Engaging Patients in Primary Care Quality Improvement Initiatives: Facilitators and Barriers

Pandhi, Nancy; Jacobson, Nora; Crowder, Madison; Quanbeck, Andrew; Hass, Mollie; Davis, Sarah

doi:10.1177/1062860619842938

Cited by 13 publications

(29 citation statements)

References 12 publications

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“…Pandhi and colleagues also identi ed a need for ongoing coaching to ensure uptake of the QI process [52]. This is consistent with ndings from the FIRE Study [53,54] in which there were no signi cant differences on clinical guideline compliance between sites receiving one of two types of facilitation support compared to those receiving no facilitation.…”

Section: Discussionsupporting

confidence: 61%

“…Spread of quality improvement and implementation strategies are not without challenges. Pandhi and colleagues faced several challenges when spreading a program to engage patients in quality improvement activities [52]. Primary among the challenges was an inability to recruit health system participants.…”

Section: Discussionmentioning

confidence: 99%

“…Primary among the challenges was an inability to recruit health system participants. Competing priorities, leadership changes, and overburdened providers and staff were identi ed as reasons for lack of participation [52]. The IF Training Program has, to date, not encountered similar challenges, possibly because it was developed as a highly partnered program within a single healthcare system, VHA, and therefore met the needs of that system [35].…”

Section: Discussionmentioning

confidence: 99%

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The Next Challenge in Implementation Science: Transferring Implementation Strategy Knowledge and Skills

Kirchner¹,

Dollar²,

Smith³

et al. 2020

Preprint

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Background: Complex evidence-based clinical innovations are challenging to implement, with many settings requiring implementation assistance to increase likelihood of innovation uptake with fidelity. Implementation science researchers are identifying evidence-based implementation strategies that support the uptake of evidence-based practices and other clinical innovations. However, there is limited information regarding how to develop methods to educate implementation practitioners on the use of implementation strategies and how to sustain these competencies over time. We developed, initiated, and evaluated an implementation training program for both implementation researchers and practitioners.Methods: Participants who attended 7 trainings were asked to complete an electronic survey 2 weeks before training, immediately post-training, and 6 months post-training. We assessed participant knowledge and confidence in applying implementation facilitation skills using a 4-point Likert scale. Scores were compared at baseline to those provided post-training and at 6 months, as well as post-training to 6 months post-training (using nonparametric Wilcoxon Signed Rank tests).Results: One hundred and two participants (76 in-person, 26 virtually) completed the pre-and post-training evaluation. Participants reported a significant increase in perceived knowledge and confidence across all implementation facilitation domains from pre- to post-training and pre- to 6-month training follow up. There was no significant difference between virtual and in-person participants. When comparing post-training to 6-months, increases in perceptions of knowledge remained unchanged though half of the domains showed significantly lower perceived confidence to apply facilitation skills. Conclusions: Our findings indicate that we have developed and conducted an effective Implementation Facilitation Program with participants reporting significant increased knowledge and confidence applying implementation facilitation skills. These results were sustained among trainees at 6 months post-training, as participants reported perceived improvements in knowledge and confidence in applying implementation facilitation skills in all domains. Additionally, knowledge and confidence change scores did not differ based on in-person versus virtual attendance, suggesting that implementation training can successfully be provided to a remote site without loss of knowledge/skills transfer. The decrease in perceived confidence in applying skills from post-training to 6-months post training in some areas indicate a need for ongoing support of facilitation practitioners.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Next Challenge in Implementation Science: Transferring Implementation Strategy Knowledge and Skills

Kirchner¹,

Dollar²,

Smith³

et al. 2020

Preprint

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“…In addition, internationally, patient and public involvement (PPI) has become a core policy requirement for health service QI across the continuum of care. It is integral to accreditation, [2][3][4] funding, 5 and is a legislative requirement 4 6 7 in many jurisdictions. PPI has been described as an ethical imperative which embraces the principles of inclusivity and mutual respect, 8 and a political necessity due to the expectations of the public.…”

Section: Introductionmentioning

confidence: 99%

“…5 16-19 Current efforts have been criticised as tokenistic, 20 21 and with limited application due to health professional resistance or lack of knowledge about how to redress power disparities. 18 Negative beliefs 17 22 and insufficient understanding of successful PPI models 5 and tools 16 have also been discussed. The importance of education and training for both staff and patients to deliver a broader and more effective approach to QI partnerships has been highlighted.…”

Section: Introductionmentioning

confidence: 99%

Co-produced capability framework for successful patient and staff partnerships in healthcare quality improvement: results of a scoping review

et al. 2021

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BackgroundInternationally, patient and public involvement (PPI) is core policy for health service quality improvement (QI). However, authentic QI partnerships are not commonplace. A lack of patient and staff capability to deliver successful partnerships may be a barrier to meaningful QI collaboration.ObjectivesThe research questions for this scoping review were: What is known regarding the capabilities required for healthcare staff and patients to effectively partner in QI at the service level?; and What is known regarding the best practice learning and development strategies required to build and support those capabilities?MethodsA six-stage scoping review was completed. Five electronic databases were searched for publications from January 2010 to February 2020. The database searches incorporated relevant terms for the following concepts: capabilities for PPI in healthcare QI; and best practice learning and development strategies to support those capabilities. Data were analysed using descriptive statistics and qualitative content analysis.ResultsForty-nine papers were included. Very little peer-reviewed literature focused explicitly on capabilities for QI partnerships and thus implicit paper content was analysed. A Capability framework for successful partnerships in healthcare quality improvement was developed. It includes knowledge, skills and attitudes across three capability domains: Personal Attributes; Relationships and Communication; and Philosophies, Models and Practices, and incorporates 10 capabilities. Sharing power and leadership was discussed in many papers as fundamental and was positioned across all of the domains. Most papers discussed staff and patients’ co-learning (n=28, 57.14%). Workshops or shorter structured training sessions (n=36, 73.47%), and face-to-face learning (n=34, 69.38%) were frequently reported.ConclusionThe framework developed here could guide individualised development or learning plans for patient partners and staff, or could assist organisations to review learning topics and approaches such as training content, mentoring guidelines or community of practice agendas. Future directions include refining and evaluating the framework. Development approaches such as self-reflection, communities of practice, and remote learning need to be expanded and evaluated.

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Patients' roles in governance of learning: Results from a qualitative study of 16 learning healthcare systems

Grob

Gleason

McLean³

et al. 2021

Learning Health Systems

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Patient and family engagement has been identified as key to fulfilling Learning Healthcare Systems' (LHSs') promise as a model for improving clinical care, catalyzing research, and controlling costs. Little is known, however, about the state of patient engagement in the learning mission of these systems or about what governance structures and processes facilitate such engagement. Here, we report on an interview study of 99 patient and employee leaders in 16 systems. We found both variable levels of engagement and broad agreement that shared governance of learning remains a work in progress. We also identified a range of practices that can support or thwart development of an organizational culture conducive to shared governance, including transparency, capacity building, infrastructure investment, leadership, attention to diversity of patient partners, and committee structures. In LHSs with most sophisticated shared governance, both employees and patients contribute to building a democratic learning culture.

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Engaging Patients in Primary Care Quality Improvement Initiatives: Facilitators and Barriers

Cited by 13 publications

References 12 publications

The Next Challenge in Implementation Science: Transferring Implementation Strategy Knowledge and Skills

The Next Challenge in Implementation Science: Transferring Implementation Strategy Knowledge and Skills

Co-produced capability framework for successful patient and staff partnerships in healthcare quality improvement: results of a scoping review

Patients' roles in governance of learning: Results from a qualitative study of 16 learning healthcare systems

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