Reframing the program from opt-in to opt-out

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Reframing the program from opt-in to opt-out

< 1 minute read

SF General increased their enrollment by making the program a built-in part of the patient’s care plan that they can opt out of if they want.

The Issue

Many of our patients had been navigating the healthcare system for a very long time and had been a part of program after program. The last thing they wanted was to sign up for another program that seemed focused on patients with more serious conditions. They’d ask us, “How did you get my name? Why did you pick me?”


San Francisco General is a non-profit hospital and level 1 trauma center in San Francisco, CA. It has 598 beds and serves a diverse population, the majority of whom are lower income and do not speak English as their first language. Many are also illiterate in English as well as their preferred language. The hospital also serves individuals who may not have health coverage, housing or access to food. They enroll the most difficult to engage patients who have a history of substance abuse and poor health outcomes. Their transitions program began in 2009 and is influenced by the Care Transitions Program and Project RED.

What We Tried

We don’t say the word “program” anymore and don’t ask people whether they want to sign up. Instead, we say, “Can I be a support person for you? Can I give you this free calendar that will help you stay organized?” We also gave them the number to our warm line so they could reach us at any time if they had a question. We share with them everything we can help them with and let them know that they can tell us to stop at any time.


Our patients now feel special that they get to work with a transitions nurse. They’ve never had anyone spend so much time with them and give them a way to reach out if they have a question. We don’t have any problems with enrollment now.


Some patients have an affinity to a certain gender or ethnicity—they’re more comfortable with a Hispanic person or a woman, for example. We want to meet patients where they are, even if they don’t match our beliefs, so we try to match patients with someone they will be the most comfortable with.

Patient and Family Challenges: Not Receptive to Our Help

Topics: Patient engagement

Collaborator (Non-Members): Larissa Thomas, Michelle Schneidermann

Organizational Background

Organization Name: San Francisco General Hospital

Location: San Francisco General Hospital, Potrero Avenue, San Francisco, CA, United States

Organization Type: Hospital