Engaging Patients at the Front Lines of Primary Care Redesign: Operational Lessons for an Effective Program

Abstract

Background The lack of patient engagement in quality improvement is concerning, given increasing recognition that this participation may be essential for improving both quality and safety. As part of an enterprise-wide initiative to redesign primary care at the University of Wisconsin Health System, interdisciplinary primary care teams received training in patient engagement. Methods Organizational stakeholders held a structured discussion and used nominal group technique to identify the key components critical to fostering a culture of patient engagement and critical lessons learned. These findings were augmented and illustrated by review of transcripts of two focus groups held with clinic managers and 69 interviews with individual microsystem team members. Results From late 2009 to early 2014, 47 (81%) of 58 teams have engaged patients in various stages of practice improvement projects. Organizational components identified as critical to fostering a culture of patient engagement were alignment of national priorities with the organization's vision guiding the redesign, readily available external experts, involvement of all care team members in patient engagement, integration within an existing continuous improvement team development program, and an intervention deliberately matched to organizational readiness. Critical lessons learned were the need to embed patient engagement into current improvement activities, designate a neutral point person(s) to navigate organizational complexities, commit resources to support patient engagement activities, and plan for sustained team-patient interactions. Conclusions Current national health care policy and local market pressures are compelling partnering with patients in efforts to improve the value of the health care delivery system. The UW Health experience may be useful for organizations seeking to introduce or strengthen the patient role in designing delivery system improvements.

Promoting Patient and Family Partnerships in Ambulatory Care Improvement: A Narrative Review and Focus Group Findings

“…Many programs incorporated patient/family partners into existing healthcare system functions, such as established committees and program material review. However, several designed new mechanisms specifically for partnership and co-design [19, 22–25]. …”

“…Many articles reported that patient/family partnerships resulted in process improvements, including staff trainings [22, 26], service redesign [16, 17, 21, 27, 28], and patient materials (e.g., for self-management or new patient orientation) [18, 29–31]. Several articles said patient/family involvement catalyzed practice improvement through “influential stories,” “different perspectives” [26] or “experiential knowledge” [32].…”

Who represents me? A patient‐derived model of patient engagement via patient and family advisory councils (PFACs)

“…While case studies suggest how PFACs could improve the safety and quality of patient care, systematic and structured reviews have repeatedly demonstrated a lack of rigorous evaluation and evidence of such impact . Much work remains to ensure PFACs can further patient‐ and family‐centred change in diverse health‐care settings …”

Across the divide: “Primary care departments working together to redesign care to achieve the Triple Aim”

“…22 One result of this training was the establishment of multiple patient and family advisory councils. Over time, the organization has continued to develop these councils and involve patients and family in improvement work.…”