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Fixing Hospital Onboarding: Reducing Patient Anxiety & Confusion
Inefficiency Insights #72
Jared Dashevsky, MD
March 20, 2025 • Estimated Reading Time: 9 minutes
INEFFICIENCY INSIGHTS
Fixing Hospital Onboarding: Reducing Patient Anxiety & Confusion
The Problem
Hospitalized patients often experience anxiety and confusion due to a lack of clear onboarding, leaving them uncertain about their care plan, care team, hospital routines, and how to escalate concerns.
Problem Description
For many patients, hospitalization is their first exposure to an unfamiliar and overwhelming system. They enter through the emergency department or direct admission, face a whirlwind of diagnostic tests, physician consults, and nursing interventions, and then are expected to navigate their care without a clear roadmap.
As physicians, we experience the hospital as a place of controlled chaos—stressful, fast-paced, but at least familiar. For patients? It’s equally chaotic, but layered with uncertainty, fear, and disempowerment.
And I don’t know about you, but “not knowing” and “uncertainty” drive my anxiety.
Think about the first thing you do in a theme park—you grab a map. Why? Because knowing where things are located reduces uncertainty. The same principle applies when traveling to a new city—you instinctively open Google Maps. Having an overview of your environment gives you a sense of control.
But when a patient is hospitalized, they receive no such map. They are instead thrust into a system that operates on its own schedule, where plans change suddenly, and where critical information is often lost in fragmented handoffs.
I came across this study in BMJ on patient journaling in the hospital setting. The authors found that two of the most valued aspects of care were explanations of what to expect and feeling included and heard. These align closely with the ICU framework I previously proposed—setting expectations upfront to avoid misalignment between patient assumptions and reality .
So why don’t we give patients a structured onboarding process? Something that clearly lays out:
Their service line (medicine, surgery, ICU, etc.)
Who is on their care team (attendings, residents, consultants)
Their general care plan (labs every morning, meals three times a day, PT once daily)
Expected discharge timeline (contingent on progress)
How to escalate concerns (who to talk to for issues or misunderstandings)
This structured approach would reduce patient anxiety and prevent avoidable frustrations that lead to complaints, dissatisfaction, and nonadherence to care recommendations.
Based on my ICU experience, I’ve found that families often arrive with misaligned expectations. Many believe that intensive care means a guarantee of survival when, in reality, it’s a place of last-resort interventions. That’s why I emphasize direct, transparent conversations when “onboarding” families to the ICU.
A similar principle applies to general hospital admissions. Patients frequently don’t know what they don’t know, and when information is withheld or unclear, frustration grows. In that BMJ study from above, poor communication about changes in medications, delays in discharge, and care transitions were among the most common patient complaints. These issues are systemic inefficiencies, not just individual communication failures.
So, what would this onboarding map look like? It could be as simple as:
A digital or paper-based guide given at admission, outlining what to expect.
A structured nurse-led or physician-led admission conversation, setting expectations for the hospital stay.
A care team “cheat sheet” so patients know who is involved and how to contact them.
While the hospital isn’t a theme park (far from it), giving patients a roadmap could transform their experience from one of uncertainty to one of informed participation.
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