Patient and Public Involvement in Healthcare Quality Improvement: How organizations can help patients and professionals to collaborate

Abstract

Citizens across the world are increasingly called upon to participate in healthcare improvement. It is often unclear how this can be made to work in practice. This 4-year ethnography of a UK healthcare improvement initiative showed that patients used elements of organizational culture as resources to help them collaborate with healthcare professionals. The four elements were: (1) organizational emphasis on nonhierarchical, multidisciplinary collaboration; (2) organizational staff ability to model desired behaviours of recognition and respect; (3) commitment to rapid action, including quick translation of research into practice; and (4) the constant data collection and reflection process facilitated by improvement methods.

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

“…Participation-influenced subthemes were “influential stories” and “different perspectives” Luxford et al [16]8 US health care organizations: 5/8 ambulatoryPatient/family advisory committees and board-of-trustee representation, QI committees, employee interview panels and medical executive committees. Activities included involvement in organizational decisions (e.g., service redesign and staff-interview panels) and point-of-care engagement (e.g., partners in care; inclusion in handoffs; 24/7 point of access)“Interviewees in five out of eight organizations cited the engagement of patients, families and carers as a critical strategy for promoting patient-centered care.” Acute inpatient facilities reported more extensive engagement Renedo et al [15]CLAHRC NWLCLAHRC NWL envisioned patient participation in QI becoming normal practice across local healthcare context; funded, trained, and supported individual teams of 8–10 multidisciplinary frontline staff from National Health Service organizations conducting QI initiatives. Patients involved in strategy development and ongoing improvement eventsPatients developed a sense of belonging and agency in interacting with healthcare professionals:”from being passive recipients of healthcare to becoming active participants in service improvement”Review articles Hubbard et al [41]Research and care planning efforts involving “people affected by cancer”Multiple activities including “one-off involvement exercises” and “user involvement partnerships” in policy and planningNo specific empirical findings reported Morrow et al 2013 [32]Mechanisms for partnership around chronic disease careAdvisory groups and patient-experience-based approaches to service design that link providers to community networks and support “perspective sharing” including patient input on agenda“Experiential knowledge” shapes relevant questions and improvement approachesCase studies Angstman et al [17]Mayo Clinic, US“Patient advisory group” (defined as involved in long-term patient-centered processes) in place 5+ years.…”

“…Examples of specific activities by patients on standing committees included strategy development [15], staff interviews [16], input on improvement projects [17] and workflow development [18]. In three studies [19–21], practice improvement efforts were part of regional healthcare planning efforts and patient/family partners helped identify local priorities.…”

Moving from rational to normative ideologies of control over public involvement: A case of continued managerial dominance

“…While PI contributions are still subject to the dominance of managerial influence, we discuss how normative approaches may enhance the potential for the collaborative nature of PI alluded to in policy. In doing so, our paper responds to calls for an exploration of PI in different health settings, particularly in relation to how managers influence PI (El Enany et al, 2013;Renedo et al, 2015).…”

“…Despite the benefits of PI for health and social care services (Mockford et al 2011), much existing research suggests that, while there is strong policy support, its potential contribution is stymied by contested terminology, limitations in the underpinning evidence base, different attitudes to PI, and variable attempts at implementation (Staniszewska et al 2011, Baggott, 2005Contandriopoulos, 2004). Commentators note the impact of professional hierarchies on the translation of PI policy into practice in public sector organisations (Boivin et al, 2014;Litva et al, 2002;Martin, 2011;Rutter et al, 2004), but neglect the impact of managerial influences on PI (Renedo et al, 2015). This is surprising, considering recent research highlights how PI representatives attempt to increase their influence by working more closely with managers (El Enany et al, 2013), suggesting changes in managerial context may represent a means by which to enhance involvement.…”

Coprodução de Serviço de Vigilância Sanitária: Certificação e Classificação de Restaurantes

“…Muitos profissionais de saúde ainda se mostram apreensivos em relação a essa nova maneira de trabalhar, já que pode ser necessária mudança na hierarquia, no compartilhamento de poder e no aprendizado (Renedo, Marston, Spyridonidis, & Barlow, 2015).…”