Organizational capacity for patient and family engagement in hospital planning and improvement: interviews with patient/family advisors, managers and clinicians

Abstract

Background Patient and family engagement (PE) in healthcare planning and improvement achieves beneficial outcomes and is widely advocated, but a lack of resources is a critical barrier. Little prior research studied how organizations support engagement specifically in hospitals. Objective We explored what constitutes hospital capacity for engagement. Methods We conducted descriptive qualitative interviews and complied with criteria for rigour and reporting in qualitative research. We interviewed patient/family advisors, engagement managers, clinicians and executives at hospitals with high engagement activity, asking them to describe essential resources or processes. We used content analysis and constant comparison to identify themes and corresponding quotes and interpreted findings by mapping themes to two existing frameworks of PE capacity not specific to hospitals. Results We interviewed 40 patient/family advisors, patient engagement managers, clinicians and corporate executives from nine hospitals (two < 100 beds, four 100 + beds, three teaching). Four over-arching themes about capacity considered essential included resources, training, organizational commitment and staff support. Views were similar across participant and hospital groups. Resources included funding and people dedicated to PE and technology to enable communication and collaboration. Training encompassed initial orientation and project-specific training for patient/family advisors and orientation for new staff and training for existing staff on how to engage with patient/family advisors. Organizational commitment included endorsement from the CEO and Board, commitment from staff and continuous evaluation and improvement. Staff support included words and actions that conveyed value for the role and input of patient/family advisors. The blended, non-hospital-specific framework captured all themes. Hospitals of all types varied in the availability of funding dedicated to PE. In particular, reimbursement of expenses and compensation for time and contributions were not provided to patient/family advisors. In addition to skilled engagement managers, the role of clinician or staff champions was viewed as essential. Conclusion The findings build on prior research that largely focused on PE in individual clinical care or research or in primary care planning and improvement. The findings closely aligned with existing frameworks of organizational capacity for PE not specific to hospital settings, which suggests that hospitals could use the blended framework to plan, evaluate and improve their PE programs. Further research is needed to yield greater insight into how to promote and enable compensation for patient/family advisors and the role of clinician or staff champions in supporting PE.

Facilitating and supporting the engagement of patients, families and caregivers in research: the “Ottawa model” for patient engagement in research

“…Importantly, the patient engagement strategy at TOH and OHRI runs across the spectrum of basic to clinical to applied research [ 26 ]. This model also includes each of the features considered essential to building capacity for patient engagement in health care settings by patients, clinicians and hospital administrators: resources, training, organizational commitment, and staff support [ 34 ].…”

Consensus on how to optimise patient/family engagement in hospital planning and improvement: a Delphi survey

“…Participants also reported a range of beneficial impacts including improved PE capacity (new PE processes were developed and spread across departments, those involved became more adept and engaged) and clinical care at multiple levels: hospital (new/improved policies, strategic plans, facilities, programmes), clinician (greater efficiency in service delivery, enhanced job satisfaction, improved patient-staff communication) and patient (educational material, discharge processes and information, improved hospital experience, decreased wait times, reduced falls, lower readmission rates). 12 13 Given the widespread interest in PE and demonstrated benefits, and lack of insight on how to optimise PE in hospitals, 9 10 the overall aim of this study was to build on our prior research, [11][12][13] and issue guidance for optimising PE in hospital planning and improvement. The specific objective was to engage stakeholders in establishing consensus on priority recommendations derived from evidence generated by our prior research.…”

“…[14][15][16][17][18][19] We must acknowledge limitations. Recommendations were derived from our own prior research, [11][12][13] given that our prior review of PE for healthcare planning and improvement specifically in hospital settings had identified only 10 studies. 9 However, that review included studies published before 2017, so an updated review may be warranted to identify recommendations that reflect international perspectives and compare those recommendations with the findings of this research.…”

“…We interviewed patient/family advisors, PE managers, clinicians and executives at hospitals with high PE capacity who identified infrastructure and processes needed to support PE. Participants also reported a range of beneficial impacts including improved PE capacity (new PE processes were developed and spread across departments, those involved became more adept and engaged) and clinical care at multiple levels: hospital (new/improved policies, strategic plans, facilities, programmes), clinician (greater efficiency in service delivery, enhanced job satisfaction, improved patient–staff communication) and patient (educational material, discharge processes and information, improved hospital experience, decreased wait times, reduced falls, lower readmission rates) 12 13…”

“…Given the widespread interest in PE and demonstrated benefits, and lack of insight on how to optimise PE in hospitals,9 10 the overall aim of this study was to build on our prior research,11–13 and issue guidance for optimising PE in hospital planning and improvement. The specific objective was to engage stakeholders in establishing consensus on priority recommendations derived from evidence generated by our prior research.…”