How might patient involvement in healthcare quality improvement efforts work—A realist literature review

Abstract

IntroductionThis realist literature review, regarding active patient involvement in healthcare quality improvement (QI), seeks to identify possible mechanisms that contribute to success or failure. Furthermore, the paper outlines key considerations for organizing and supporting patient involvement in healthcare QI efforts.MethodsTwo literature searches were performed. Altogether, 1204 articles from a healthcare context were screened, focusing on improvement efforts that involve patients, healthcare professionals and/or managers and leaders. Among these, 107 articles fulfilled the chosen study selection criteria and were further analysed. Eighteen articles underwent a full realist review. In the realist synthesis, context‐mechanism‐outcome configurations were articulated as middle‐range theories and organized thematically to generate a program theory on how active patient involvement in QI efforts might work.ResultsThe articles exhibited a diversity of patient involvement approaches at different levels of healthcare organizations. To be successful, organizations’ support of QI efforts that actively involved patients tailored the QI efforts to their context to achieve the desired outcomes, and involved the relevant microsystem members. Furthermore, it promoted interaction and partnership within the microsystem, and supported the behavioural change that follows.ConclusionThis realist synthesis generates a program theory for active patient involvement in QI efforts; active patient involvement can be a tool (resource), if tailored for interaction and partnership (reasoning), that leads to behaviour change (outcome) within healthcare QI efforts. The theory explains essential resource and reasoning mechanisms, and outcomes that together form guidance for healthcare organizations when managing active patient involvement in QI efforts.

Reluctant educators and self‐advocates: Older trans adults’ experiences of health‐care services and practitioners in seeking gender‐affirming services

“…The views and experiences of health‐care consumers are paramount to improving the quality and provision of health‐care services, with growing awareness of the importance of co‐creation with consumer groups in delivering good services 1‐3 . This paper focuses on a consumer group whose unique life accounts have received little recognition in health‐care research—the experiences of older trans‐identifying 1 adults accessing trans‐related health‐care services.…”

Enhancing patient involvement in quality improvement: How complaint managers see their roles and limitations

“…The new practices have not been identified in other studies on complaint handling, and are particularly important in the context of implementing PI models and strategies in Canadian HCOs and abroad. [1][2][3] Our results show that complaints and dissatisfaction handling give opportunities for complaint managers to integrate the patient's voice in QI. At the same time, their function within HCOs and the formal process of complaint handling also prevent patients from being systematically included in QI decisions.…”

“…Internationally, patient involvement (PI) has become a priority for healthcare organizations (HCOs) seeking to improve the quality of care and services. [1][2][3] In Canada, accreditation bodies and governments have defined new guidelines, standards, and policies that make PI a core dimension of healthcare delivery. The involvement of patients in quality improvement (QI) can take different forms in HCOs, from retrospective to proactive.…”

“…8,12 The information gathered from the patient's perspective can be valuable for enhancing PI in QI. 2 In many countries, complaint handling is a formal, independent and confidential management process in HCOs that can help integrate patient perspectives in QI. In the province of Quebec (Canada), HCOs have a legal obligation to appoint local service quality and complaint commissioners in charge of handling complaints.…”

How helpful are Patient and Public Involvement strategic documents - Results of a framework analysis using 4Pi National Involvement Standards

“…They can provide a mechanism to communicate opportunities for wider community influence in healthcare. The presence of a PPI strategic document on a website or the production of this evidence on request is interpreted as a signal that efforts are being made to connect with people who use services or with those who may be able to contribute to the generation of new knowledge about health and healthcare, for example through research and quality improvement (QI) [1–3]. The absence of documentation can be negatively interpreted, for example during regulatory inspection, as a lack of intent by organisations to collaborate with a wider constituency [4].…”