Khan Lab | Research Projects

The Khan Lab centers around engaging families in hospital safety and communication efforts and uncovering and addressing language related health disparities. 

Communication with families

In early work, Dr. Khan found that:

• Parents and providers lacked a shared understanding about hospital care plans in 45% of cases
• Miscommunications between parents and providers are common in the hospital
• Poor communication between parents and providers worsens hospital experience
• A family-centered bundle of nighttime communication interventions was associated with improved hospital experience and shared understanding between parents and providers

Family Centered Rounds

This work provided key preliminary data for the multicenter, PCORI-funded Patient and Family Centered I-PASS Study (Principal Investigator Chris Landrigan); which sought to improve communication on rounds between parents, nurses, and doctors. Together with the Patient and Family Centered I-PASS Study Group—a team of collaborating parents, nurses, and physicians—we developed an intervention known as Patient and Family Centered I-PASS (PFC I-PASS). PFC I-PASS included guidelines for engaging families and nurses on rounds, using health literacy best principles, using structured communication (in I-PASS format), and written and verbal communication. Implementing PFC I-PASS was associated with a 38% reduction in harmful medical errors and improvements in hospital experience, family engagement, and nurse engagement. 

In conjunction with the PFC I-PASS Study group (PI Landrigan), we then conducted a dissemination implementation study of PFC I-PASS to assess the feasibility and uptake of the intervention in varied community and academic hospitals. We were able to implement the intervention successfully, which was associated with improvements in safety climate as reported by staff and in resident physician reported harms in larger hospitals.

Language Equity

• In a 7-center study, hospitalized children whose parents were not comfortable speaking English had twice the rate of adverse events as children whose parents were comfortable speaking English.
• In a 21-center study, patients and families with limited English proficiency were three to five times less likely to ask questions, question decisions of health care providers, and speak up.
• We wrote perspective pieces on promoting equity on rounds for patients who speak languages other than English and effectively partnering with interpreters.

Building on this work examining healthcare disparities for patients who speak languages other than English and the work of the PFC I-PASS Study Group, Dr. Khan received a grant from PCORI in 2022 for a multicenter randomized controlled trial to improve safety, experience, and equity for hospitalized children and families. This study will compare different approaches to communication on rounds for families who speak languages other than English. 

Dr. Khan was also named the Director of the inaugural Program for Language Equity in February 2024.

Family Safety Reporting

One of the Khan lab’s most important projects has been to design a methodology to engage families in hospital safety reporting, both in research-based and operational surveillance. 

• In conjunction with Dr. Landrigan and the PFC I-PASS Study Group, Dr. Khan developed a methodology to incorporate families into research-based hospital safety surveillance, which currently does not include patients or families. We found that between 9-26% of families report safety concerns, with families reporting 5-fold higher medical error rates than hospital incident reporting systems. 
• In a study of parents of hospitalized children with medical complexity, nearly one in two parents reported safety concerns during hospitalization, the majority of which were medical errors.
• In a qualitative study of parents, nurses, physicians, and hospital leaders of children with medical complexity, staff and leaders did not always buy into the value of actively soliciting safety input from families. Parents also reported going through a complicated internal process of deciding whether to report their safety concerns with hospital staff.
• We consequently developed a mobile tool for families to share safety concerns. 30% of families used the tool to share safety concerns, comments, and suggestions. After we implemented this intervention on a hospital unit for hospitalized children with medical complexity, families with lower levels of educational attainment were 3 times more likely to report concerns. Thus, the intervention appeared to reduce some of our previously detected disparities in reporting by parent educational attainment.

Building on the Khan labs research around family safety reporting and language equity, in 2022, Dr. Khan was awarded an R01 grant from AHRQ. Entitled I-SHARE (Patients and Families Improving Safety in Hospitals by Actively Reporting Experiences), this multicenter randomized controlled trial will examine the impact of a multilingual family safety reporting intervention on error surveillance and disparities in reporting.