Background: Pain management in hospitalized patients remains a priority area for improvement; effective strategies for consensus development are needed to prioritize interventions. Objective: To identify challenges, barriers, and perspectives of healthcare providers in managing pain among hospitalized patients. Design: Qualitative and quantitative group consensus using a brainstorming technique for quality improvement-the nominal group technique (NGT). Setting: One medical, 1 medical-surgical, and 1 surgical hospital unit at a large academic medical center. Participants: Nurses, resident physicians, patient care technicians, and unit clerks. MEASUREMENTS: Responses and ranking to the NGT question: "What causes uncontrolled pain in your unit?" Results: Twenty-seven health workers generated a total of 94 ideas. The ideas perceived contributing to a suboptimal pain control were grouped as system factors (timeliness, n = 18 ideas; communication, n = 11; pain assessment, n = 8), human factors (knowledge and experience, n = 16; provider bias, n = 8; patient factors, n = 19), and interface of system and human factors (standardization, n = 14). Knowledge, timeliness, provider bias, and patient factors were the top ranked themes. Conclusions: Knowledge and timeliness are considered main priorities to improve pain control. NGT is an efficient tool for identifying general and context-specific priority areas for quality improvement; teams of healthcare providers should consider using NGT to address their own challenges and barriers. © 2011 Society of Hospital Medicine.