After the FACE™ card intervention, hospitalized patients were significantly more likely to correctly identify their inpatient physicians. However, with FACE™ cards, patients were less likely to report understanding the roles of their inpatient physicians.
It is important to consider the possible mechanisms for these findings. It is possible that FACE™ cards may have served as a reminder to physicians to introduce themselves to their patients. In addition to a heightened awareness of physicians' introductions, all staff may have responded to the FACE™ intervention by making a more concerted effort at introductions, which may in part explain why more nurses and other specialists were identified in the intervention period. Nurses had been taught about the FACE™ cards and encouraged to emphasize their own introductions. Nurses often wrote their names on the white board next to where FACE™ cards were posted. Patients may have been more likely to inquire about their nurses' names after receiving FACE™ cards.
It is also important to understand why the FACE™ card intervention did not work as well as it could have. In spite of the intervention, the majority of patients could not correctly identify an inpatient physician. Possible reasons for this are that patients did not have FACE™ cards, either because doctors did not distribute them, or because plastic card holders were not in patients' rooms. It is possible that certain patient factors, such as low health literacy, poor recall, and acute illness, impair patients' ability to correctly identify their doctors even with this intervention.
Although the study has ended, certain attending champions continue to use FACE™ cards. Card holders are no longer provided since many physicians stated that the card holders were not present in the room. FACE™ cards were also modified to have the picture on one side and the role of the physician on the other. Residents and attendings receive FACE™ cards at the beginning of the academic year to use on their own volition. Embedding photos in business cards is another way to implement this project, which has been done at MacNeal Hospital in Berwyn, IL and Good Samaritan Hospital in Phoenix, AZ after learning about FACE™ cards.23, 24
Although FACE™ cards may have helped patients correctly identify their inpatient physicians, fewer patients reported understanding their physicians' roles with the intervention. It is possible that FACE™ cards highlighted the degree to which patients don't understand their physicians' roles. In other words, by introducing more team members, FACE™ cards exposed deficiencies in patients' prior understanding of their physicians' roles. It is also possible that the roles as listed on the cards were too confusing for patients to understand.
One limitation of this study is that it is not a randomized controlled trial, making it possible that some type of secular trend may have been concurrent with the intervention. As a single-site study with residents and attendings resorting and rotating on different teams every month, randomization would be challenging. Another limitation of this study is that fewer patients consented to participate in the intervention. This appears to be due to seasonal effect with higher consent rates in summer months, which were not included in the FACE intervention period. Further, it is possible that errors during data recoding or cleaning occurred. Finally, these results may not be generalizable to other practices.