Facilitating patient and caregiver voicing in hospital settings: A narrative synthesis of the literature and conceptual framework

While health systems increasingly recognize the critical role that patient and caregiver feedback plays in person-centered care, patients and caregivers often experience barriers to voicing their ideas, suggestions, and concerns. The aim of this narrative synthesis is to identify within the literature organizational behaviours and contextual factors that have been shown to help facilitate patient and caregiver voicing (expressing ideas, opinions, or suggestions to improve individual, group, or organizational functioning) in hospital settings and develop a conceptual framework of these enablers. A narrative synthesis review of the literature was conducted. A systematic search across three databases generated 14,273 records, and 10,129 once duplicates were removed. Following full-text review and application of the inclusion criteria, 89 articles were included in the synthesis. The results from this narrative synthesis identify practice and organizational factors that, when implemented together, may enable patient and caregiver voice in inpatient hospital settings. The organizational behaviours and interventions described include creating spaces to elicit patient and caregiver voice, using communication practices that support voice, and showing care for the full person. Enabling factors identified were having an organizational commitment to person-centered practice, supportive work processes and organizational policies, patient personal resources and voicing preferences, and staff motivation, orientation to care, and skills. There is an opportunity to improve patient and caregiver voicing during care episodes to advance the provision of person-centered care in healthcare organizations. Drawing from the literature, we propose a conceptual framework that reflects the conditions needed to support patient and caregiver voicing in hospital settings.