Implementation of patient involvement methods in the clinical setting: A qualitative study exploring the health professional perspective

Abstract

Rationale, aims and objectives: Patient involvement is increasingly recognized as a key component on the international health care agenda. This attention has brought a need for developing generic and standardized open-source methods, tools, and guidelines on how to systematically implement patient involvement initiatives in the clinical setting. The large-scale project the User-involving Hospital was initiated to implement two systematic methods for patient involvement at a Danish university hospital, but the required methods can only be implemented if embraced by the health professionals. This evaluation study aimed to explore the health professional perspective on the development and implementation of shared decision making (SDM) and userled health care. Specifically, the objectives were to identify the most crucial preconditions for success and to translate the findings into practice recommendations. Method:The study was based on a simple questionnaire survey and a qualitative descriptive analysis of semistructured focus group interviews with representatives of 21 multidisciplinary clinical teams (nine interviews) and 18 health professional department managers (six interviews).Results: Two years after the initiation of the User-involving Hospital, 13 out of 21 developed patient involvement initiatives were fully incorporated into clinical practice. Five domains were found significant for successful development and implementation of the patient involvement methods: the patients' perspectives, composition of multidisciplinary teams, bottom-up and skill building, support from management, and information sharing with colleagues. Conclusions: The findings draw attention to several significant factors for successful implementation of large-scale patient involvement initiatives in hospitals, including the importance of having both a top-down and bottom-up approach and of active listening to the patients' perspectives. On the basis of these findings, the study outlines four recommendations incorporating the five identified key domains, which may inspire future projects on systematic development and implementation of patientinvolvement initiatives based on either shared decision making or user-led health care in the clinical setting.

Development and Test of a Decision Aid for Shared Decision Making in Patients with Anterior Cruciate Ligament Injury

“…The study was conducted at Aarhus University Hospital in Denmark from 2015 to 2019 and included a stepwise method. 14 A subsequent evaluation was based on the questionnaire “Shared Decision Making 9 questions” (SDM-Q9, 15 , 16 and a thematic analysis of semistructured interviews with patients and doctors. 17 …”

“…The design included 6 phases: preparation, reality check, developing a prototype, repeated testing, quality assessment, and implementing the new practice ( Figure 1 ). 14 The phases included the steps from the 2013 update of the International Patient Decision Aid Standard: prototype development and the alpha and beta testing with patients and clinicians. In the following, each phase will be presented in detail.…”

“…The study was a part of a large-scale project at Aarhus University Hospital about patient involvement of different patient groups with mandatory implementation of methods for SDM and user-led health care. 14 In the Department of Orthopaedic Surgery, we decided to focus on patients with an ACL injury and set up an interdisciplinary project team of doctors, nurses, and physiotherapists. The status of the project was presented and discussed once a month with the other health care professionals in the Clinic of Sports Traumatology.…”

Managerial Strategies for Long-Term Care Organization Professionals: COVID-19 Pandemic Impacts

“…Deyo et al [53] believe that the role of nurse manager requires specific skills to translate the vision of the patient. Patient engagement is a set of behaviors by the patients, family members, and healthcare professionals and the implementation of organizational policy engagement into practice and procedures that facilitate inclusion of patients and their family as active members of the healthcare team [53,54].…”

Leadership assumptions on implementation of patient involvement methods

“…Our study was conducted among a group of top leaders concerning a large-scale implementation project at a Danish university hospital called ‘The User-involving Hospital’ [ 9 ] (Fig. 1 ).…”