Expanding patient engagement in quality improvement and health system redesign

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.

Quality Improvement in Rehabilitation: A Primer for Physical Medicine and Rehabilitation Specialists

“…QI teams can utilize patient interviews, patient experience surveys, and patient co‐design to engage patients. The patient perspective on a problem often leads to unexpected solutions that were in the “blindspots” of clinicians . Inpatient and outpatient rehabilitation patients and their families constitute readily available cohorts of potential QI project collaborators.

We interviewed inpatients to help understand potential barriers to taking the required medications, and patient feedback was used when developing the intervention .

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Engaging patients in primary care design: An evaluation of a novel approach to codesigning care

“…Those cases where patients are engaged at the partnership level have encountered a number of challenges, including clinical staff concerns about involving patients, recruitment and training issues, differences in content knowledge, and perceived power between patients and clinical staff . Even when organizations make an effort to bring patients in as full partners, only a few are typically included, often relegating them to token participation . Overall, the studies that exist report variable benefits of engaging patients as partners and describe a need for more evidence‐based models …”

“…4,5 Patient engagement at the organizational-design level has been primarily confined to consultation, using mechanisms such as patient-experience surveys or patient advisory councils. 2,6 There have been recent examples of health-care organizations testing more robust approaches of engaging patients in quality improvement or care design 7 ; however, patients are still seldom brought in as partners or coleaders. 3,8 Those cases where patients are engaged at the partnership level have encountered a number of challenges, including clinical staff concerns about involving patients, recruitment and training issues, differences in content knowledge, and perceived power between patients and clinical staff.…”

“…8,9 Even when organizations make an effort to bring patients in as full partners, only a few are typically included, often relegating them to token participation. 7,10 Overall, the studies that exist report variable benefits of engaging patients as partners and describe a need for more evidence-based models. 7,[11][12][13] This study presents evaluation results from a care design effort that attempted to engage patients as equal partners in designing a new clinic service in three primary care clinics within Kaiser Permanente Washington, a large integrated delivery system in Washington State.…”

“…7,10 Overall, the studies that exist report variable benefits of engaging patients as partners and describe a need for more evidence-based models. 7,[11][12][13] This study presents evaluation results from a care design effort that attempted to engage patients as equal partners in designing a new clinic service in three primary care clinics within Kaiser Permanente Washington, a large integrated delivery system in Washington State. Twelve patients contributed as codesigners in creating the new service-a lay staff person to connect patients with community resources.…”