Developing patient-centred care: an ethnographic study of patient perceptions and influence on quality improvement (original) (raw)
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BMC Health Services Research
Background Understanding quality improvement from a patient perspective is important for delivering patient-centred care. Yet the ways patients define quality improvement remains unexplored with patients often excluded from improvement work. We examine how patients construct ideas of ‘quality improvement’ when collaborating with healthcare professionals in improvement work, and how they use these understandings when attempting to improve the quality of their local services. Methods We used in-depth interviews with 23 'patient participants' (patients involved in quality improvement work) and observations in several sites in London as part of a four-year ethnographic study of patient and public involvement (PPI) activities run by Collaborations for Leadership in Applied Health Research and Care for Northwest London. We took an iterative, thematic and discursive analytical approach. Results When patient participants tried to influence quality improvement or discussed different ...
Optimizing patient involvement in quality improvement
Health Expectations, 2013
Introduction Patient 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.
Exploring the patient journey: a collaborative approach to patient-centred improvement in healthcare
2014
Despite widespread endeavours over many years, patient-centred care continues to evade some areas of healthcare. This can be clearly evidenced by regular reporting of sub-standard care and the findings of national patient experience surveys which repeatedly highlight a number of common contributory factors. Amongst these include a predominant culture of secrecy and blame rather than openness and support; failure to listen and respond to staff or patient issues; workloads and time constraints; fragmented teamwork; an overriding focus on targets rather than people; in addition to varying perceptions and interpretations of, and expectations and priorities for patient-centred care (PCC). These occur between patients, staff, educationalists, policy-makers, healthcare managers and the public. These factors, which are further reinforced by this study’s review of empirical studies of patient-centred care, strongly indicate that new approaches to improvement, that involve service providers a...
Health services organisations are increasingly incorporating patient engagement strategies as a form of quality improvement. Such strategies take form in programmes where organisations partner with patients in order to learn from their experiences and thereby change how services are designed, delivered, and implemented. In this study, we examined the enactment of patient engagement programmes within an academic health science organisation in Canada. This was accomplished through an exploration of the various constructions of patient participants' legitimacy, credibility, and expertise as manifesting through participation in the various practices associated with the programmes. Analysis was based on a selection of international, national, and organisational texts, as well as interviews with patient participants (n = 20) and hospital staff members (n = 6). Through this analysis, we argue that organisations are not learning from patients per se, but are learning from particular constructions of patient subjectivities in the form of patient advisers. We argue that if patient engagement programmes are premised upon opportunities to learn from patients, these programmes require a coherent theory of workplace learning. We suggest attention to the politics of knowledge production as a fruitful way to conceptualise how clinicians and administrators might learn from patients at the organisational level.
Patient Experience Journal
This research focuses on the perception of patients who participated in Continuous Quality Improvement Committees (CIC) regarding their contribution, lessons learned, and challenges encountered. The committees are engaged in a care partnership approach where patients are recognized for their experiential knowledge and treated as full members of the clinical team. Based on patient interviews, we conclude tha experience. They identify themselves as real partners in the care process and are grateful for the opportunity to improve the care provided to other patients by using their own experience and by brin relationship, particularly in terms of communication. They also become better acquainted with the complexity of the health system and its organization. However, their participation in CICs raised two challenges. The availability, as their professional schedules did not always allow them to participate in meetings. The second was their frustration with the slow decision-making process and implementation of necessary measures for quality improvement of healthcare and services. This study highlights the contribution of successful patient participation to quality of care improvement.
Involving patients and users of services in quality improvement: what are the benefits?
Journal of Clinical Effectiveness, 1996
The current interest in involving all members of the health care team in the evaluation and improvement of care has grown to include patients and recipients of care. Although much is written about how important it is to involve patients there is less information available about how this might be achieved. Even the term ‘involvement’ is itself open to various interpretations and this may result in involving patients in quality improvement remaining in the realms of rhetoric rather than reality. In this article we outline the benefits obtained from the active collaboration of patients with health care professionals in making decisions about their care. We examine ways in which patients’ views about the quality of the care that they receive can be heard and suggest that clinical guidelines might be one way of bridging the knowledge gap between health care professionals and patients so that joint decision‐making becomes more effective.
BMC Health Services Research, 2013
Background: Patient involvement in health care decision making is part of a wider trend towards a more bottomup approach to service planning and provision, and patient experience is increasingly conceptualized as a core dimension of health care quality. The aim of this multi-level study is twofold: 1) to describe and analyze how governmental organizations expect acute hospitals to incorporate patient involvement and patient experiences into their quality improvement (QI) efforts and 2) to analyze how patient involvement and patient experiences are used by hospitals to try to improve the quality of care they provide. Methods: This multi-level case study combines analysis of national policy documents and regulations at the macro level with semi-structured interviews and non-participant observation of key meetings and shadowing of staff at the meso and micro levels in two purposively sampled Norwegian hospitals. Fieldwork at the meso and micro levels was undertaken over a 12-month period (2011-2012). Results: Governmental documents and regulations at the macro level demonstrated wide-ranging expectations for the integration of patient involvement and patient experiences in QI work in hospitals. The expectations span from systematic collection of patients' and family members' experiences for the purpose of improving service quality through establishing patient-oriented arenas for ongoing collaboration with staff to the support of individual involvement in decision making. However, the extent of involvement of patients and application of patient experiences in QI work was limited at both hospitals. Even though patient involvement was gaining prominence at the meso level − and to a lesser extent at the micro level − relevant tools for measuring and using patient experiences in QI work were lacking, and available measures of patient experience were not being used meaningfully or systematically. Conclusions: The relative lack of expertise in Norwegian hospitals of adapting and implementing tools and methods for improving patient involvement and patient experiences at the meso and micro levels mark a need for health care policymakers and hospital leaders to learn from experiences of other industries and countries that have successfully integrated user experiences into QI work. Hospital managers need to design and implement wider strategies to help their staff members recognize and value the contribution that patient involvement and patient experiences can make to the improvement of healthcare quality.
BMJ Open, 2018
ObjectivesInvolving patients in quality improvement is often suggested as a critical step for improving healthcare processes. However, this comes with challenges related to resources, tokenism, validity and competence. Therefore, to optimise the use of available resources, there is a need to understand at what stage in the improvement cycle patient involvement is most beneficial. Thus, the purpose of this study was to identify the phase of an improvement cycle in which patient involvement had the highest impact on radicality of improvement.DesignAn exploratory cross-sectional survey was used.Setting and methodsA questionnaire was completed by 155 Swedish healthcare professionals (response rate 34%) who had trained and had experience in patient involvement in quality improvement. Based on their replies, the impact of patient involvement on radicality in various phases of the improvement cycle was modelled using the partial least squares method.ResultsPatient involvement in quality im...