General medical wards in hospitals provide care to large and growing numbers of patients. As a result, identifying effective ways to improve the quality of care can enhance the experiences and outcomes of many individuals. A new study from UHN and the University of Toronto is shedding light on what matters most to patients and caregivers during a hospital stay, revealing that better communication, fewer delays, and greater inclusion in care decisions are among the top priorities for improvement.

By using an open-ended, multi-step approach, known as group concept mapping, researchers led by Dr. Lauren Lapointe-Shaw, Staff Physician in General Internal Medicine and Scientist at UHN’s Organ Systems & Integrated Health Sciences Research Institute, sought to identify high-priority areas directly from patients' and caregivers' experiences.

Over 500 patients and caregivers from general medical wards at 10 Canadian hospitals (in Ontario, Nova Scotia, British Columbia, and Alberta) participated in this multiphase study between November 2023 and February 2025. Participants included people from groups that are often underrepresented in health research, such as non-English speakers, people experiencing homelessness, individuals with mental health conditions, and people living with dementia.

Patients and caregivers first told researchers what contributed to their inpatient experience, and then later rated and sorted the resulting experience statements. The sorting exercise resulted in six main themes: Environment and Facilities, Personal Support, Delays, Communication, Nutrition, and Inclusivity and Engagement.

Overall, patients’ and caregivers’ own negative inpatient experiences, many of them related to the hospital environment, did not correlate with what issues they prioritized for improvement. Instead, it was system-level concerns such as care delays, communication breakdowns, and lack of inclusivity that were seen as the most important to improve. One example of this is how rare but harmful events, such as perceived discrimination, were prioritized for improvement by many, despite few having experienced these directly. Notably, priorities for improvement were consistent across different patient and caregiver groups, even when their experiences varied.

Although negative experience ratings and priorities for improvement were not strongly correlated, the top-rated item was the same for both: having to wait a long time in the emergency department before getting a bed on the ward. This issue negatively affected many patients and was also identified as the highest priority for improvement.

The other highest-ranked priorities for improvement centered around communication, inclusivity, and engagement. For example, not having enough opportunities to speak with a doctor was another top priority for improvement.

“This study offers a patient-defined roadmap to guide quality improvement efforts on inpatient wards,” says Dr. Lapointe-Shaw. “Our findings also demonstrate that patients and caregivers can and do make a distinction between their own negative experiences and what they consider most essential to improve, for the benefit of all patients.”

Dr. Lauren Lapointe-Shaw is a Scientist at UHN’s Organ Systems & Integrated Health Sciences Research Institute, Research Director of the Myrna Daniels Seniors Emergency Medicine Centre at UHN, and Associate Professor in the Departments of Medicine & Institute of Health Policy, Management and Evaluation (IHPME) at the University of Toronto. She is the lead and senior author of the study.

This work was supported by the Canadian Institutes of Health Research, the PSI Foundation, the Sinai UHN Medical Organization, St Michael’s Hospital Academic Medical Organization, and UHN Foundation.

Lapointe-Shaw L, Salahub C, Lee M, Verma AA, Razak F, Ambasta A, Refaei M, Carpenter T, Moses B, Shetty N, Miller AP, Spicer E, Rawal S, Soong C, Kuluski K, Okrainec K, Baker GR, Chartier LB, Dhalla IA, Joseph R, Wodchis WP, Desveaux L, Wu W, Granieri M; GIM Priorities Group. Patient and caregiver priorities for quality improvement on general medical wards: a multicentre group concept mapping study. BMJ Qual Saf. 2026 Jul 19:bmjqs-2026-020280. doi: 10.1136/bmjqs-2026-020280. Epub ahead of print.