Hospitals are many things: necessary, lifesaving, impressively complex. Yet they are rarely described as “navigable.” If you’re a patient, the modern inpatient experience often begins with confusion and ends with frustration, with not a lot of clarity in between. You arrive sick, get assigned a room, meet more strangers than you can remember, and are left to decode a series of unspoken rules while trying to heal.
It’s not hard to understand why patients feel lost. We throw them into a labyrinth of teams, schedules, and shifting plans, with little to no orientation. The few attempts at communication (laminated signs on the wall, half-hearted whiteboard updates, or a brief hello from someone in a white coat who might be the attending) rarely provide the context that would actually help.
Jared Dashevsky, MD recently proposed something refreshingly obvious: hospitals should onboard patients. Give them a basic orientation, set expectations, tell them who’s who, what might happen, and how to speak up when things seem off. It’s the sort of idea that makes you wonder why we haven’t been doing it all along. After all, when you check into a hotel, you get a key and short orientation to the grounds (at least you find out where the elevators are!) When you open a new app, there’s a tutorial. When you visit a theme park, you get a map. But when you’re admitted to a hospital – a far more consequential event – you get very little beyond a gown and a plastic wristband.
Patients are lost and families are desperate for clarity
There’s a predictable retort here, and I’ve made it myself: most patients who are sick enough to be admitted aren’t exactly in a place to process orientation materials. They're overwhelmed, exhausted, medicated, and sometimes not even fully conscious. What’s the point?
Angela Ingraham, MD, MS had a compelling answer: the onboarding isn’t always for the patient. It’s for the people around them. Families, caregivers, and surrogates are often present, trying to make sense of a situation that’s terrifying and unfamiliar. They’re the ones who absorb the details, ask the questions, and advocate when needed. Orienting them to what’s happening may do more to improve the inpatient experience than any app or concierge service ever could.
Even when patients are alert and engaged, they rarely know what questions to ask. That’s where proactive, structured communication can dramatically shift their experience. Knowing who’s on the team, what the daily routine entails, how to escalate concerns, and what progress looks like changes the dynamic entirely. It moves patients from passive recipients of care to informed participants in it. No, it won’t make the hospital stay enjoyable, but it makes it less mystifying and less frightening.
Discharge shouldn’t feel like a surprise party
One of the more practical and high-impact suggestions comes from Dr. Ingraham, who emphasized the importance of discussing discharge criteria, not just timelines. When patients ask when they can go home, they’re rarely asking about a date on the calendar. They’re trying to understand whether they’re improving, what milestones matter, and whether they’re close to the finish line.
Unfortunately, our answers tend to be vague. We say things like, “maybe tomorrow,” or “depending on how things look,” which translates to nothing useful. Internally, we’re tracking lab values, mobility progress, and oral intake. But we rarely share those criteria with patients or families. So, when discharge is announced, it might feel arbitrary or even unsafe.
Changing the conversation from “when” to “what needs to happen” puts everyone on the same page. It demystifies the care process and sets clear, tangible goals. This doesn’t just help patients prepare for discharge: it helps them buy into it.
We already do more complex things, so what’s the real excuse?
Of course, onboarding patients sounds great in theory. But in practice, it immediately runs into a familiar wall of operational resistance. There’s no time. There’s too much variability. Patients are too sick. It’s one more thing for already stretched nurses and physicians to manage. These concerns aren’t unfounded, but they’re also not particularly compelling.
Hospitals already find time for all kinds of less critical tasks. We obtain redundant consents, complete required documentation for Joint Commission compliance, and conduct post-discharge calls that might not have been necessary if communication had been clearer during the admission. The time is there. We’re just not spending it well.
This doesn’t require an electronic health record (EHR) overhaul or a six-figure vendor solution. A short, consistent conversation, ideally at the time of admission, can set expectations, introduce the care team, and lay out what progress and discharge will look like. That conversation can be reinforced by a physical handout, a digital summary in the patient portal, or a shared note visible in the EHR. None of this is complicated. What it takes is prioritization and some minor workflow design.
Physician leaders can incorporate expectation-setting into admission templates and rounding scripts. Nursing leaders can standardize onboarding into admission checklists without adding time-consuming steps. Executives can support this work by measuring what matters: patient confusion, discharge delays, readmission rates, and satisfaction scores related to communication and understanding of care plans.
It’s not about comfort; it’s about safety and trust
Improving how we onboard patients and families isn’t about making hospitalization “comfortable.” That’s not the goal, and it’s rarely achievable under any circumstances. But it is possible to make the experience less opaque and less alienating. In the absence of clear communication, people create their own narratives, often based on fear and frustration. We shouldn’t be surprised when this leads to resistance, complaints, or breakdowns in trust.
Patients may forget what we said during rounds. They may not remember every medication they were given. But they will remember how they felt: whether they understood what was happening, whether they were treated like partners in their care, and whether anyone bothered to tell them what to expect.
Hospitals don’t have to become theme parks. But they also shouldn’t feel like bureaucratic obstacle courses designed to confuse. We have the tools. We have the people. What’s often missing is the will to do something different, even when the status quo is demonstrably broken.
We can do better. It starts with a map.