Rx for Patient Safety: Use Ask Me 3 to Improve Patient Engagement and Communication

Leslie J. Castaneda, BSN, MSHA-HCQA, Patient Safety Healthcare Quality and Risk Management Consultant, The Doctors Company

Patient engagement and communication excellence are essential components for improving health outcomes, promoting patient safety, and partnering effectively in the diagnostic process of care.

Although it is common for patients to nod their heads and indicate that they understand what the healthcare provider is saying, they might leave the provider’s office and tell a friend or family member, “I did not understand a word that was said.”

What happens during the patient-provider communication? Research has shown that most physicians interrupt the patient 22 seconds after he or she begins speaking. When given the opportunity to speak, however, most patients will talk for only two minutes. Frequent interruptions may result in ineffective communication between the provider, the patient, and the patient’s family or other support person.

Ask Me 3 Program

To promote effective communication and patient knowledge about their condition, the Institute for Healthcare Improvement offers Ask Me 3®, a patient education program designed by health literacy experts. 

The Ask Me 3 program is a time-efficient, effective tool that encourages patients to participate in their own healthcare by understanding the answers to three questions:

  1. What is my main problem?
  1. What do I need to do?
  1. Why is it important for me to do this?

During the visit, the patient is given a preprinted Ask Me 3 form and instructed to write down the answers to the three questions in the presence of the provider.

Once the patient has written the answers, the provider asks the patient to repeat back his or her understanding of the responses. The patient keeps the original copy, and the provider may choose to keep a copy in the patient’s medical record as a good tool to use at the next visit.

The benefits of the Ask Me 3 program include increased patient responsibility for healthcare outcomes, a better understanding of medications (purpose, dosage, and times), improved documentation of conversations in the medical record, and more effective patient-provider communication—which may help reduce or prevent malpractice claims.

Download free educational materials to implement the Ask Me 3 program on the Institute for Healthcare Improvement website.

Additional Strategies

Effective and clear communication can be a challenge for all stakeholders due to health literacy, time constraints, interruptions, and distractions. When implementing Ask Me 3, consider these additional strategies:

  • Determine the literacy level of the patient, and maintain a safe environment so that the patient does not feel intimidated or rushed.
  • Use everyday language; avoid medical terminology.
  • Utilize friendly body mechanics, such as being at the same eye level as the patient.
  • Include the patient’s family or other support person as part of the healthcare team during each encounter.

For additional strategies on uncovering and addressing communication barriers, read our articles “Nonadherent and Noncompliant Patients: Overcoming Barriers” and “Cultural Diversity Creates Language Barriers: Reducing Claims with Multilingual Patients” or contact the Department of Patient Safety and Risk Management at (800) 421-2368 or patientsafety@thedoctors.com.


The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

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