About

Milisa Manojlovich is a Professor in the Department of Systems, Populations and Leadership at the University of Michigan School of Nursing. Her research focuses on how communication can be used to improve healthcare delivery for cancer patients, utilizing innovative visual-based methods such as video and photo to understand the patient perspective and develop effective education materials. She studies communication from both conceptual and methodological perspectives, emphasizing the development of shared understanding and transformational communication that can enhance patient adherence to oral anti-cancer agents and ultimately improve treatment outcomes and quality of life. Dr. Manojlovich's work is agnostic to cancer type or population, recognizing that communication plays a critical role in all cancer care. She is actively involved as a co-investigator in multiple research projects related to medication safety, health and wellness in hospital care, outpatient antimicrobial therapy, and communication in diagnostic processes. She is also dedicated to teaching at both undergraduate and graduate levels, employing a constructivist and humanist approach that encourages student engagement and exploration. Her contributions to nursing research and education have been recognized through various awards and honors, including being named a 'Top-Cited Scientist' and receiving the Ruth M. Colket Visiting Professorship.

Research topics

• Medicine
• Nursing
• Psychology
• Family medicine
• Medical education

Selected publications

• The Impact of the COVID-19 Pandemic on Registered Nurse Employment Across Settings

  Medical Care · 2026-02-04

  articleCorresponding

  BACKGROUND: It is unknown whether the stress of the COVID-19 pandemic, which had a particular impact on inpatient and long-term care (LTC) nurses, had an effect on nurses' choice of employment settings. OBJECTIVE: Determine whether the COVID-19 pandemic contributed to changes in nurses' choice of employment setting. METHODS: This study used data from the 2018 and 2022 National Sample Survey of Registered Nurses to conduct a difference-in-difference analysis. We constructed a state-level measure of COVID-19 caseload, defined as COVID-19 cases per hospital bed; High versus Low COVID-19 states were defined as those above versus below the median, respectively. Logistic regression models were used to estimate the effect of exposure to High COVID-19 caseload (vs. Low) and time (2022 vs. 2018) on nurse employment choices across inpatient, LTC, outpatient, and nonclinical settings. RESULTS: From 2018 to 2022, the size of the US nursing workforce grew from 3.27 to 3.57 million nurses; however, RN FTEs increased in outpatient settings and decreased in all other settings. In adjusted analyses, nurses were less likely to work in LTC settings in 2022 than in 2018; yet, those exposed to High COVID-19 caseloads were 0.9% (95% CI: 0.3-1.5) more likely to work in LTC than those exposed to Low COVID-19 caseloads. Differences between High versus Low COVID-19 caseload exposure were not statistically significant for the likelihood of working in inpatient, outpatient, and nonclinical settings. CONCLUSIONS: Our findings suggest that exposure to High COVID-19 caseload was not associated with changes in nurses' employment settings.

  PublisherDOI

• Noise, Hearing, and Communication in the Operating Room: A Mixed‐Methods Study

  Otolaryngology · 2026-04-30

  articleOpen access

  OBJECTIVE: To evaluate noise-related communication barriers in the operating room and to identify strategies for overcoming them. STUDY DESIGN: Cross-sectional mixed-methods survey. SETTING: Tertiary academic medical center. METHODS: An anonymous 21-item electronic survey was distributed to operating room personnel, including surgeons, anesthesiologists, residents, medical students, nurses, and allied health professionals. Items assessed hearing difficulties, baseline hearing loss, communication barriers, coping strategies, and intervention preferences. Quantitative data were analyzed using descriptive statistics, chi-square tests, and logistic regression; open-text responses underwent thematic analysis. RESULTS: Among 225 survey respondents 80.4% (181/225) reported difficulty hearing in the OR and 14.7% (33/225) reported difficulty every case. All respondents with suspected or confirmed hearing loss reported hearing difficulty during surgery. Respondents with ≥5 years of OR exposure had higher odds of diagnosed hearing loss versus <5 years (OR 3.0, 95% CI 1.2-7.9; P = .024); there was no association by age (P = .89). Among hearing aid users, 88% struggled to understand speech in the OR. Communication was most challenging in orthopedic cases (31%), with environmental noise sources (suction, drills, music, alarms) frequently cited (29%), and during robotic surgery (24%). Common self-accommodations included asking for repetition, anticipating steps, environmental adjustments, and positioning. Qualitative themes emphasized challenges arising from ambient noise, physical barriers, and psychosocial factors such as hierarchy or lack of psychological safety. CONCLUSION: Noise-related hearing and communication barriers were reported across all OR roles. Interventional studies are needed to assess the role of acoustic, cultural, and technological strategies for overcoming hearing barriers and promoting effective teamwork.

  PublisherDOI

• Patient symptoms, confidence, and adherence during the first 8 weeks of targeted oral anticancer agent treatment

  Supportive Care in Cancer · 2026-02-13

  articleOpen access

  PURPOSE: We aimed to understand patients' initial experiences with targeted oral anticancer agents (OAAs). We investigated symptoms experienced and how symptom severity affected patient confidence to manage and seek care for symptoms and OAA adherence. METHODS: We conducted a longitudinal prospective cohort study of patients during the first 8 weeks of targeted OAA treatment at an NCI-designated cancer center. Participants completed patient-reported outcome measures (PROMs) online at three timepoints. Descriptive statistics quantified demographics, cancer characteristics, symptom severity, confidence, and OAA adherence. Logistic regression was used to estimate confidence and adherence by each symptom at each timepoint. Mixed effects logistic regressions accounted for repeated measures and time effects on outcomes. RESULTS: Participants (n = 59) reported severe symptoms at all timepoints. Tiredness and drowsiness were most frequently reported as severe. Participants' confidence increased from timepoint 1 to 3. Most participants reported high confidence (61-86%) and excellent adherence (75-80%) across all timepoints, but 20-25% had less than excellent OAA adherence. High confidence to manage symptoms was positively associated with older age. Confidence to manage symptoms was inversely related to the severity of depression, tiredness, drowsiness, constipation, and tingling/numbness. CONCLUSION: Confidence to manage symptoms increased with time on OAAs, but severe symptoms persisted. Although self-reported OAA adherence was high, a notable number of participants reported suboptimal adherence. Relationships between confidence, symptom severity, and adherence should be identified in clinical settings to evaluate patients who may need extra clinical support during OAA treatment.

  PublisherOA PDFDOI

• Nurse-Patient Communication During Postpartum Discharge Teaching: Protocol for a Mixed Methods Study

  JMIR Research Protocols · 2025-10-17

  articleOpen accessSenior author

  BACKGROUND: Communication failures in inpatient maternity care are one of the leading causes of preventable maternal mortality. Most maternal mortality occurs during the postpartum period after hospital discharge. Nurses provide most direct inpatient maternity care and are responsible for postpartum discharge teaching, which is a critical moment for communicating about the care plan, concerns, warning signs, and follow-up plans to the patient, who will likely not be seen by a health care practitioner for 6 weeks, if at all. OBJECTIVE: The purpose of this study is to develop a deeper understanding of communication practices between nurses and first-time mothers during postpartum discharge teaching, including what supports or hinders the transfer of critical information and recommendations for improvement from the nurses and patients themselves. A secondary objective is to assess the acceptability, feasibility, and appropriateness of video-reflexive ethnography (VRE) as an intervention to improve care quality and processes. METHODS: We are using a health equity-informed mixed methods study design to develop a deeper understanding of communication practices between nurses and patients during postpartum discharge teaching for first-time mothers, including determinants for optimal communication and recommendations for improvement. Qualitative data will come from VRE, which will take place in 3 rounds: round 1 comprises video recording of actual postpartum discharge teaching, round 2 comprises independent review of the recording by both nurses and mothers, and round 3 comprises group reflexivity sessions with nurse participants. The planned analyses include a qualitative descriptive analysis of the video recordings and qualitative content analyses of the transcripts of the independent review and group reflexivity sessions. Quantitative data will come from a survey of nurse respondents regarding the feasibility, acceptability, and appropriateness of using VRE to reflect on and improve their practice. Survey results and reflections on VRE from round 3 will be integrated into a joint display. RESULTS: This project was funded in 2023 and approved by the Institutional Review Board of the University of Pennsylvania on December 6, 2023. Data collection will take place from 2024 to 2025. Results are expected to be published in 2026. CONCLUSIONS: Our work aims to engage with nurses and first-time mothers to identify opportunities to improve postpartum discharge teaching and communication. Secondarily, we plan to find out whether study participants find VRE feasible, acceptable, and appropriate for improving the quality of care and health care communication. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/72139.

  PublisherDOI

• Creating Clarity Amid the Operating Room Clamor: A Mixed Methods Analysis of Noise-Related Barriers and Facilitators to Effective Communication.

  PubMed · 2025-01-01

  articleOpen access

  Background: The operating room is one of the noisiest healthcare environments, creating critical challenges for patient safety, team efficiency, and surgical outcomes. Operating room nurses, essential for patient care and team coordination, face unique risks from noise exposure and impaired communication, yet their challenges remain underexplored. Objective: To assess hearing challenges and communication barriers in operating room teams from nurses' perspectives, with implications for patient safety and interventions. Design: Cross-sectional survey. Methods: An electronic survey was distributed to operating room personnel, examining hearing difficulties, communication barriers, and current solutions using multiple-choice, Likert-scale, and open-ended formats. Quantitative and qualitative data were analyzed via descriptive statistics and summative thematic analysis. Results: Among 225 participants, 51 were nurses (23%), with 25% reporting hearing loss, 63% no hearing loss, and 12% uncertain. All nurses with baseline hearing loss reported auditory challenges in the operating room, while half without hearing loss reported frequent struggles during surgery (p<.0021). Nurses with > 5 years' operating room exposure had over 5-fold risk of hearing loss (95% confidence interval: 1.3-21.2; p=0.028). Noise from suction devices, alarms, and music hindered communication. Self-accommodations included asking for repetition (62%) and modifying the environment (32%). Nearly all respondents (96%) emphasized improving communication, supporting ambient noise reduction, technology, or behavioral interventions like closed-loop communication. Conclusions: Operating room nurses, central to surgical safety and team efficiency, are disproportionately impacted by noise-related communication challenges. Their dual role positions them to lead the implementation of targeted noise mitigation and communication strategies, driving critical improvements in the surgical environment.

  PublisherOA PDF

• Author response for "The Influence of Patient and Physician Race-Related Attitudes and Perceptions on Nonverbal Synchrony in Oncology Treatment Interactions Between Black Patients and Non-Black Physicians"

  2025-08-11

  peer-review
  PublisherDOI

• Clinician attitudes, opinions and practice patterns regarding inotrope use for cardiac surgery in the USA: a multicentre mixed methods study protocol

  BMJ Open · 2025-03-01 · 1 citations

  articleOpen access

  INTRODUCTION: Cardiac inotrope medications administered to cardiac surgical patients carry steep risk-benefit trade-offs, yet wide inter-institutional variation exists in inotrope practices. Despite known wide variation in use of any inotrope for cardiac surgery, limited multicentre data exist regarding determinants of inotrope selection and time course for use. Additionally, the reasons that underpin how clinicians decide on inotrope usage and the factors that influence inotrope practice change are not well understood. METHODS AND ANALYSIS: This is an investigator-initiated, multicentre mixed methods study. Quantitative data will include electronic health records from an observational cohort of adult cardiac procedures within the Multicenter Perioperative Outcomes Group (MPOG) database, comprising cardiac surgical procedures from over 30 US academic and community hospitals. Additional quantitative data will be collected via surveys of clinicians involved in inotrope decision-making, contacted through an existing multicentre research and quality improvement infrastructure with engaged clinician representatives participating across MPOG hospitals. Qualitative data will be collected from open-ended questions within surveys, as well as semi-structured interviews with surveyed clinicians, sampled across approximately six institutions selected for diversity of settings and inotrope practices. An explanatory sequential mixed methods design will merge quantitative and qualitative data to develop meta-inferences explaining inotrope practices, as guided by an existing framework for characterising clinical practice variation and levers for practice change. ETHICS AND DISSEMINATION: The study is approved by the institutional review board at the University of Michigan Medical School (HUM00245353). Findings will be disseminated through peer-reviewed journals, conference proceedings and quality improvement forums. The study began in February 2025 and will continue until 2028.

  PublisherOA PDFDOI

• Development, implementation, and evaluation of an intervention to improve multidisciplinary communication about complex patients

  Journal of Communications In Healthcare · 2025-03-05 · 3 citations

  articleOpen access

  BACKGROUND: Complex patients require multidisciplinary input for optimal care, but this can lead to fragmented care. This project aimed to improve multidisciplinary communication, care coordination, and patient satisfaction in primary care clinics. METHODS: Multidisciplinary team meetings focused on discussing complex patients over six months. Pre- and post-intervention surveys assessed changes in communication and satisfaction among healthcare providers and staff. Patient surveys evaluated their satisfaction with care. The generated action items at multidisciplinary meetings, such as new referrals, were categorized to evaluate the impact on care coordination. RESULTS: Post-intervention surveys showed positive responses regarding improved teamwork, communication, and patient care, but ongoing challenges in the selection of patients and team meeting participants. On average, there were 2.3 new referrals per patient, indicating enhanced care coordination. CONCLUSIONS: Multidisciplinary team meetings showed promise in enhancing communication, care coordination, and staff satisfaction. Ongoing refinement and assessment are necessary to optimize their feasibility and effectiveness over a longer time period.

  PublisherOA PDFDOI

• “Everything is electronic health record-driven”: the role of the electronic health record in the emergency department diagnostic process

  JAMIA Open · 2025-03-06 · 1 citations

  articleOpen access

  Objectives: There is limited knowledge on how providers and patients in the emergency department (ED) use electronic health records (EHRs) to facilitate the diagnostic process. While EHRs can support diagnostic decision-making, EHR features that are not user-centered may increase the likelihood of diagnostic error. We aimed to identify how EHRs facilitate or impede the diagnostic process in the ED and to identify opportunities to reduce diagnostic errors and improve care quality. Materials and Methods: We conducted semistructured interviews with 10 physicians, 15 nurses, and 8 patients across 4 EDs. Data were analyzed using a hybrid thematic analysis approach, which blends deductive (ie, using multiple conceptual frameworks) and inductive coding strategies. A team of 4 coders performed coding. Results: We identified 4 themes, 3 at the care team level and 1 at the patient level. At the care team level, the benefits of the EHR in the diagnostic process included (1) customizing features to facilitate diagnostic workup and (2) aiding in communication. However, (3) EHR-driven protocols were found to potentially burden the care process and reliance on asynchronous communication could impede team dynamics. At the patient-level, we found that (4) patient portals facilitated meaningful patient engagement through timely delivery of results. Discussion: While EHRs can improve the diagnostic process, they can also impair communication and increase workload. Electronic health record design should leverage provider-created tools to improve usability and enhance diagnostic safety. Conclusions: Our findings have important implications for health information technology design and policy. Further work should assess optimal ways to release patient results via the EHR portal.

  PublisherOA PDFDOI

• Exploring factors affecting the adoption and use of digital health technologies among older adults with cancer: A qualitative study

  Supportive Care in Cancer · 2025-08-06

  articleOpen access

  PURPOSE: Although digital health technologies (DHTs) are promising to improve health outcomes in older adults with cancer, the low adoption and limited use remain significant gaps in their effective digital health care. Little is known about their concerns about adopting and using DHTs in routine life, particularly in the continued use phase. This study aims to explore factors affecting the initial adoption and continued use of DHTs among older adults with cancer. METHODS: A secondary analysis of qualitative data was conducted based on interviews with 21 older adults (≥ 65 years) with breast, prostate, lung, or colorectal cancer. The transcripts of interview recordings were analyzed using a thematic analysis. RESULTS: Three major themes and several subthemes were identified as potential factors affecting the (1) initial adoption, (2) continued use, and (3) limited use of DHTs. Digitalized healthcare systems and access to technology influenced the initial adoption of DHTs. Perceived ease of use, perceived usefulness, expected timely care from providers, and increased sense of control emerged as leading factors to the continued use. The limited use of DHTs was influenced by a lack of knowledge and skills, a lack of direct interaction with providers, and concerns about digital communication quality. CONCLUSIONS: Ensuring digital access and providing technology-based solutions that meet diverse patient needs is crucial to promoting the adoption and use of DHTs among older adults with cancer. Healthcare providers should address older adults' low digital literacy and uncertainty to ensure the quality of cancer care provided through DHTs.

  PublisherOA PDFDOI

Recent grants

• NIH Grant R01HS022305

  NIH · $1.6M · 2019

• NIH Grant R01HS024914

  NIH · $1.4M · 2020

• NIH Grant R03HS024760

  NIH · $100k · 2018

Frequent coauthors

• Sarah L. Krein

  VA Center for Clinical Management Research

  55 shared

• Christopher R. Friese

  41 shared

• Deena Kelly Costa

  Yale University

  30 shared

• David Ratz

  VA Ann Arbor Healthcare System

  29 shared

• Nathan Wright

  Yale University

  27 shared

• Melissa A. Miller

  Agency for Healthcare Research and Quality

  27 shared

• Amanda C. Blok

  20 shared

• Sanjay Saint

  National Patient Safety Foundation

  19 shared

Labs

• Milisa Manojlovich LabPI

Education

• Master of Science, College of Nursing

  Rush University

• Associate Degree in Nursing, School of Nursing

  Indiana University Northwest

• PhD, School of Nursing

  University of Michigan

• Bachelor of Arts, Sociology

  Queen's University

Awards & honors

• Midwest Nursing Research Society (MNRS) Dissertation Grant (…
• New Investigator Award, Interdisciplinary Research Group on…
• Rackham Graduate School, University of Michigan, Spring/Summ…
• Award for Excellence in Nursing Research: Sigma Theta Tau In…
• Recognized "Top-Cited Scientist", Science-Wide Author Databa…