs useful, especially when used in conjunction with Tool 5: Use the Teach-Back Method.

  • Ask Me 3: The National Patient Safety Foundation's program encourages patients to ask three specific questions (and you to answer those questions even if they don't ask) at every visit.
  • Questions Are the Answer: This resource, created by AHRQ, encourages patients to get more involved in their health care. It contains videos, handouts, and an online question builder.

Return to Contents

Page last reviewed February 2015
Page originally created February 2015
Internet Citation: Encourage Questions: Tool #14. Content last reviewed February 2015. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/healthlittoolkit2-tool14.html