Optimizing patient involvement in quality improvement

Abstract

IntroductionPatient and public involvement in healthcare planning, service development and health-related research has received significant attention. However, evidence about the role of patient involvement in quality improvement work is more limited. We aimed to characterize patient involvement in three improvement projects and to identify strengths and weaknesses of contrasting approaches.MethodsThree case study quality improvement projects were purposively sampled from a broader programme. We used an ethnographic approach involving 126 in-depth interviews, 12 weeks of non-participant observations and documentary analysis. Data analysis was based on the constant comparative method.ResultsThe three projects differed in the ways they involved patients in their quality improvement work, including their rationales for including patients. We characterized three very different models of patient involvement, which were each influenced by project context. Patients played distinctive roles across the three projects, acting in some cases as intermediaries between the wider patient community and clinicians, and sometimes undertaking persuasive work to convince clinicians of the need for change. We identified specific strategies that can be used to help ensure that patient involvement works most effectively and that the enthusiasm of patients to make a difference is not dissipated.ConclusionPatient involvement in quality improvement work needs careful management to realize its full potential.

Commissioning for long-term conditions: hearing the voice of and engaging users – a qualitative multiple case study

“…The research design was structured to avoid only examining decision-making and service changes where the process was framed by the health service and its approach to engaging patient or user involvement. 124 …”

“…In order to address problems of recruiting only patient representatives who were already involved with local health agencies, we recruited participants via local voluntary groups and support groups as well as through advertising in clinics and practices and identifying participants who were not in formal groups. 123,124 For example, in one case study, site participants with RA were not involved in any group or health-care organisation approaches to PPI. Theoretical data saturation also guided sampling, in that sampling relevant cases would continue until no new theoretical insights emerged from the data.…”

“…We specifically mapped as many relevant patient groups and organisations, voluntary groups related to people with diabetes, neurological conditions and RA in each area as possible (including support groups run by services, local groups of national organisations), as well as contacting some specific individuals identified through a snowballing technique to ensure that we reached as wider patient/user community as we could. [122][123][124] The aim of this meeting was to map the terrain of local PPEI to understand the contextual features impacting on each case study. It was also used to identify any key issues, projects or mechanisms for PPEI, which we aimed to follow up in more depth in the next phase.…”

Patient involvement in healthcare professional practice – a question about knowledge

“…However, the concept of patient involvement is ambiguous. In practice, patient involvement ranges from professionals informing and guiding patients about disease and treatment, to involving patient representatives in the development of procedures of healthcare practice [1,6–8]. In regards to restoring time for the patient-provider relations, one could ask how exactly patient involvement may contribute to quality?…”

“…At the other end of the continuum are qualitative studies, often with an ethnographic approach. These studies represent a wider understanding of patient involvement, and often emphasise opportunities given to patients to handle their disease in everyday life and the capacity of the healthcare system to support them [2,3,7,8,13,14]. This research is oriented towards patients’ life situations, i.e.…”