Capturing children's voices for quality improvement

PURPOSE: To query children about the perceptions of their inpatient healthcare experiences in order to improve care to make it more developmentally appropriate and responsive to children's needs and desires. STUDY DESIGN AND METHODS: Children (n = 120) were interviewed and their comments were recorded as they described the best and worst things about their hospitalization and made recommendations for change. They were approached at the time of discharge from a tertiary care unit. Content analysis was used to compare their responses within their developmental levels. Themes were developed, and data were co-coded for trustworthiness of findings. Quotes were extracted that illustrated the themes. RESULTS: Children provided insightful and specific data regarding the perceptions of their hospital experiences. Pain and discomfort were cited most frequently as the worst aspects of hospitalization and the areas most needing improvement. Play activities were valued by children of all ages. Their positive relationships with hospital staff were described frequently. The developmental stage of children determined the specificity and diversity of their comments. CLINICAL IMPLICATIONS: Children's unique perspectives should be sought regularly and their data included in ongoing programs of quality assessment. When only parents are queried, important and insightful perspectives of children are missed that could improve care quality.