Developing a ‘critical’ approach to patient and public involvement in patient safety in the NHS: learning lessons from other parts of the public sector?

Abstract

There has been considerable momentum within the NHS over the last 10 years to develop greater patient and public involvement (PPI). This commitment has been reflected in numerous policy initiatives. In patient safety, the drive to increase involvement has increasingly been seen as an important way of building a safety culture. Evidence suggests, however, that progress has been slow and even more variable than in health care generally. Given this context, the paper analyses some of the key underlying drivers for involvement in the wider context of health and social care and makes some suggestions on what lessons can be learned for developing the PPI agenda in patient safety. To develop PPI further, it is argued that a greater understanding is needed of the contested nature of involvement in patient safety and how this has similarities to the emergence of user involvement in other parts of the public services. This understanding has led to the development of a range of critical theories to guide involvement that also make more explicit the underlying factors that support and hinder involvement processes, often related to power inequities and control. Achieving greater PPI in patient safety is therefore seen to require a more critical framework for understanding processes of involvement that can also help guide and evaluate involvement practices.

Value Co-Creation through Patient Engagement in Health Care: A micro-level approach and research agenda

“…It has variously been proposed as a vehicle for maintaining the sustainability of the National Health Service (NHS); delivering safer health care, managing long term conditions, and improving accountability, health care delivery, and health equity (Coulter 2012;Ocloo and Fulop 2012;Francis 2013;Department of Health 2002;Renedo and Marston 2011). Despite the increasing concern for patient involvement in health care, improvements to practice remain slow and variable (Ward et al 2011;Ward and Armitage 2012;Ocloo and Fulop 2012;Hor et al 2013). Additionally, the research evidence base underpinning patient engagement in health care is limited, with the results being difficult to assess or generalize (Staniszewska, Herron-Marx, and Mockford 2008).…”

Beware Zombies and Unicorns: Toward Critical Patient and Public Involvement in Health Research in a Neoliberal Context

“…The involvement imperative has led to an increase in the levels of PPI activity, but it is not yet the case that, "involvement is a mainstream activity that sits alongside other policy and performance requirements in the NHS" (Ocloo and Fulop, 2011;Crowe and Ceinwen, 2016). Furthermore, the empirical evidence-base demonstrating the worth and impact of PPI remains poor, with supporting evidence tending to be descriptive rather than evaluative (Brett et al, 2010;Wilson et al, 2015).…”

ReseArch with Patient and Public invOlvement: a RealisT evaluation – the RAPPORT study

“…There has been a growing interest in PPI and its potential impact on improving patient safety in health care. [214][215][216][217][218] Arguments for PPI in patient safety include providing a final 'buffer' to prevent errors 214 and reinforcing the moral argument that patients should be included in processes regarding their own care and treatment. 216 However, what is surprising is the lack of consideration of PPI in health-care research acting as the final check for participants.…”