Summary: CHAIR placement, a simple, no-cost, low-tech intervention, increases the likelihood that a physician will sit during a bedside consultation. Resulted in higher patient scores on satisfaction and communication. |
Etiquette-based medicine is a practice that emphasizes good manners and behaviors when communicating with patients, and such a practice has been shown to have a beneficial effect on the doctor-patient relationship. Sitting at a patient’s bedside is one of the etiquette behaviors that has been associated with improved doctor-patient communication, as well as patient satisfaction and trust.
However, amidst busy rounds, it could be challenging for healthcare professionals to sit with patients on a regular basis; Previous studies found that hospitalists sit during one in five patient encounters. Despite evidence suggesting that sitting with patients is beneficial, identifying ways to change physicians’ behavior is complex.
A nudge is defined as an attempt to predictably influence an individual’s judgment, choice, or behavior by targeting subconscious routines and biases present in decision- making . Nudges have been successfully leveraged to modify physician behavior and have resulted, for example, in increased flu vaccination rates and more frequent prescribing of statins .
Choice architecture is a specific stimulus strategy that influences the social and physical environment in which decisions are made. Choice architecture studies have shown that intentional placement of healthier food options improves health-conscious decisions without any specific interaction with consumers. Previous studies in the hospital setting have shown that stimuli such as visual cues and fresh scents can increase hand hygiene behaviors.
Several reviews have also shown that electronic nudges can improve clinical decision making when filling prescriptions, ordering laboratory tests, and conducting preventive health screenings. Therefore, nudges and choice architecture may be effective in influencing subconscious behaviors during rounds, such as doctors sitting while caring for patients.
Using these concepts of behavior change, we hypothesized that using choice architecture could affect physician behavior and improve patients’ perceptions of their physician. As such, we conducted a single-center randomized deception trial to determine the effect of chair location on physician sitting rates and patient satisfaction.
Aim
To evaluate the effect of chair placement on physicians’ sitting time during a bedside consultation and patient satisfaction.
Design
Single-center, double-blind, randomized, deception- controlled trial .
Setting Texas County Hospital, USA
Participants:
51 hospitalists providing direct care services and 125 observed patient encounters who could correctly answer four counseling questions before entering the study, from April 2022 to February 2023.
Intervention
Each patient encounter was randomly assigned to the chair location (≤3 ft (0.9 m) next to the patient’s bed and in front of the bed) or to the usual chair location (control).
Main outcome measures
The primary outcome was the clinician’s binary decision to sit or not sit at any time during the patient encounter.
Secondary outcomes included patient satisfaction, assessed with the Tool to Assess Inpatient Satisfaction with Care from Hospitalists (TAISCH) and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, time in the room, and the perception of both physicians as of the patients’ time in the room.
Results
125 patient encounters were randomized (60 for chair placement and 65 for control). 38 of 60 physicians in the seating group sat during the patient encounter compared with five of 65 physicians in the control group (odds ratio 20.7; 95% confidence interval: 7.2 to 59.4; P < 0.001).
The absolute risk difference between the intervention and control groups was 0.55 (95% confidence interval: 0.42 to 0.69). In total, it was necessary to place 1.8 chairs for one doctor to sit on.
The intervention was associated with 3.9% higher TAISCH scores (effect estimate 3.9; 95% confidence interval: 0.9 to 7.0; P = 0.01) and 5.1 higher odds of obtaining full HCAHPS scores (95% confidence interval: 1.06 to 24.9, P = 0.04).
Chair placement was not associated with time spent in the room (10.6 minutes versus control 10.6 minutes) or with physicians’ perception of time in the room (9.4 minutes versus 9.6 minutes). 8 minutes) or patients (13.1 minutes versus 13.5 minutes).
Discussion
In this randomized controlled deception study , we found that a simple, no-cost nudge of conveniently placing a chair next to a patient’s bed can statistically significantly affect hospitalist physician behavior and patient satisfaction. With this nudge , physicians were substantially more likely to sit during the patient encounter (63%) compared to a control group where the chair was left in its usual location (8%). Additionally, physicians who received a nudge received higher TAISCH and HCAHPS patient communication scores. Our findings highlight how choice architecture within hospital rooms can change physician behavior and improve patient experience.
Conclusions In this randomized study, a no-cost, low-tech nudge in chair placement significantly increased the likelihood that a hospitalist would sit with a patient at no cost to the hospital and no disadvantage to the physician. Future work should leverage behavioral intervention strategies to improve care delivery in healthcare settings. |
What is already known about this topic?
- The architecture chosen, such as specific designs for patient rooms, can influence the behavior of doctors.
- Doctors’ etiquette behaviors, such as sitting while caring for a patient, positively impact patient satisfaction.
- Despite this evidence, doctors rarely sit at bedsides.
What this study adds
- A simple, low-cost nudge, such as placing a chair next to a patient’s bed, can increase the likelihood that a doctor will sit down by 20 times.
- Such a nudge can also improve patients’ perception of their doctor.
Final message
Chair placement is a simple, no-cost, low-tech intervention that increases the likelihood that a physician will sit during a bedside consultation and resulted in higher patient scores for both satisfaction and communication.
