The patient representation struggle during the COVID-19 pandemic: Missed opportunities for resilient healthcare systems

Public participation in decisions about measures to manage the COVID-19 pandemic: a systematic review

BACKGROUND

During the COVID-19 pandemic, governments and health authorities faced tough decisions about infection prevention and control measures such as social distancing, face masks and travel. Judgements underlying those decisions require democratic input, as well as expert input. The aim of this review is to inform decisions about how best to achieve public participation in decisions about public health and social interventions in the context of a pandemic or other public health emergencies.

OBJECTIVES

To systematically review examples of public participation in decisions by governments and health authorities about how to control the COVID-19 pandemic.

DESIGN

We searched Participedia and relevant databases in August 2022. Two authors reviewed titles and abstracts and one author screened publications promoted to full text. One author extracted data from included reports using a standard data-extraction form. A second author checked 10% of the extraction forms. We conducted a structured synthesis using framework analysis.

RESULTS

We included 24 reports (18 from Participedia). Most took place in high-income countries (n=23), involved 'consulting' the public (n=17) and involved public meetings (usually online). Two initiatives reported explicit support for critical thinking. 11 initiatives were formally evaluated (only three reported impacts). Many initiatives did not contribute to a decision, and 17 initiatives did not include any explicit decision-making criteria.

CONCLUSIONS

Decisions about how to manage the COVID-19 pandemic affected nearly everyone. While public participation in those decisions had the potential to improve the quality of the judgements and decisions that were made, build trust, improve adherence and help ensure transparency and accountability, few examples of such initiatives have been reported and most of those have not been formally evaluated. Identified initiatives did point out potential good practices related to online engagement, crowdsourcing and addressing potential power imbalance. Future research should address improved reporting of initiatives, explicit decision-making criteria, support for critical thinking, engagement of marginalised groups and decision-makers and communication with the public.

PROSPERO REGISTRATION NUMBER

358991.

The patient representation struggle during the COVID-19 pandemic: Missed opportunities for resilient healthcare systems

BACKGROUND

The role of patient participation and representation during crises, such as the COVID-19 pandemic, has been under-researched. Existing studies paint a pessimistic picture of patient representation during the pandemic. However, there are indications that patient representatives have adapted to the new situation and can contribute to the resilience of healthcare systems. This paper aims to further explore the potential contribution of patient representatives for healthcare system resilience during the COVID-19 pandemic.

METHODS

The study used a qualitative approach. We conducted a thematic analysis on the following data: interviews with client council members (n = 32) and representatives from patient organizations (n = 6) and focus groups (n = 2) to investigate patient representation on both the national policy level and organizational level in the Netherlands.

RESULTS

We identified the crisis discourse, the dependent position, the diversity of patient perspectives and the layered decision-making structure as themes that help to understand what made patient representation in pandemic times a struggle for national and local patient representatives. The analysis of the subjects these representatives put forward during decision-making shows that their input can play an important role in broadening discussions, challenging decisions, and suggesting alternatives during a crisis. We identified several strategies (e.g., collaborating with other actors, proactively putting subjects on the policy agenda, finding new ways of contacting their 'constituency') used by the patient representatives studied to exert influence despite the difficulties encountered.

CONCLUSIONS

The struggle for patient representation during pandemic decision-making is a missed opportunity for resilient healthcare systems as these representatives can play a role in opening up discussions and putting different perspectives to the fore. Moreover, the adaptive strategies used by representatives to influence decision-making offer lessons for future representation activities. However, adaptations to the crisis decision-making structure are also needed to enable patient representatives to play their role.

PATIENT CONTRIBUTION

We conducted interviews with patient representatives and discussed our preliminary findings with patient representatives during the focus groups. Zorgbelang, a patient organization supporting client councils and enabling and organizing patient participation for organizations and municipalities, was partner in this research and contributed to the interview guide, conducting interviews and focus groups. Additionally, the analysis made by the first author was discussed and refined multiple times with the partners of Zorgbelang and one of them co-authored this paper.