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Iziduh S, Abenoja A, Theodorlis M, Ahluwalia V, Battistella M, Borkhoff CM, Hazlewood GS, Lofters A, MacKay C, Marshall DA, Gagliardi AR. Priority strategies to reduce socio-gendered inequities in access to person-centred osteoarthritis care: Delphi survey. BMJ Open 2024; 14:e080301. [PMID: 38373862 PMCID: PMC10897840 DOI: 10.1136/bmjopen-2023-080301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/11/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES Osteoarthritis (OA) prevalence, severity and related comorbid conditions are greater among women compared with men, but women, particularly racialised women, are less likely than men to access OA care. We aimed to prioritise strategies needed to reduce inequities in OA management. DESIGN Delphi survey of 28 strategies derived from primary research retained if at least 80% of respondents rated 6 or 7 on a 7-point Likert scale. SETTING Online. PARTICIPANTS 35 women of diverse ethno-cultural groups and 29 healthcare professionals of various specialties from across Canada. RESULTS Of the 28 initial and 3 newly suggested strategies, 27 achieved consensus to retain: 20 in round 1 and 7 in round 2. Respondents retained 7 patient-level, 7 clinician-level and 13 system-level strategies. Women and professionals agreed on all but one patient-level strategy (eg, consider patients' cultural needs and economic circumstances) and all clinician-level strategies (eg, inquire about OA management needs and preferences). Some discrepancies emerged for system-level strategies that were more highly rated by women (eg, implement OA-specific clinics). Comments revealed general support among professionals for system-level strategies provided that additional funding or expanded scope of practice was targeted to only formally trained professionals and did not reduce funding for professionals who already managed OA. CONCLUSIONS We identified multilevel strategies that could be implemented by healthcare professionals, organisations or systems to mitigate inequities and improve OA care for diverse women.
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Affiliation(s)
- Sharon Iziduh
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Angela Abenoja
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Madeline Theodorlis
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Vandana Ahluwalia
- William Osler Health System - Brampton Civic Hospital, Brampton, Ontario, Canada
| | - Marisa Battistella
- University of Toronto Leslie Dan Faculty of Pharmacy, Toronto, Ontario, Canada
| | - Cornelia M Borkhoff
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Aisha Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Deborah A Marshall
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
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Bayeh Y, Tsehay CT, Negash WD. Health system responsiveness and associated factors for delivery care in public health facilities, Dessie City Administration, South Wollo zone, Ethiopia: Cross-sectional study design. BMJ Open 2023; 13:e069655. [PMID: 37479512 PMCID: PMC10364148 DOI: 10.1136/bmjopen-2022-069655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
OBJECTIVE To assess health system responsiveness (HSR) and associated factors for delivery care in public health facilities, Northeast Ethiopia. DESIGN Institutional-based cross-sectional study. SETTING South Wollo zone, Ethiopia. PARTICIPANTS A total of 430 women who delivered within the study period from 1 June 2022 to 5 July 2022 were included for this analysis. OUTCOME HSR. METHODS Institutional-based cross-sectional study was conducted from 1 June 2022 to 5 July 2022 in nine public health facilities. The data were collected through semistructured interviewer administered questionnaire, reviewing delivery registration books and client charts. HSR for delivery care was assessed by eight domains based on WHO responsiveness assessment framework. Binary logistic regression analyses were employed to check the association of variables with HSR. An adjusted OR (AOR) with 95% CI was determined to show the strength of association, and a p<0.05 was taken as level of statistical significance. RESULTS In this study, the health system was responsive for 45.8% (95% CI 41.1% to 50.6%) of delivered mothers. The highest (74.2%) and lowest (45.8%) rated domains were dignity and basic amenity, respectively. In multivariable logistic regression analysis, caesarian delivery (AOR 3.67, 95% CI 1.91 to 7.06), obstetric complication in current pregnancy (AOR 0.45, 95% CI 0.23 to 0.85), referred during labour (AOR 0.36, 95% CI 0.18 to 0.69), birth within 17:30-8:30 hours (AOR 0.51, 95% CI 0.32 to 0.81) and good satisfaction (AOR 5.77, 95% CI 3.44 to 9.69) were statistically significant associated factors with HSR. CONCLUSION The overall responsiveness of delivery care was low. Basic amenities, choice of provider and social support domains were least rated responsiveness domains. If health professionals give emphasis to mothers during spontaneous vaginal delivery, able to prevent obstetric complications, and if health facilities increase the number of professionals to duty time, handover, the referred mothers appropriately; having clean and attractive delivery wards will be important interventions to improve responsiveness for delivery care.
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Affiliation(s)
- Yalew Bayeh
- Wogdie primary hospital, south Wollo zone, Dessie city, Ethiopia
| | - Chalie Tadie Tsehay
- Department of Health Systems and Policy, University of Gondar, Gondar, Ethiopia
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Moldovan F, Moldovan L, Bataga T. Assessment of Labor Practices in Healthcare Using an Innovatory Framework for Sustainability. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040796. [PMID: 37109755 PMCID: PMC10143905 DOI: 10.3390/medicina59040796] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: The concept of sustainability in healthcare is poorly researched. There is a perceived need for new theoretical and empirical studies, as well as for new instruments to assess the implementation of new labor practices in the field. Such practices address unmet social needs and consolidate the sustainable development systems which promote health equity. The objective of the research is to design an innovative reference framework for sustainable development and health equity of healthcare facilities, and to provide a practical validation of this framework. Materials and Methods: The research methods consist of designing the elements of the new frame of reference, designing an indicator matrix, elaborating indicator content, and assessing the reference framework. For the assessment stage, we used sustainable medical practices reported in the scientific literature as well as a pilot reference framework that was implemented in healthcare practice. Results: The new reference framework suggested by the present study is composed of 57 indicators organized in five areas: environmental responsibility, economic performance, social responsibility, institutional capacity, and provision of sustainable healthcare services. These indicators were adapted and integrated into the seven basic topics of the social responsibility standard. The study presents the content of the indicators in the field of labor practices, as well as their evaluation grids. The innovative format of the evaluation grids aims to describe achievement degrees, both qualitatively and quantitatively. The theoretical model was validated in practice through its implementation at the Emergency Hospital in Targu Mures. Conclusions: The conclusions of the study reflect the usefulness of the new reference framework, which is compatible with the requirements in the healthcare field, but differs from other existing frameworks, considering its objective regarding the promotion of sustainable development. This objective facilitates the continuous quantification of the sustainability level, the promotion of sustainable development strategies, and sustainability-oriented approaches on the part of interested parties.
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Affiliation(s)
- Flaviu Moldovan
- Orthopedics-Traumatology Department, Faculty of Medicine, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Liviu Moldovan
- Quality Engineering Research Center, Faculty of Engineering and Information Technology, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Tiberiu Bataga
- Orthopedics-Traumatology Department, Faculty of Medicine, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
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Merner B, Schonfeld L, Virgona A, Lowe D, Walsh L, Wardrope C, Graham-Wisener L, Xafis V, Colombo C, Refahi N, Bryden P, Chmielewski R, Martin F, Messino NM, Mussared A, Smith L, Biggar S, Gill M, Menzies D, Gaulden CM, Earnshaw L, Arnott L, Poole N, Ryan RE, Hill S. Consumers' and health providers' views and perceptions of partnering to improve health services design, delivery and evaluation: a co-produced qualitative evidence synthesis. Cochrane Database Syst Rev 2023; 3:CD013274. [PMID: 36917094 PMCID: PMC10065807 DOI: 10.1002/14651858.cd013274.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Partnering with consumers in the planning, delivery and evaluation of health services is an essential component of person-centred care. There are many ways to partner with consumers to improve health services, including formal group partnerships (such as committees, boards or steering groups). However, consumers' and health providers' views and experiences of formal group partnerships remain unclear. In this qualitative evidence synthesis (QES), we focus specifically on formal group partnerships where health providers and consumers share decision-making about planning, delivering and/or evaluating health services. Formal group partnerships were selected because they are widely used throughout the world to improve person-centred care. For the purposes of this QES, the term 'consumer' refers to a person who is a patient, carer or community member who brings their perspective to health service partnerships. 'Health provider' refers to a person with a health policy, management, administrative or clinical role who participates in formal partnerships in an advisory or representative capacity. This QES was co-produced with a Stakeholder Panel of consumers and health providers. The QES was undertaken concurrently with a Cochrane intervention review entitled Effects of consumers and health providers working in partnership on health services planning, delivery and evaluation. OBJECTIVES 1. To synthesise the views and experiences of consumers and health providers of formal partnership approaches that aimed to improve planning, delivery or evaluation of health services. 2. To identify best practice principles for formal partnership approaches in health services by understanding consumers' and health providers' views and experiences. SEARCH METHODS We searched MEDLINE, Embase, PsycINFO and CINAHL for studies published between January 2000 and October 2018. We also searched grey literature sources including websites of relevant research and policy organisations involved in promoting person-centred care. SELECTION CRITERIA We included qualitative studies that explored consumers' and health providers' perceptions and experiences of partnering in formal group formats to improve the planning, delivery or evaluation of health services. DATA COLLECTION AND ANALYSIS Following completion of abstract and full-text screening, we used purposive sampling to select a sample of eligible studies that covered a range of pre-defined criteria, including rich data, range of countries and country income level, settings, participants, and types of partnership activities. A Framework Synthesis approach was used to synthesise the findings of the sample. We appraised the quality of each study using the CASP (Critical Appraisal Skill Program) tool. We assessed our confidence in the findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. The Stakeholder Panel was involved in each stage of the review from development of the protocol to development of the best practice principles. MAIN RESULTS We found 182 studies that were eligible for inclusion. From this group, we selected 33 studies to include in the final synthesis. These studies came from a wide range of countries including 28 from high-income countries and five from low- or middle-income countries (LMICs). Each of the studies included the experiences and views of consumers and/or health providers of partnering in formal group formats. The results were divided into the following categories. Contextual factors influencing partnerships: government policy, policy implementation processes and funding, as well as the organisational context of the health service, could facilitate or impede partnering (moderate level of confidence). Consumer recruitment: consumer recruitment occurred in different ways and consumers managed the recruitment process in a minority of studies only (high level of confidence). Recruiting a range of consumers who were reflective of the clinic's demographic population was considered desirable, particularly by health providers (high level of confidence). Some health providers perceived that individual consumers' experiences were not generalisable to the broader population whereas consumers perceived it could be problematic to aim to represent a broad range of community views (high level of confidence). Partnership dynamics and processes: positive interpersonal dynamics between health providers and consumers facilitated partnerships (high level of confidence). However, formal meeting formats and lack of clarity about the consumer role could constrain consumers' involvement (high level of confidence). Health providers' professional status, technical knowledge and use of jargon were intimidating for some consumers (high level of confidence) and consumers could feel their experiential knowledge was not valued (moderate level of confidence). Consumers could also become frustrated when health providers dominated the meeting agenda (moderate level of confidence) and when they experienced token involvement, such as a lack of decision-making power (high level of confidence) Perceived impacts on partnership participants: partnering could affect health provider and consumer participants in both positive and negative ways (high level of confidence). Perceived impacts on health service planning, delivery and evaluation: partnering was perceived to improve the person-centredness of health service culture (high level of confidence), improve the built environment of the health service (high level of confidence), improve health service design and delivery e.g. facilitate 'out of hours' services or treatment closer to home (high level of confidence), enhance community ownership of health services, particularly in LMICs (moderate level of confidence), and improve consumer involvement in strategic decision-making, under certain conditions (moderate level of confidence). There was limited evidence suggesting partnering may improve health service evaluation (very low level of confidence). Best practice principles for formal partnering to promote person-centred care were developed from these findings. The principles were developed collaboratively with the Stakeholder Panel and included leadership and health service culture; diversity; equity; mutual respect; shared vision and regular communication; shared agendas and decision-making; influence and sustainability. AUTHORS' CONCLUSIONS Successful formal group partnerships with consumers require health providers to continually reflect and address power imbalances that may constrain consumers' participation. Such imbalances may be particularly acute in recruitment procedures, meeting structure and content and decision-making processes. Formal group partnerships were perceived to improve the physical environment of health services, the person-centredness of health service culture and health service design and delivery. Implementing the best practice principles may help to address power imbalances, strengthen formal partnering, improve the experiences of consumers and health providers and positively affect partnership outcomes.
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Affiliation(s)
- Bronwen Merner
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Lina Schonfeld
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Ariane Virgona
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Dianne Lowe
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
- Child and Family Evidence, Australian Institute of Family Studies, Melbourne, Australia
| | - Louisa Walsh
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Cheryl Wardrope
- Clinical Governance, Metro South Hospital and Health Service, Eight Mile Plains, Australia
| | | | - Vicki Xafis
- The Sydney Children's Hospitals Network, Sydney, Australia
| | - Cinzia Colombo
- Laboratory for medical research and consumer involvement, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Nora Refahi
- Consumer Representative, Melbourne, Australia
| | - Paul Bryden
- Consumer Representative, Caboolture, Australia
| | - Renee Chmielewski
- Planning and Patient Experience, The Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | | | | | | | - Lorraine Smith
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Susan Biggar
- Consumer Representative, Melbourne, Australia
- Australian Health Practitioner Regulation Agency (AHPRA), Melbourne, Australia
| | - Marie Gill
- Gill and Wilcox Consultancy, Melbourne, Australia
| | - David Menzies
- Chronic Disease Programs, South Eastern Melbourne Primary Health Network, Heatherton, Australia
| | - Carolyn M Gaulden
- Detroit Wayne County Authority Health Residency Program, Michigan State University, Providence Hospital, Southfield, Michigan, USA
| | | | | | - Naomi Poole
- Strategy and Innovation, Australian Commission on Safety and Quality in Health Care, Sydney, Australia
| | - Rebecca E Ryan
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
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O’Hanlon CE, Giannitrapani KF, Gamboa RC, Walling AM, Lindvall C, Garrido M, Asch SM, Lorenz KA. Integrating Patient and Expert Perspectives to Conceptualize High-Quality Palliative Cancer Care for Symptoms in the US Veterans Health Administration: A Qualitative Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231160374. [PMID: 36891952 PMCID: PMC9998402 DOI: 10.1177/00469580231160374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 02/01/2023] [Accepted: 02/10/2023] [Indexed: 03/10/2023]
Abstract
Quality measurement is typically the domain of clinical experts and health system leaders; patient/caregiver perspectives are rarely solicited. We aimed to describe and integrate clinician and patient/caregiver conceptualizations of high-quality palliative symptom care for patients receiving care for advanced cancer within the US Veterans Health Administration in the context of existing quality measures. We conducted a secondary qualitative analysis of transcripts from prioritization discussions of process quality measures relevant to cancer palliative care. These discussions occurred during 2 modified RAND-UCLA appropriateness panels: a panel of 10 palliative care clinical expert stakeholders (7 physicians, 2 nurses, 1 social worker) and a panel of 9 patients/caregivers with cancer experience. Discussions were recorded, transcribed, and independently double-coded using an a priori logical framework. Content analysis was used to identify subthemes within codes and axial coding was used to identify crosscutting themes. Patients/caregivers and clinical experts contributed important perspectives to 3 crosscutting themes. First, proactive elicitation of symptoms is critical. Patients/caregivers especially emphasized importance of comprehensive and proactive screening and assessment, especially for pain and mental health. Second, screening and assessment alone is not enough; information elicited from patients must inform care. Measuring screening/assessment and management care processes separately has important limitations. Lastly, high-quality symptom management can be broadly defined if it is patient-centered; high-quality care takes an individualized approach and might include non-medical or non-pharmacological symptom management. Integrating the perspectives of clinical experts and patients/caregivers is critical for health systems to consider as they design and implement quality measures for palliative cancer care.
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Affiliation(s)
- Claire E. O’Hanlon
- RAND Corporation, Santa Monica, CA, USA
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA, USA
| | - Karleen F. Giannitrapani
- Center for Innovation to Implementation (Ci2i), Palo Alto, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
| | - Raziel C. Gamboa
- Center for Innovation to Implementation (Ci2i), Palo Alto, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
| | - Anne M. Walling
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA, USA
- University of California Los Angeles, Los Angeles, CA, USA
| | - Charlotta Lindvall
- Dana-Farber Cancer Institute, Boston, MA, USA
- Brigham and Women’s Hospital, Boston, MA, USA
| | - Melissa Garrido
- Partnered Evidence-Based Policy Resource Center (PEPReC), Boston, MA, USA
- Boston University School of Public Health, Boston, USA
| | - Steven M. Asch
- Center for Innovation to Implementation (Ci2i), Palo Alto, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
| | - Karl A. Lorenz
- Center for Innovation to Implementation (Ci2i), Palo Alto, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
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Anderson NN, Baker GR, Moody L, Scane K, Urquhart R, Wodchis WP, Gagliardi AR. Consensus on how to optimise patient/family engagement in hospital planning and improvement: a Delphi survey. BMJ Open 2022; 12:e061271. [PMID: 36127114 PMCID: PMC9490572 DOI: 10.1136/bmjopen-2022-061271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Patient and family engagement (PE) in health service planning and improvement is widely advocated, yet little prior research offered guidance on how to optimise PE, particularly in hospitals. This study aimed to engage stakeholders in generating evidence-informed consensus on recommendations to optimise PE. DESIGN We transformed PE processes and resources from prior research into recommendations that populated an online Delphi survey. SETTING AND PARTICIPANTS Panellists included 58 persons with PE experience including: 22 patient/family advisors and 36 others (PE managers, clinicians, executives and researchers) in round 1 (100%) and 55 in round 2 (95%). OUTCOME MEASURES Ratings of importance on a seven-point Likert scale of 48 strategies organised in domains: engagement approaches, strategies to integrate diverse perspectives, facilitators, strategies to champion engagement and hospital capacity for engagement. RESULTS Of 50 recommendations, 80% or more of panellists prioritised 32 recommendations (27 in round 1, 5 in round 2) across 5 domains: 5 engagement approaches, 4 strategies to identify and integrate diverse patient/family advisor perspectives, 9 strategies to enable meaningful engagement, 9 strategies by which hospitals can champion PE and 5 elements of hospital capacity considered essential for supporting PE. There was high congruence in rating between patient/family advisors and healthcare professionals for all but six recommendations that were highly rated by patient/family advisors but not by others: capturing diverse perspectives, including a critical volume of advisors on committees/teams, prospectively monitoring PE, advocating for government funding of PE, including PE in healthcare worker job descriptions and sharing PE strategies across hospitals. CONCLUSIONS Decision-makers (eg, health system policy-makers, hospitals executives and managers) can use these recommendations as a framework by which to plan and operationalise PE, or evaluate and improve PE in their own settings. Ongoing research is needed to monitor the uptake and impact of these recommendations on PE policy and practice.
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Affiliation(s)
- Natalie N Anderson
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - G Ross Baker
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lesley Moody
- Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Kerseri Scane
- Patient Partnerships, University Health Network, Toronto, Ontario, Canada
| | - Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Walter P Wodchis
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
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Saut AM, Berssaneti FT, Ho LL, Berger S. How do hospitals engage patients and family members in quality management? A grounded theory study of hospitals in Brazil. BMJ Open 2022; 12:e055926. [PMID: 35985775 PMCID: PMC9396118 DOI: 10.1136/bmjopen-2021-055926] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient and family engagement (PFE) is considered an essential element of the transformation of the healthcare system. However, it is characterised by its complexity and a small number of institutions that have implemented the mechanisms of engagement. OBJECTIVE To understand PFE in quality management (QM) in the hospital environment. DESIGN A qualitative approach was guided by the grounded theory based in Straussian perspective. Data were gathered using semistructured interviews. The coding was performed by excerpts, using an inductive approach and the constant comparison technique. SETTING AND PARTICIPANTS A total of seven Brazilian hospitals were selected based on the theoretical sampling technique. RESULTS A total of five categories emerged, namely: patient partner, mechanisms of engagement, internal structure for engagement, maturity of the QM system and openness to change. Externally, three contextual factors can impact the engagement: the local health system, the profile of the community and the change in access to the information. At the centre of the change is the balance in power relations between patients and professionals, the sharing of information from the hospital and a proactive attitude towards improving services. CONCLUSIONS The PFE involves a cultural and process change. Cultural change is represented by 'openness', that is, openness to learn, to listen and to consider new perspectives. The change in processes is in turn characterised by the phrase 'test and venture' because the model to be adopted may be different between hospitals. The patient's perspective allows actions to be driven towards what really matters to them, ensuring quality of service and safety, obtaining a new perspective to understand and solve problems, and stimulating a sense of urgency, more empathy and compassion in professionals.
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Affiliation(s)
- Ana Maria Saut
- Polytechnic School, Production Engineering Department, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Linda Lee Ho
- Polytechnic School, Production Engineering Department, University of Sao Paulo, Sao Paulo, Brazil
| | - Simone Berger
- Polytechnic School, Production Engineering Department, University of Sao Paulo, Sao Paulo, Brazil
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O'Hanlon CE, Giannitrapani KF, Lindvall C, Gamboa RC, Canning M, Asch SM, Garrido MM, Walling AM, Lorenz KA. Patient and Caregiver Prioritization of Palliative and End-of-Life Cancer Care Quality Measures. J Gen Intern Med 2022; 37:1429-1435. [PMID: 34405352 PMCID: PMC9086093 DOI: 10.1007/s11606-021-07041-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 07/14/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Development and prioritization of quality measures typically relies on experts in clinical medicine, but patients and their caregivers may have different perspectives on quality measurement priorities. OBJECTIVE To inform priorities for health system implementation of palliative cancer and end-of-life care quality measures by eliciting perspectives of patients and caregivers. DESIGN Using modified RAND-UCLA Appropriateness Panel methods and materials tailored for knowledgeable lay participants, we convened a panel to rate cancer palliative care process quality measure concepts before and after a 1-day, in-person meeting. PARTICIPANTS Nine patients and caregivers with experience living with or caring for patients with cancer. MAIN MEASURES Panelists rated each concept on importance for providing patient- and family-centered care on a nine-point scale and each panelist nominated five highest priority measure concepts ("top 5"). KEY RESULTS Cancer patient and caregiver panelists rated all measure concepts presented as highly important to patient- and family- centered care (median rating ≥ 7) in pre-panel (mean rating range, 6.9-8.8) and post-panel ratings (mean rating range, 7.2-8.9). Forced choice nominations of the "top 5" helped distinguish similarly rated measure concepts. Measure concepts nominated into the "top 5" by three or more panelists included two measure concepts of communication (goals of care discussions and discussion of prognosis), one measure concept on providing comprehensive assessments of patients, and three on symptoms including pain management plans, improvement in pain, and depression management plans. Patients and caregivers nominated one additional measure concept (pain screening) back into consideration, bringing the total number of measure concepts under consideration to 21. CONCLUSIONS Input from cancer patients and caregivers helped identify quality measurement priorities for health system implementation. Forced choice nominations were useful to discriminate concepts with the highest perceived importance. Our approach serves as a model for incorporating patient and caregiver priorities in quality measure development and implementation.
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Affiliation(s)
- Claire E O'Hanlon
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Health Care System, Los Angeles, CA, USA. Claire.O'
| | - Karleen F Giannitrapani
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care (POPC), Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Raziel C Gamboa
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Mark Canning
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Health Care System, Los Angeles, CA, USA
| | - Steven M Asch
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Melissa M Garrido
- Partnered Evidence-Based Policy Resource Center (PEPReC), VA Boston Healthcare System Research & Development, Boston, MA, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, USA
| | | | - Anne M Walling
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Health Care System, Los Angeles, CA, USA.,Division of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, CA, USA
| | - Karl A Lorenz
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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Bergerum C, Wolmesjö M, Thor J. Organising and managing patient and public involvement to enhance quality improvement – comparing a Swedish and a Dutch hospital. Health Policy 2022; 126:603-612. [DOI: 10.1016/j.healthpol.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 03/07/2022] [Accepted: 04/06/2022] [Indexed: 11/26/2022]
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Anderson NN, Dong K, Baker GR, Moody L, Scane K, Urquhart R, Wodchis WP, Gagliardi AR. Impacts of patient and family engagement in hospital planning and improvement: qualitative interviews with patient/family advisors and hospital staff. BMC Health Serv Res 2022; 22:360. [PMID: 35303884 PMCID: PMC8932199 DOI: 10.1186/s12913-022-07747-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/08/2022] [Indexed: 11/30/2022] Open
Abstract
Background Patient engagement (PE) in hospital planning and improvement is widespread, yet we lack evidence of its impact. We aimed to identify benefits and harms that could be used to assess the impact of hospital PE. Methods We interviewed hospital-affiliated persons involved in PE activities using a qualitative descriptive approach and inductive content analysis to derive themes. We interpreted themes by mapping to an existing framework of healthcare performance measures and reported themes with exemplar quotes. Results Participants included 38 patient/family advisors, PE managers and clinicians from 9 hospitals (2 < 100 beds, 4 100 + beds, 3 teaching). Benefits of PE activities included 9 impacts on the capacity of hospitals. PE activities involved patient/family advisors and clinicians/staff in developing and spreading new PE processes across hospital units or departments, and those involved became more adept and engaged. PE had beneficial effects on hospital structures/resources, clinician staff functions and processes, patient experience and patient outcomes. A total of 14 beneficial impacts of PE were identified across these domains. Few unintended or harmful impacts were identified: overextended patient/family advisors, patient/family advisor turnover and clinician frustration if PE slowed the pace of planning and improvement. Conclusions The 23 self reported impacts were captured in a Framework of Impacts of Patient/Family Engagement on Hospital Planning and Improvement, which can be used by decision-makers to assess and allocate resources to hospital PE, and as the basis for ongoing research on the impacts of hospital PE and how to measure it. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07747-3.
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Affiliation(s)
- Natalie N Anderson
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, M5G2C4, Toronto, Canada
| | - Kelly Dong
- Faculty of Medicine, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - G Ross Baker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Lesley Moody
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Kerseri Scane
- Patient Partnerships, University Health Network, Toronto, Canada
| | - Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Walter P Wodchis
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, M5G2C4, Toronto, Canada.
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An Innovative Framework for Sustainable Development in Healthcare: The Human Rights Assessment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042222. [PMID: 35206410 PMCID: PMC8872572 DOI: 10.3390/ijerph19042222] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/05/2022] [Accepted: 02/14/2022] [Indexed: 12/21/2022]
Abstract
Healthcare providers are investing considerable resources for the development of quality management systems in hospitals. Contrary to these efforts, the number of tools that allow the evaluation of implementation efforts and the results of quality, security and sustainable development is quite limited. The purpose of the study is to develop a reference framework for quality and sustainable development in healthcare, Sanitary-Quality (San-Q) at the micro system level, which is compatible with applicable national and international standards in the field. The research method consisted of the study of literature, identification and analysis of good sustainability practices in healthcare, which allowed identification of the areas of the new San-Q framework: quality, economic, environmental, social, institutional and healthcare. These areas are incorporated into the core topics of social responsibility mentioned by ISO26000. A total of 57 indicators have been defined that make up the new reference framework. The evaluation format of the indicators is innovative through a couple of values: completion degree–significance. In the experimental part of the research, a pilot implementation of the San-Q framework at an emergency hospital was performed, the results recorded in terms of responsibility for human rights being presented. The conclusions of the study reveal the innovative aspects of the framework that facilitate the development of a sustainability strategy promoted through performance indicators, the results obtained after evaluation being useful in establishing a reference level of sustainability but also in developing sustainability policies.
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Anderson NN, Baker GR, Moody L, Scane K, Urquhart R, Wodchis WP, Gagliardi AR. Organizational capacity for patient and family engagement in hospital planning and improvement: interviews with patient/family advisors, managers and clinicians. Int J Qual Health Care 2021; 33:6413798. [PMID: 34718601 PMCID: PMC8678957 DOI: 10.1093/intqhc/mzab147] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/23/2021] [Accepted: 10/28/2021] [Indexed: 11/14/2022] Open
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.
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Affiliation(s)
- Natalie N Anderson
- Toronto General Hospital Research
Institute, University Health Network, 200 Elizabeth
Street, Toronto M5G2C4, Canada
| | - G Ross Baker
- Institute of Health Policy,
Management and Evaluation, University of Toronto, 155
College Street, Toronto M5T 3M6, Canada
| | - Lesley Moody
- Princess Margaret Cancer Centre,
University Health Network, 610 University Avenue, Toronto,
ON M5G 2C1, Canada
| | - Kerseri Scane
- Patient Partnerships, University
Health Network, 200 Elizabeth Street, Toronto, ON M5G2C4,
Canada
| | - Robin Urquhart
- Department of Community Health and
Epidemiology, Dalhousie University, 5790 University
Avenue, Halifax, NS B3H 1V7, Canada
| | - Walter P Wodchis
- Institute of Health Policy,
Management and Evaluation, University of Toronto, 155
College Street, Toronto M5T 3M6, Canada
| | - Anna R Gagliardi
- Address reprint requests to: Anna R. Gagliardi, Toronto
General Hospital Research Institute, University Health Network, 200 Elizabeth
Street, Toronto, ON M5G3C4, Canada. Tel: +416-340-4800; Fax:
+416-340-4816; E-mail:
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Lowe D, Ryan R, Schonfeld L, Merner B, Walsh L, Graham-Wisener L, Hill S. Effects of consumers and health providers working in partnership on health services planning, delivery and evaluation. Cochrane Database Syst Rev 2021; 9:CD013373. [PMID: 34523117 PMCID: PMC8440158 DOI: 10.1002/14651858.cd013373.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Health services have traditionally been developed to focus on specific diseases or medical specialties. Involving consumers as partners in planning, delivering and evaluating health services may lead to services that are person-centred and so better able to meet the needs of and provide care for individuals. Globally, governments recommend consumer involvement in healthcare decision-making at the systems level, as a strategy for promoting person-centred health services. However, the effects of this 'working in partnership' approach to healthcare decision-making are unclear. Working in partnership is defined here as collaborative relationships between at least one consumer and health provider, meeting jointly and regularly in formal group formats, to equally contribute to and collaborate on health service-related decision-making in real time. In this review, the terms 'consumer' and 'health provider' refer to partnership participants, and 'health service user' and 'health service provider' refer to trial participants. This review of effects of partnership interventions was undertaken concurrently with a Cochrane Qualitative Evidence Synthesis (QES) entitled Consumers and health providers working in partnership for the promotion of person-centred health services: a co-produced qualitative evidence synthesis. OBJECTIVES To assess the effects of consumers and health providers working in partnership, as an intervention to promote person-centred health services. SEARCH METHODS We searched the CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL databases from 2000 to April 2019; PROQUEST Dissertations and Theses Global from 2016 to April 2019; and grey literature and online trial registries from 2000 until September 2019. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs, and cluster-RCTs of 'working in partnership' interventions meeting these three criteria: both consumer and provider participants meet; they meet jointly and regularly in formal group formats; and they make actual decisions that relate to the person-centredness of health service(s). DATA COLLECTION AND ANALYSIS Two review authors independently screened most titles and abstracts. One review author screened a subset of titles and abstracts (i.e. those identified through clinical trials registries searches, those classified by the Cochrane RCT Classifier as unlikely to be an RCT, and those identified through other sources). Two review authors independently screened all full texts of potentially eligible articles for inclusion. In case of disagreement, they consulted a third review author to reach consensus. One review author extracted data and assessed risk of bias for all included studies and a second review author independently cross-checked all data and assessments. Any discrepancies were resolved by discussion, or by consulting a third review author to reach consensus. Meta-analysis was not possible due to the small number of included trials and their heterogeneity; we synthesised results descriptively by comparison and outcome. We reported the following outcomes in GRADE 'Summary of findings' tables: health service alterations; the degree to which changed service reflects health service user priorities; health service users' ratings of health service performance; health service users' health service utilisation patterns; resources associated with the decision-making process; resources associated with implementing decisions; and adverse events. MAIN RESULTS We included five trials (one RCT and four cluster-RCTs), with 16,257 health service users and more than 469 health service providers as trial participants. For two trials, the aims of the partnerships were to directly improve the person-centredness of health services (via health service planning, and discharge co-ordination). In the remaining trials, the aims were indirect (training first-year medical doctors on patient safety) or broader in focus (which could include person-centredness of health services that targeted the public/community, households or health service delivery to improve maternal and neonatal mortality). Three trials were conducted in high income-countries, one was in a middle-income country and one was in a low-income country. Two studies evaluated working in partnership interventions, compared to usual practice without partnership (Comparison 1); and three studies evaluated working in partnership as part of a multi-component intervention, compared to the same intervention without partnership (Comparison 2). No studies evaluated one form of working in partnership compared to another (Comparison 3). The effects of consumers and health providers working in partnership compared to usual practice without partnership are uncertain: only one of the two studies that assessed this comparison measured health service alteration outcomes, and data were not usable, as only intervention group data were reported. Additionally, none of the included studies evaluating this comparison measured the other primary or secondary outcomes we sought for the 'Summary of findings' table. We are also unsure about the effects of consumers and health providers working in partnership as part of a multi-component intervention compared to the same intervention without partnership. Very low-certainty evidence indicated there may be little or no difference on health service alterations or health service user health service performance ratings (two studies); or on health service user health service utilisation patterns and adverse events (one study each). No studies evaluating this comparison reported the degree to which health service alterations reflect health service user priorities, or resource use. Overall, our confidence in the findings about the effects of working in partnership interventions was very low due to indirectness, imprecision and publication bias, and serious concerns about risk of selection bias; performance bias, detection bias and reporting bias in most studies. AUTHORS' CONCLUSIONS The effects of consumers and providers working in partnership as an intervention, or as part of a multi-component intervention, are uncertain, due to a lack of high-quality evidence and/or due to a lack of studies. Further well-designed RCTs with a clear focus on assessing outcomes directly related to partnerships for patient-centred health services are needed in this area, which may also benefit from mixed-methods and qualitative research to build the evidence base.
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Affiliation(s)
- Dianne Lowe
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Rebecca Ryan
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Lina Schonfeld
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Bronwen Merner
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Louisa Walsh
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | | | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
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Anderson NN, Gagliardi AR. Development, characteristics and impact of quality improvement casebooks: a scoping review. Health Res Policy Syst 2021; 19:123. [PMID: 34496875 PMCID: PMC8425030 DOI: 10.1186/s12961-021-00777-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 08/25/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Quality improvement (QI) casebooks, compilations of QI experiences, are one way to share experiential knowledge that healthcare policy-makers, managers and professionals can adapt to their own contexts. However, QI casebook use, characteristics and impact are unknown. We aimed to synthesize published research on QI prevalence, development, characteristics and impact. METHODS We conducted a scoping review by searching MEDLINE, EMBASE, CINAHL and SCOPUS from inception to 4 February 2021. We extracted data on study characteristics and casebook definitions, development, characteristics (based on the WIDER [Workgroup for Intervention Development and Evaluation Research] framework) and impact. We reported findings using summary statistics, text and tables. RESULTS We screened 2999 unique items and included five articles published in Canada from 2011 to 2020 describing three studies. Casebooks focused on promoting positive weight-related conversations with children and parents, coordinating primary care-specialist cancer management, and showcasing QI strategies for cancer management. All defined casebooks similarly described real-world experiences of developing and implementing QI strategies that others could learn from, emulate or adapt. In all studies, casebook development was a multistep, iterative, interdisciplinary process that engages stakeholders in identifying, creating and reviewing content. While casebooks differed in QI topic, level of application and scope, cases featured common elements: setting or context, QI strategy details, impacts achieved, and additional tips for implementing strategies. Cases were described with a blend of text, graphics and tools. One study evaluated casebook impact, and found that it enhanced self-efficacy and use of techniques to improve clinical care. Although details about casebook development and characteristics were sparse, we created a template of casebook characteristics, which others can use as the basis for developing or evaluating casebooks. CONCLUSION Future research is needed to optimize methods for developing casebooks and to evaluate their impact. One approach is to assess how the many QI casebooks available online were developed. Casebooks should be evaluated alone or in combination with other interventions that support QI on a range of outcomes.
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Affiliation(s)
- Natalie N Anderson
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada.
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Coren F, Brown MK, Ikeda DJ, Tietz D, Steinbock C, Baim-Lance A, Agins BD. Beyond tokenism in quality management policy and programming: moving from participation to meaningful involvement of people with HIV in New York State. Int J Qual Health Care 2021; 33:6068878. [PMID: 33415331 DOI: 10.1093/intqhc/mzab004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/07/2020] [Accepted: 01/07/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Consumer involvement in health-care policy and quality management (QM) programming is a key element in making health systems people-centered. Involvement of health-care consumers in these areas, however, remains underdeveloped and under-prioritized. When consumer involvement is actively realized, few mechanisms for assessing its impact have been developed. The New York State Department of Health (NYSDOH) embraces consumer involvement of people with HIV in QM as a guiding principle, informed by early HIV/AIDS advocacy and a framework of people-centered quality care. METHOD HIV consumer involvement is implemented statewide and informs all quality of care programming as a standard for QM in health-care organizations, implemented through four key several initiatives: (i) a statewide HIV Consumer Quality Advisory Committee; (ii) leadership and QM trainings for consumers; (iii) specific tools and activities to engage consumers in QM activities at state, regional and health-care facility levels and (iv) formal organizational assessments of consumer involvement in health-care facility QM programs. RESULTS We review the literature on this topic and place the methods used by the NYSDOH within a theoretical framework for consumer involvement. CONCLUSION We present a model that offers a paradigm for practical implementation of routine consumer involvement in QM programs that can be replicated in other health-care settings, both disease-specific and general, reflecting the priority of active participation of consumers in QM activities at all levels of the health system.
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Affiliation(s)
- Freda Coren
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | | | - Daniel J Ikeda
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Daniel Tietz
- New York State Department of Health, AIDS Institute, 90 Church Street, New York, NY 10007, USA
| | - Clemens Steinbock
- New York State Department of Health, AIDS Institute, 90 Church Street, New York, NY 10007, USA
| | - Abigail Baim-Lance
- Veterans Health Administration James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA
| | - Bruce D Agins
- University of California, San Francisco Institute for Global Health Sciences 550 16th Street, Third Floor, San Francisco, CA 94158, USA
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Anderson NN, Baker GR, Moody L, Scane K, Urquhart R, Wodchis WP, Gagliardi AR. Approaches to optimize patient and family engagement in hospital planning and improvement: Qualitative interviews. Health Expect 2021; 24:967-977. [PMID: 33761175 PMCID: PMC8235895 DOI: 10.1111/hex.13239] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 11/30/2022] Open
Abstract
Background Patient engagement (PE) in health‐care planning and improvement is a growing practice. We lack evidence‐based guidance for PE, particularly in hospital settings. This study explored how to optimize PE in hospitals. Methods This study was based on qualitative interviews with individuals in various roles at hospitals with high PE capacity. We asked how patients were engaged, rationale for approaches chosen and solutions for key challenges. We identified themes using content analysis. Results Participants included 40 patient/family advisors, PE managers, clinicians and executives from 9 hospitals (2 < 100 beds, 4 100 + beds, 3 teaching). Hospitals most frequently employed collaboration (standing committees, project teams), followed by blended approaches (collaboration + consultation), and then consultation (surveys, interviews). Those using collaboration emphasized integrating perspectives into decisions; those using consultation emphasized capturing diverse perspectives. Strategies to support engagement included engaging diverse patients, prioritizing what benefits many, matching patients to projects, training patients and health‐care workers, involving a critical volume of patients, requiring at least one patient for quorum, asking involved patients to review outputs, linking PE with the Board of Directors and championing PE by managers, staff and committee/team chairs. Conclusion This research generated insight on concrete approaches and strategies that hospitals can use to optimize PE for planning and improvement. On‐going research is needed to understand how to recruit diverse patients and best balance blended consultation/collaboration approaches. Patient or public contribution Three patient research partners with hospital PE experience informed study objectives and interview questions.
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Affiliation(s)
- Natalie N Anderson
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - G Ross Baker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Lesley Moody
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Kerseri Scane
- Patient Partnerships, University Health Network, Toronto, Canada
| | - Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
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Braithwaite J, Clay-Williams R, Taylor N, Ting HP, Winata T, Hogden E, Li Z, Selwood A, Warwick M, Hibbert P, Arnolda G. Deepening our Understanding of Quality in Australia (DUQuA): An overview of a nation-wide, multi-level analysis of relationships between quality management systems and patient factors in 32 hospitals. Int J Qual Health Care 2020; 32:8-21. [PMID: 31725882 DOI: 10.1093/intqhc/mzz103] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/19/2019] [Accepted: 09/12/2019] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE The Deepening our Understanding of Quality in Australia (DUQuA) project is a multisite, multi-level, cross-sectional study of 32 of the largest hospitals in Australia. This overview examines relationships between (i) organization-level quality management systems and department-level quality management strategies and (ii) patient-level measures (clinical treatment processes, patient-reported perceptions of care and clinical outcomes) within Australian hospitals. DESIGN We examined hospital quality improvement structures, processes and outcomes, collecting data at organization, department and patient levels for acute myocardial infarction (AMI), hip fracture and stroke. Data sources included surveys of quality managers, clinicians and patients, hospital visits, medical record reviews and national databases. Outcomes data and patient admissions data were analysed. Relationships between measures were evaluated using multi-level models. We based the methods on the Deepening our Understanding of Quality Improvement in Europe (DUQuE) framework, extending that work in parts and customizing the design to Australian circumstances. SETTING, PARTICIPANTS AND OUTCOME MEASURES The 32 hospitals, containing 119 participating departments, provided wide representation across metropolitan, inner and outer regional Australia. We obtained 31 quality management, 1334 clinician and 857 patient questionnaires, and conducted 2401 medical record reviews and 151 external assessments. External data via a secondary source comprised 14 460 index patient admissions across 14 031 individual patients. Associations between hospital, Emergency Department (ED) and department-level systems and strategies and five patient-level outcomes were assessed: 19 of 165 associations (11.5%) were statistically significant, 12 of 79 positive associations (15.2%) and 7 of 85 negative associations (8.2%). RESULTS We did not find clear relationships between hospital-level quality management systems, ED or department quality strategies and patient-level outcomes. ED-level clinical reviews were related to adherence to clinical practice guidelines for AMI, hip fracture and stroke, but in different directions. The results, when considered alongside the DUQuE results, are suggestive that front line interventions may be more influential than department-level interventions when shaping quality of care and that multi-pronged strategies are needed. Benchmark reports were sent to each participating hospital, stimulating targeted quality improvement activities. CONCLUSIONS We found no compelling relationships between the way care is organized and the quality of care across three targeted patient-level outcome conditions. The study was cross-sectional, and thus we recommend that the relationships studied should be assessed for changes across time. Tracking care longitudinally so that quality improvement activities are monitored and fed back to participants is an important initiative that should be given priority as health systems strive to develop their capacity for quality improvement over time.
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Affiliation(s)
- Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Natalie Taylor
- Cancer Research Division, Cancer Council NSW, 153 Dowling Street, Woolloomooloo, NSW 2011, Australia.,Faculty of Health Sciences, University of Sydney, Camperdown, Sydney, NSW 2006, Australia
| | - Hsuen P Ting
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Teresa Winata
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Emily Hogden
- Cancer Research Division, Cancer Council NSW, 153 Dowling Street, Woolloomooloo, NSW 2011, Australia
| | - Zhicheng Li
- Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW 2006, Australia
| | - Amanda Selwood
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Meagan Warwick
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Peter Hibbert
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia.,Australian Centre for Precision Health, Cancer Research Institute (UniSA CRI), School of Health Sciences, University of South Australia, 101 Currie Street, Adelaide, SA 5000, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
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Nunes FG, Robert G, Weggelaar-Jansen AM, Wiig S, Aase K, Karltun A, Fulop NJ. Enacting quality improvement in ten European hospitals: a dualities approach. BMC Health Serv Res 2020; 20:658. [PMID: 32678008 PMCID: PMC7364540 DOI: 10.1186/s12913-020-05488-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/01/2020] [Indexed: 11/30/2022] Open
Abstract
Background Hospitals undertake numerous initiatives searching to improve the quality of care they provide, but these efforts are often disappointing. Current models guiding improvement tend to undervalue the tensional nature of hospitals. Applying a dualities approach that is sensitive to tensions inherent to hospitals’ quest for improved quality, this article aims to identify which organizational dualities managers should particularly pay attention to. Methods A set of cross-national, multi-level case studies was conducted involving 383 semi-structured interviews and 803 h of non-participant observation of key meetings and shadowing of staff in ten purposively sampled hospitals in five European countries (England, the Netherlands, Portugal, Sweden, and Norway). Results Six dualities that describe the quest for improved quality, each embracing a seemingly contradictory feature were identified: plural consensus, distributed connectedness, orchestrated emergence, formalized fluidity, patient coreness, and cautious generativeness. Conclusions We advocate for a move from the usual sequential and project-based and systemic thinking about quality improvement to the development of meta-capabilities to balance the simultaneous operation of opposing ideas or concepts. Doing so will help hospital managers to deal with major challenges of change inherent to quality improvement initiatives.
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Affiliation(s)
- Francisco G Nunes
- ISCTE-IUL, Lisbon University Institute, BRU-IUL, Avenida das Forças Armadas, 1649-026, Lisbon, Portugal.
| | - Glenn Robert
- King's College London, Strand, London, WC2R 2LS, UK
| | | | - Siri Wiig
- SHARE-Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway
| | - Karina Aase
- SHARE-Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway
| | - Anette Karltun
- The Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare and Department of Supply Chain and Operations Management, School of Engineering, Jönköping University, PO Box 1026, SE-551 11, Jönköping, Sweden
| | - Naomi J Fulop
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
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Harrington RL, Hanna ML, Oehrlein EM, Camp R, Wheeler R, Cooblall C, Tesoro T, Scott AM, von Gizycki R, Nguyen F, Hareendran A, Patrick DL, Perfetto EM. Defining Patient Engagement in Research: Results of a Systematic Review and Analysis: Report of the ISPOR Patient-Centered Special Interest Group. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:677-688. [PMID: 32540224 DOI: 10.1016/j.jval.2020.01.019] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 01/17/2020] [Accepted: 01/30/2020] [Indexed: 05/13/2023]
Abstract
OBJECTIVES Lack of clarity on the definition of "patient engagement" has been highlighted as a barrier to fully implementing patient engagement in research. This study identified themes within existing definitions related to patient engagement and proposes a consensus definition of "patient engagement in research." METHODS A systematic review was conducted to identify definitions of patient engagement and related terms in published literature (2006-2018). Definitions were extracted and qualitatively analyzed to identify themes and characteristics. A multistakeholder approach, including academia, industry, and patient representation, was taken at all stages. A proposed definition is offered based on a synthesis of the findings. RESULTS Of 1821 abstracts identified and screened for eligibility, 317 were selected for full-text review. Of these, 169 articles met inclusion criteria, from which 244 distinct definitions were extracted for analysis. The most frequently defined terms were: "patient-centered" (30.5%), "patient engagement" (15.5%), and "patient participation" (13.4%). The majority of definitions were specific to the healthcare delivery setting (70.5%); 11.9% were specific to research. Among the definitions of "patient engagement," the most common themes were "active process," "patient involvement," and "patient as participant." In the research setting, the top themes were "patient as partner," "patient involvement," and "active process"; these did not appear in the top 3 themes of nonresearch definitions. CONCLUSION Distinct themes are associated with the term "patient engagement" and with engagement in the "research" setting. Based on an analysis of existing literature and review by patient, industry, and academic stakeholders, we propose a scalable consensus definition of "patient engagement in research."
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Affiliation(s)
| | - Maya L Hanna
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT USA
| | | | - Rob Camp
- Community Advisory Board Programme, EURORDIS, Barcelona, Spain
| | | | - Clarissa Cooblall
- Scientific & Health Policy Initiatives, ISPOR, Lawrenceville, NJ, USA
| | - Theresa Tesoro
- Scientific & Health Policy Initiatives, ISPOR, Lawrenceville, NJ, USA
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Bergerød IJ, Dalen I, Braut GS, Gilje B, Wiig S. Measuring next of kin satisfaction with hospital cancer care: Using a mixed-method approach as basis for improving quality and safety. J Adv Nurs 2020; 76:1232-1246. [PMID: 32026486 DOI: 10.1111/jan.14315] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/02/2020] [Accepted: 01/23/2020] [Indexed: 12/16/2022]
Abstract
AIM/S To explore next of kin satisfaction with cancer care, map next of kin suggestions for involvement and combine this information to create a basis for improving quality and safety in hospitals. DESIGN Convergent parallel mixed-methods design applying the 20-item FAMCARE Scale survey instrument for quantitative measurement of satisfaction with care and with an open-ended question used for qualitative analysis. DATA SOURCES Responses from 238 next of kin (November 2016-November 2017). METHODS Exploratory factor analysis, regression analysis and qualitative content analysis were combined. RESULTS Both hospitals scored better in medical treatment (median, interquartile range: 1.5, 1.1-2.0), than in satisfaction with information and involvement of next of kin (1.9, 1.3-2.4), p < .001 (Wilcoxon signed ranks test). After adjusting for differences in demographical and clinical variables, the total FAMCARE scores were 13% higher (95% confidence interval: 1%-27%, Wald p = .029) at one of the hospitals. Qualitative findings support that the hospitals are not providing an equal offer to next of kin involvement in hospital cancer care that includes a proactive approach. CONCLUSION As a basis for quality and safety improvement, next of kin satisfaction and involvement in cancer care should be addressed in a two-sided perspective, balancing the next of kin's need for involvement in cancer treatment with the patient's perspective. IMPACT There is limited knowledge of next of kin satisfaction with hospital cancer care and how next of kin would like to be involved in this trajectory. Several aspects of satisfaction with cancer care can prompt change to improve service quality and safety (e.g. information, involvement, practical care), but this is an underused source of information. Next of kin are key in cancer care and our study demonstrates a potential large impact on future practical ways of improving cancer care service provision in an integrative perspective including next of kin.
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Affiliation(s)
- Inger J Bergerød
- Department of Hematology and Oncology, Stavanger University Hospital, Stavanger, Norway.,SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | | | - Geir S Braut
- Stavanger University Hospital, Stavanger, Norway
| | - Bjørnar Gilje
- Department of Hematology and Oncology, Stavanger University Hospital, Stavanger, Norway
| | - Siri Wiig
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Oldfield BJ, Harrison MA, Genao I, Greene AT, Pappas ME, Glover JG, Rosenthal MS. Patient, Family, and Community Advisory Councils in Health Care and Research: a Systematic Review. J Gen Intern Med 2019; 34:1292-1303. [PMID: 30051331 PMCID: PMC6614241 DOI: 10.1007/s11606-018-4565-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/29/2018] [Accepted: 06/30/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patient-centeredness is a characteristic of high-quality medical care and requires engaging community members in health systems' decision-making. One key patient engagement strategy is patient, family, and community advisory boards/councils (PFACs), yet the evidence to guide PFACs is lacking. Systematic reviews on patient engagement may benefit from patient input, but feasibility is unclear. METHODS A team of physicians, researchers, and a PFAC member conducted a systematic review to examine the impact of PFACs on health systems and describe optimal strategies for PFAC conduct. We searched MEDLINE, Embase, PsycINFO, CINAHL, Scopus, and Social Science Citation Index from inception through September 2016, as well as pre-identified websites. Two reviewers independently screened and abstracted data from studies, then assessed randomized studies for risk of bias and observational studies for quality using standardized measures. We performed a realist synthesis-which asks what works, for whom, under what circumstances-of abstracted data via 12 monthly meetings between investigators and two feedback sessions with a hospital-based PFAC. RESULTS Eighteen articles describing 16 studies met study criteria. Randomized studies demonstrated moderate to high risk of bias and observational studies demonstrated poor to fair quality. Studies engaged patients at multiple levels of the health care system and suggested that in-person deliberation with health system leadership was most effective. Studies involving patient engagement in research focused on increasing study participation. PFAC recruitment was by nomination (n = 11) or not described (n = 5). No common measure of patient, family, or community engagement was identified. Realist synthesis was enriched by feedback from PFAC members. DISCUSSION PFACs engage communities through individual projects but evidence of their impact on outcomes is lacking. A paucity of randomized controlled trials or high-quality observational studies guide strategies for engagement through PFACs. Standardized measurement tools for engagement are needed. Strategies for PFAC recruitment should be investigated and reported. PFAC members can feasibly contribute to systematic reviews. REGISTRATION AND FUNDING SOURCE A protocol for record eligibility was developed a priori and was registered in the PROSPERO database of systematic reviews (registration number CRD42016052817). The Department of Veterans Affairs' Office of Academic Affiliations, through the National Clinician Scholars Program, funded this study.
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Affiliation(s)
- Benjamin J Oldfield
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA.
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA.
- National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, USA.
| | | | - Inginia Genao
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Ann T Greene
- National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, USA
| | - Mary Ellen Pappas
- General Patient and Family Advisory Council, Yale-New Haven Hospital, New Haven, CT, USA
| | - Janis G Glover
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA
| | - Marjorie S Rosenthal
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
- National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, USA
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Webster CS, Jowsey T, Lu LM, Henning MA, Verstappen A, Wearn A, Reid PM, Merry AF, Weller JM. Capturing the experience of the hospital-stay journey from admission to discharge using diaries completed by patients in their own words: a qualitative study. BMJ Open 2019; 9:e027258. [PMID: 30862638 PMCID: PMC6429883 DOI: 10.1136/bmjopen-2018-027258] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To capture and better understand patients' experience during their healthcare journey from hospital admission to discharge, and to identify patient suggestions for improvement. DESIGN Prospective, exploratory, qualitative study. Patients were asked to complete an unstructured written diary expressed in their own words, recording negative and positive experiences or anything else they considered noteworthy. PARTICIPANTS AND SETTING Patients undergoing vascular surgery in a metropolitan hospital. PRIMARY OUTCOME MEASURES Complete diary transcripts underwent a general inductive thematic analysis, and opportunities to improve the experience of care were identified and collated. RESULTS We recruited 113 patients in order to collect 80 completed diaries from 78 participants (a participant response rate of 69%), recording patients' experiences of their hospital-stay journey. Participating patients were a median (range) age of 69 (21-99) years and diaries contained a median (range) of 197 (26-1672) words each. Study participants with a tertiary education wrote more in their diaries than those without-a median (range) of 353.5 (48-1672) vs 163 (26-1599) words, respectively (Mann-Whitney U test, p=0.001). Three primary and eight secondary themes emerged from analysis of diary transcripts-primary themes being: (1) communication as central to care; (2) importance of feeling cared for and (3) environmental factors shaping experiences. In the great majority, participants reported positive experiences on the hospital ward. However, a set of 12 patient suggestions for improvement were identified, the majority of which could be addressed with little cost but result in substantial improvements in patient experience. Half of the 12 suggestions for improvement fell into primary theme 1, concerning opportunities to improve communication between healthcare providers and patients. CONCLUSIONS Unstructured diaries completed in a patient's own words appear to be an effective and simple approach to capture the hospital-stay experience from the patient's own perspective, and to identify opportunities for improvement.
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Affiliation(s)
- Craig S Webster
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Tanisha Jowsey
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
| | - Lucy M Lu
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Marcus A Henning
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
| | - Antonia Verstappen
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
| | - Andy Wearn
- Medical Programme Directorate, University of Auckland, Auckland, New Zealand
| | - Papaarangi M Reid
- Te Kupenga Hauora Māori, University of Auckland, Auckland, New Zealand
| | - Alan F Merry
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
| | - Jennifer M Weller
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
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Baker GR, Fancott C, Judd M, O'Connor P. Expanding patient engagement in quality improvement and health system redesign: Three Canadian case studies. Healthc Manage Forum 2018; 29:176-82. [PMID: 27576853 DOI: 10.1177/0840470416645601] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Healthcare organizations face growing pressures to increase patient-centred care and to involve patients more in organizational decisions. Yet many providers worry that such involvement requires additional time and resources and do not see patients as capable of contributing meaningfully to decisions. This article discusses three efforts in four organizations to engage patients in quality improvement efforts. McGill University Health Centre, Saskatoon Health Region, and Vancouver Coastal and Fraser Health Regions all engaged patients in quality improvement and system redesign initiatives that were successful in improving care processes, outcomes, and patient experience measures. Patient involvement in redesigning care may provide a way to demonstrate the value of patients' experiences and inputs into problem-solving, building support for their involvement in other areas. Further study of these cases and a broader survey of organizational experiences with patient involvement may help elucidate the factors that support greater patient engagement.
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Affiliation(s)
- G Ross Baker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | | | - Maria Judd
- Canadian Foundation for Healthcare Improvement, Ottawa, Ontario, Canada
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Bombard Y, Baker GR, Orlando E, Fancott C, Bhatia P, Casalino S, Onate K, Denis JL, Pomey MP. Engaging patients to improve quality of care: a systematic review. Implement Sci 2018; 13:98. [PMID: 30045735 PMCID: PMC6060529 DOI: 10.1186/s13012-018-0784-z] [Citation(s) in RCA: 532] [Impact Index Per Article: 88.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 06/20/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND To identify the strategies and contextual factors that enable optimal engagement of patients in the design, delivery, and evaluation of health services. METHODS We searched MEDLINE, EMBASE, CINAHL, Cochrane, Scopus, PsychINFO, Social Science Abstracts, EBSCO, and ISI Web of Science from 1990 to 2016 for empirical studies addressing the active participation of patients, caregivers, or families in the design, delivery and evaluation of health services to improve quality of care. Thematic analysis was used to identify (1) strategies and contextual factors that enable optimal engagement of patients, (2) outcomes of patient engagement, and (3) patients' experiences of being engaged. RESULTS Forty-eight studies were included. Strategies and contextual factors that enable patient engagement were thematically grouped and related to techniques to enhance design, recruitment, involvement and leadership action, and those aimed to creating a receptive context. Reported outcomes ranged from educational or tool development and informed policy or planning documents (discrete products) to enhanced care processes or service delivery and governance (care process or structural outcomes). The level of engagement appears to influence the outcomes of service redesign-discrete products largely derived from low-level engagement (consultative unidirectional feedback)-whereas care process or structural outcomes mainly derived from high-level engagement (co-design or partnership strategies). A minority of studies formally evaluated patients' experiences of the engagement process (n = 12; 25%). While most experiences were positive-increased self-esteem, feeling empowered, or independent-some patients sought greater involvement and felt that their involvement was important but tokenistic, especially when their requests were denied or decisions had already been made. CONCLUSIONS Patient engagement can inform patient and provider education and policies, as well as enhance service delivery and governance. Additional evidence is needed to understand patients' experiences of the engagement process and whether these outcomes translate into improved quality of care. REGISTRATION N/A (data extraction completed prior to registration on PROSPERO).
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Affiliation(s)
- Yvonne Bombard
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street 4th Floor, Toronto, Ontario, M5T 3M6, Canada.
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada.
| | - G Ross Baker
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street 4th Floor, Toronto, Ontario, M5T 3M6, Canada
| | - Elaina Orlando
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street 4th Floor, Toronto, Ontario, M5T 3M6, Canada
- Niagara Health System, 1200 Fourth Avenue, St. Catharines, Ontario, L2S 0A9, Canada
| | - Carol Fancott
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street 4th Floor, Toronto, Ontario, M5T 3M6, Canada
| | - Pooja Bhatia
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street 4th Floor, Toronto, Ontario, M5T 3M6, Canada
| | - Selina Casalino
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada
| | - Kanecy Onate
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street 4th Floor, Toronto, Ontario, M5T 3M6, Canada
| | - Jean-Louis Denis
- Professor of Health Policy and Management, School of Public Health, Université de Montréal-CRCHUM & Canada Research Chair in Health System Design and Adaptation, 900, Saint Denis Street, Pavillion R, Montreal, Quebec, H2X 0A9, Canada
| | - Marie-Pascale Pomey
- Départment de Gestion, d'Évaluation et de Politique de Santé, École de santé Publique, Université de Montréal, Centre de recherche du CHUM, Carrefour de l'innovation et de l'évaluation en santé, 850 rue Saint-Denis, Montréal, Quebec, H2X 0A9, Canada
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Patient and public involvement in hospital policy-making: Identifying key elements for effective participation. Health Policy 2018; 122:380-388. [DOI: 10.1016/j.healthpol.2018.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 11/21/2017] [Accepted: 02/14/2018] [Indexed: 11/19/2022]
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Liang L, Cako A, Urquhart R, Straus SE, Wodchis WP, Baker GR, Gagliardi AR. Patient engagement in hospital health service planning and improvement: a scoping review. BMJ Open 2018; 8:e018263. [PMID: 29382676 PMCID: PMC5829665 DOI: 10.1136/bmjopen-2017-018263] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Patient engagement (PE) improves patient, organisation and health system outcomes, but most research is based on primary care. The primary purpose of this study was to describe the characteristics of published empirical research that evaluated PE in hospital health service improvement. DESIGN Scoping review. METHODS Five databases were searched from 2006 to September 2016. English language studies that evaluated patient or provider beliefs, participation in PE, influencing factors or impact were eligible. Screening and data extraction were done in triplicate. PE characteristics, influencing factors and impact were extracted and summarised. RESULTS From a total of 3939 search results, 227 studies emerged as potentially relevant; of these, 217 were not eligible, and 10 studies were included in the review. None evaluated behavioural interventions to promote or support PE. While most studies examined involvement in standing committees or projects, patient input and influence on decisions were minimal. Lack of skill and negative beliefs among providers were PE barriers. PE facilitators included careful selection and joint training of patients and providers, formalising patient roles, informal interaction to build trust, involving patients early in projects, small team size, frequent meetings, active solicitation of patient input in meetings and debriefing after meetings. Asking patients to provide insight into problems rather than solutions and deploying provider champions may enhance patient influence on hospital services. CONCLUSIONS Given the important role of PE in improving hospital services and the paucity of research on this topic, future research should develop and evaluate behavioural interventions for PE directed at patients and providers informed by the PE barriers and facilitators identified here. Future studies should also assess the impact on various individual and organisational outcomes.
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Affiliation(s)
- Laurel Liang
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Albina Cako
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Robin Urquhart
- Beatrice Hunter Cancer Research Institute, Dalhousie University, Halifax, UK
| | - Sharon E Straus
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - G Ross Baker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
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Abstract
PURPOSE The spotlight has recently been placed on managers' responsibility for patient-centred care as a result of Mid Staffordshire NHS Foundation Trust failings. In previous research, clinicians reported that managers do not have an adequate structured plan for implementing patient-centred care. The purpose of this paper is to assess the perceptions of European hospital management with respect to factors affecting the implementation of a patient-centred approach. DESIGN/METHODOLOGY/APPROACH In total, 15 semi-structured interviews were conducted with hospital managers (n=10), expert country informants (n=2), patient organisations (n=2) and a user representative (n=1) from around Europe. Participants were purposively and snowball sampled. Interviews were analysed using framework analysis. FINDINGS Most participants felt that current levels of patient-centred care are inadequate, but accounted that there were a number of macro, meso and micro challenges they faced in implementing this approach. These included budget constraints, political and historical factors, the resistance of clinicians and other frontline staff. Organisational culture emerged as a central theme, shaped by these multi-level factors and influencing the way in which patient-centred care was borne out in the hospital. Participants proposed that the needs of patients might be better met through increasing advocacy by patient organisations and greater staff contact with patients. ORIGINALITY/VALUE This study is the first of its kind to obtain management views from around Europe. It offers an insight into different models of how patient-centred care is realised by management. It indicates that managers see the value of a patient-centred approach but that they feel restricted by a number of factors at multiple levels.
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Affiliation(s)
- Angelina Taylor
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
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Du HS, Ma JJ, Li M. High-quality Health Information Provision for Stroke Patients. Chin Med J (Engl) 2016; 129:2115-22. [PMID: 27569241 PMCID: PMC5009598 DOI: 10.4103/0366-6999.189065] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE High-quality information provision can allow stroke patients to effectively participate in healthcare decision-making, better manage the stroke, and make a good recovery. In this study, we reviewed information needs of stroke patients, methods for providing information to patients, and considerations needed by the information providers. DATA SOURCES The literature concerning or including information provision for patients with stroke in English was collected from PubMed published from 1990 to 2015. STUDY SELECTION We included all the relevant articles on information provision for stroke patients in English, with no limitation of study design. RESULTS Stroke is a major public health concern worldwide. High-quality and effective health information provision plays an essential role in helping patients to actively take part in decision-making and healthcare, and empowering them to effectively self-manage their long-standing chronic conditions. Different methods for providing information to patients have their relative merits and suitability, and as a result, the effective strategies taken by health professionals may include providing high-quality information, meeting patients' individual needs, using suitable methods in providing information, and maintaining active involvement of patients. CONCLUSIONS It is suggested that to enable stroke patients to access high-quality health information, greater efforts need to be made to ensure patients to receive accurate and current evidence-based information which meets their individual needs. Health professionals should use suitable information delivery methods, and actively involve stroke patients in information provision.
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Affiliation(s)
- Hong-Sheng Du
- Department of Neurosurgery, Tianjin First Central Hospital, Tianjin 300192, China
| | - Jing-Jian Ma
- Department of Neurosurgery, Tianjin First Central Hospital, Tianjin 300192, China
| | - Mu Li
- Department of Neurosurgery, Tianjin First Central Hospital, Tianjin 300192, China
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Robinson PD, Dupuis LL, Tomlinson G, Phillips B, Greenberg M, Sung L. Strategies facilitating practice change in pediatric cancer: a systematic review. Int J Qual Health Care 2016; 28:426-32. [PMID: 27272405 DOI: 10.1093/intqhc/mzw052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2016] [Indexed: 12/14/2022] Open
Abstract
PURPOSE By conducting a systematic review, we describe strategies to actively disseminate knowledge or facilitate practice change among healthcare providers caring for children with cancer and we evaluate the effectiveness of these strategies. DATA SOURCES We searched Ovid Medline, EMBASE and PsychINFO. STUDY SELECTION Fully published primary studies were included if they evaluated one or more professional intervention strategies to actively disseminate knowledge or facilitate practice change in pediatric cancer or hematopoietic stem cell transplantation. DATA EXTRACTION Data extracted included study characteristics and strategies evaluated. In studies with a quantitative analysis of patient outcomes, the relationship between study-level characteristics and statistically significant primary analyses was evaluated. RESULTS OF DATA SYNTHESIS Of 20 644 titles and abstracts screened, 146 studies were retrieved in full and 60 were included. In 20 studies, quantitative evaluation of patient outcomes was examined and a primary outcome was stated. Eighteen studies were 'before and after' design; there were no randomized studies. All studies were at risk for bias. Interrupted time series was never the primary analytic approach. No specific strategy type was successful at improving patient outcomes. CONCLUSIONS Literature describing strategies to facilitate practice change in pediatric cancer is emerging. However, major methodological limitations exist. Studies with robust designs are required to identify effective strategies to effect practice change.
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Affiliation(s)
- Paula D Robinson
- Pediatric Oncology Group of Ontario, 480 University Avenue, Toronto, Canada M5G 1V2
| | - Lee L Dupuis
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada M5G 1X8 Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada M5G 1X8
| | - George Tomlinson
- Department of Medicine, 555 University Avenue, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4
| | - Bob Phillips
- Leeds General Infirmary, Leeds Teaching Hospitals, NHS Trust, Great George Street, Leeds, UK LS1 3EX Centre for Reviews and Dissemination, University of York, York, UK YO10 5DD
| | - Mark Greenberg
- Pediatric Oncology Group of Ontario, 480 University Avenue, Toronto, Canada M5G 1V2 Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada M5G 1X8
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada M5G 1X8 Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada M5G 1X8
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Abstract
Purpose
– The purpose of this paper is to review how patient and public involvement (PPI) can contribute to quality improvement functions and describe the levels of PPI in quality improvement functions at hospital and departmental level in a sample of European hospitals.
Design/methodology/approach
– Literature review and cross-sectional study.
Findings
– PPI takes multiple forms in health care and there is not a single strategy or method that can be considered to reflect best practice. The literature reveals that PPI can serve important functions to support quality improvement efforts. In contrast, the assessment of actual PPI in quality improvement shows that PPI is low.
Research limitations/implications
– Findings are not representative of hospitals in the EU.
Practical implications
– A diverse set of methods and tools that can be employed to realize PPI. Service providers should consider PPI at all stages, in particular in setting quality standards and criteria and in evaluating the results.
Originality/value
– Contextualization of empirical findings with case studies from the literature that inform further practice and research on PPI.
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Groene O, Arah OA, Klazinga NS, Wagner C, Bartels PD, Kristensen S, Saillour F, Thompson A, Thompson CA, Pfaff H, DerSarkissian M, Sunol R. Patient Experience Shows Little Relationship with Hospital Quality Management Strategies. PLoS One 2015; 10:e0131805. [PMID: 26151864 PMCID: PMC4494712 DOI: 10.1371/journal.pone.0131805] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 06/07/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Patient-reported experience measures are increasingly being used to routinely monitor the quality of care. With the increasing attention on such measures, hospital managers seek ways to systematically improve patient experience across hospital departments, in particular where outcomes are used for public reporting or reimbursement. However, it is currently unclear whether hospitals with more mature quality management systems or stronger focus on patient involvement and patient-centered care strategies perform better on patient-reported experience. We assessed the effect of such strategies on a range of patient-reported experience measures. MATERIALS AND METHODS We employed a cross-sectional, multi-level study design randomly recruiting hospitals from the Czech Republic, France, Germany, Poland, Portugal, Spain, and Turkey between May 2011 and January 2012. Each hospital contributed patient level data for four conditions/pathways: acute myocardial infarction, stroke, hip fracture and deliveries. The outcome variables in this study were a set of patient-reported experience measures including a generic 6-item measure of patient experience (NORPEQ), a 3-item measure of patient-perceived discharge preparation (Health Care Transition Measure) and two single item measures of perceived involvement in care and hospital recommendation. Predictor variables included three hospital management strategies: maturity of the hospital quality management system, patient involvement in quality management functions and patient-centered care strategies. We used directed acyclic graphs to detail and guide the modeling of the complex relationships between predictor variables and outcome variables, and fitted multivariable linear mixed models with random intercept by hospital, and adjusted for fixed effects at the country level, hospital level and patient level. RESULTS Overall, 74 hospitals and 276 hospital departments contributed data on 6,536 patients to this study (acute myocardial infarction n = 1,379, hip fracture n = 1,503, deliveries n = 2,088, stroke n = 1,566). Patients admitted for hip fracture and stroke had the lowest scores across the four patient-reported experience measures throughout. Patients admitted after acute myocardial infarction reported highest scores on patient experience and hospital recommendation; women after delivery reported highest scores for patient involvement and health care transition. We found no substantial associations between hospital-wide quality management strategies, patient involvement in quality management, or patient-centered care strategies with any of the patient-reported experience measures. CONCLUSION This is the largest study so far to assess the complex relationship between quality management strategies and patient experience with care. Our findings suggest absence of and wide variations in the institutionalization of strategies to engage patients in quality management, or implement strategies to improve patient-centeredness of care. Seemingly counterintuitive inverse associations could be capturing a scenario where hospitals with poorer quality management were beginning to improve their patient experience. The former suggests that patient-centered care is not yet sufficiently integrated in quality management, while the latter warrants a nuanced assessment of the motivation and impact of involving patients in the design and assessment of services.
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Affiliation(s)
- Oliver Groene
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Red de investigación en servicios de salud en enfermedades crónicas REDISSEC, Barcelona, Spain
| | - Onyebuchi A. Arah
- Department of Epidemiology, The Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, United States of America
| | - Niek S. Klazinga
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Cordula Wagner
- Netherlands Institute for Health Services Research, Utrecht, the Netherlands
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, the Netherlands
| | - Paul D. Bartels
- Danish Clinical Registries, Aarhus, Denmark, and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Solvejg Kristensen
- Danish Clinical Registries, Aarhus, Denmark, and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Florence Saillour
- Unité Méthodes Evaluation en Santé, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Andrew Thompson
- School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Caroline A. Thompson
- Palo Alto Medical Foundation Research Institute (PAMFRI), Palo Alto, California, United States of America
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Maral DerSarkissian
- Department of Epidemiology, The Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, United States of America
| | - Rosa Sunol
- Avedis Donabedian Research Institute (FAD), Universitat Autonoma de Barcelona, Barcelona, Spain
- Red de investigación en servicios de salud en enfermedades crónicas REDISSEC, Barcelona, Spain
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Renedo A, Marston C. Developing patient-centred care: an ethnographic study of patient perceptions and influence on quality improvement. BMC Health Serv Res 2015; 15:122. [PMID: 25903663 PMCID: PMC4407290 DOI: 10.1186/s12913-015-0770-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 02/27/2015] [Indexed: 11/26/2022] Open
Abstract
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 dimensions of quality improvement their accounts and actions frequently started with talk about improvement as dependent on collective action (e.g. multidisciplinary healthcare professionals and the public), but usually quickly shifted away from that towards a neoliberal discourse emphasising the role of individual patients. Neoliberal ideals about individual responsibility were taken up in their accounts moving them away from the idea of state and healthcare providers being held accountable for upholding patients' rights to quality care, and towards the idea of citizens needing to work on self-improvement. Participants portrayed themselves as governed by self-discipline and personal effort in their PPI work, and in doing so provided examples of how neoliberal appeals for self-regulation and self-determination also permeated their own identity positions. CONCLUSIONS When including patient voices in measuring and defining 'quality', governments and public health practitioners should be aware of how neoliberal rationalities at the heart of policy and services may discourage consumers from claiming rights to quality care by contributing to public unwillingness to challenge the status quo in service provision. If the democratic potential of patient and public involvement initiatives is to be realised, it will be crucial to help citizens to engage critically with how neoliberal rationalities can undermine their abilities to demand quality care.
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Affiliation(s)
- Alicia Renedo
- Department of Social & Environmental Health Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Cicely Marston
- Department of Social & Environmental Health Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
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Aghaei Hashjin A, Kringos DS, Manoochehri J, Ravaghi H, Klazinga NS. Implementation of patient safety and patient-centeredness strategies in Iranian hospitals. PLoS One 2014; 9:e108831. [PMID: 25268797 PMCID: PMC4182570 DOI: 10.1371/journal.pone.0108831] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 08/27/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To examine the extent of implementation for patient safety (PS) and patient-centeredness (PC) strategies and their association with hospital characteristics (type, ownership, teaching status, annual evaluation grade) in Iran. METHODS A cross-sectional study through an adapted version of the MARQuIS questionnaire, eliciting information from hospital and nursing managers in 84 Iranian hospitals on the implementation of PS and PC strategies in 2009-2010. RESULTS The majority of hospitals reported to have implemented 84% of the PS and 72% of the PC strategies. In general, implementation of PS strategies was unrelated to the type of hospital, with the exception of health promotion reports, which were more common in the Social Security Organization (SSO), and MRSA testing, which was reported more often in nonprofit hospitals. MRSA testing was also more common among teaching hospitals compared to non-teaching hospitals. The higher grade hospitals reported PS strategies significantly more frequently than lower grade hospitals. Overall, there was no significant difference in the reported implementation of PC strategies across general and specialized hospitals; except for the provision of information in different languages and recording of patient's diet which were reported significantly more often by general than specialized hospitals. Moreover, patient hotel services were more common in private compared to public hospitals. CONCLUSIONS Despite substantial reporting of PS and PC strategies, there is still room for strengthening standard setting on safety, patient services and patient-centered information strategies in Iranian hospitals. To assure effective implementation of PS and PC strategies, enforcing standards, creating a PS and PC culture, increasing organizational responsiveness, and partnering with patients and their families need more attention.
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Affiliation(s)
- Asgar Aghaei Hashjin
- Department of Public Health, Academic Medical Center (AMC)/University of Amsterdam, Amsterdam, the Netherlands
- Department of Health Services Management, School of Health Services Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Dionne S. Kringos
- Department of Public Health, Academic Medical Center (AMC)/University of Amsterdam, Amsterdam, the Netherlands
| | - Jila Manoochehri
- Department of Quality Improvement, Tehran Heart Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Ravaghi
- Department of Health Services Management, School of Health Services Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Niek S. Klazinga
- Department of Public Health, Academic Medical Center (AMC)/University of Amsterdam, Amsterdam, the Netherlands
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Secanell M, Groene O, Arah OA, Lopez MA, Kutryba B, Pfaff H, Klazinga N, Wagner C, Kristensen S, Bartels PD, Garel P, Bruneau C, Escoval A, França M, Mora N, Suñol R. Deepening our understanding of quality improvement in Europe (DUQuE): overview of a study of hospital quality management in seven countries. Int J Qual Health Care 2014; 26 Suppl 1:5-15. [PMID: 24671120 PMCID: PMC4001699 DOI: 10.1093/intqhc/mzu025] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction and Objective This paper provides an overview of the DUQuE (Deepening our Understanding of Quality Improvement in Europe) project, the first study across multiple countries of the European Union (EU) to assess relationships between quality management and patient outcomes at EU level. The paper describes the conceptual framework and methods applied, highlighting the novel features of this study. Design DUQuE was designed as a multi-level cross-sectional study with data collection at hospital, pathway, professional and patient level in eight countries. Setting and Participants We aimed to collect data for the assessment of hospital-wide constructs from up to 30 randomly selected hospitals in each country, and additional data at pathway and patient level in 12 of these 30. Main outcome measures A comprehensive conceptual framework was developed to account for the multiple levels that influence hospital performance and patient outcomes. We assessed hospital-specific constructs (organizational culture and professional involvement), clinical pathway constructs (the organization of care processes for acute myocardial infarction, stroke, hip fracture and deliveries), patient-specific processes and outcomes (clinical effectiveness, patient safety and patient experience) and external constructs that could modify hospital quality (external assessment and perceived external pressure). Results Data was gathered from 188 hospitals in 7 participating countries. The overall participation and response rate were between 75% and 100% for the assessed measures. Conclusions This is the first study assessing relation between quality management and patient outcomes at EU level. The study involved a large number of respondents and achieved high response rates. This work will serve to develop guidance in how to assess quality management and makes recommendations on the best ways to improve quality in healthcare for hospital stakeholders, payers, researchers, and policy makers throughout the EU.
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Affiliation(s)
- Mariona Secanell
- Avedis Donabedian Reseach Institute, University Autonomous of Barcelona, C/Provenza 293, Pral. 08037 Barcelona, Spain.
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