Patient and family caregiver dyads will be recruited for a prospective cohort observation for at least 24 hours and a maximum of seven days. At inclusion, baseline and self-reported data from admission until inclusion will be collected. After inclusion, data will be collected every 24 hours on self-reported outcomes of the last 24 hours. Patients and family caregiver dyads will be followed until discharge, transfer to another department, death or a maximum of seven days of follow-up. If dyads stay longer than seven days, daily follow-up is ended and they are called once 14 days later to collect outcome data.

Nurses and doctors will be recruited for time-and-motion observations by a trained non-participant observer during their shift on the medicine ward. Observers will use a REDCap to record where, what, for how long and how health workers perform tasks and interactions during their shifts. Observations will take place in sets of two hours each. Approximate equal amounts of observations will be done on all medicine wards. Observations will occur on different days of the week, at different shifts during the day, and at different times during a shift to collect data from different care contexts. Baseline data of the shift is recorded at the start of the observation.

The qualitative arm of the study involves interviews and focus group discussions with patients, family caregivers, nurses, doctors and hospital administrators. The FGDs and interviews will be performed in English, Twi or Ga by a local researcher experienced in qualitative research. An interview guide is used to define themes for the conversations, however, the interviewer is encouraged to follow the flow of the conversation by changing the order of topics or asking additional questions. The main themes of the interview guide are (1) the role of family participation in hospital care, (2) the perceived effect of family participation, (3) the barriers and facilitators for family participation in hospital care, and (4) the opportunities for improving family caregiver participation in hospital care.

The role of family participation will be described with data from:

1. Prospective observational cohort: patient baseline characteristics, family caregiver baseline characteristics, care characteristics during follow-up (for example: tasks performed, number of caregivers present, hours caregiver is present), end of follow-up status (example: discharged, transferred, death).
2. Interviews and FDG: with patients, family caregivers, nurses, doctors, ward assistants, and hospital administrators.

The perceived effect of family participation will be described with data from:

1. Time and motion: division of work time of nurses and doctors, time spend interacting with patients and family caregivers.
2. Interviews and FDG: with patients, family caregivers, nurses, doctors, ward assistants, and hospital administrators.

The barriers and facilitators of family participation will be described with data from:

1. Prospective observational cohort: patient baseline characteristics, family caregiver baseline characteristics, care characteristics during follow-up (for example: tasks performed, number of caregivers present, hours caregiver is present), end of follow-up status (example: discharged, transferred, death).
2. Time and motion: division of work time of nurses and doctors, time spend interacting with patients and family caregivers.
3. Interviews and FDG: with patients, family caregivers, nurses, doctors, ward assistants, and hospital administrators.

The barriers and facilitators of family participation will be described with data from:

1. Interviews and FDG: with patients, family caregivers, nurses, doctors, ward assistants, and hospital administrators.