Patient Advisors: How to implement a process for involvement at all levels of governance in a healthcare organization

Abstract

Patient involvement at the operational (clinical care and services), tactical (management), and strategic (board of directors and executive management) levels of establishments is increasingly sought after. To address this specific challenge, a Canadian healthcare organization, the Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec, has developed an integrated strategy based on three principles: (1) shared leadership between a patient and a manager to build the strategy; (2) a clear process for recruiting, training, and coaching patient advisors (PA) so that they can participate in decision-making at the various levels of governance of the establishment; and (3) a feedback process for improving the strategy over time. This initiative gave rise to a pool of 30 patient advisors who reviewed documentation (39.07%), presented testimonies to establishment practitioners (13.73%), participated in process improvement activities (12.97%) and committees (8.93%), and helped train students in health sciences (11.61%). It also led to the development of a request form for all persons wishing to involve PAs in their projects. This PA involvement, highly appreciated by both managers (94%) and PAs (81%), brought back the fundamental meaning of the patient-practitioner relationship and helped incorporate patients' experiential knowledge into the care and service improvement process. This strategy can serve as a model for other organizations wishing to structure optimal patient engagement at the different levels of governance of their organization.

A voice for the patients: Evaluation of the implementation of a strategic organizational committee for patient engagement in mental health

“…Patients participated in each implementation stage of the committee, which is a key element when it comes to changes in mental healthcare organizations [ 55 , 64 ] and challenges the perception that mental health patients may not have the capacity to participate in decision-making within organizations [ 16 ]. Finally, this study supports and illustrates the importance of constant management support, as brought up in the literature on both implementation [ 39 ] and patient engagement [ 23 ].…”

“…Despite the lack of literature on the subject, both in mental health specifically and in other healthcare domains, the need for strategies at the organizational level to spread the practice of patient engagement has been emphasized [ 23 , 26 , 51 ]. In the present study, successful realization of such a strategy was made effective by ensuring representation from various departments on the strategic committee, and by advocating more extensive participation of patient partners.…”

“…The literature indicates that patient engagement requires a certain support or structure in order to work well within mental health organizations, which means explicit actions need to be taken in this direction [ 2 , 16 , 21 , 22 ]. Elements of successful patient participation that are frequently cited include actor preparation, support mechanisms, and resource allocation [ 20 , 23 ]. These positive ingredients must be successfully combined, while overcoming the negative influences prevailing both within the organization and in society at large [ 22 ].…”

“…This knowledge gap has also been identified by Rise, Solbjør, and Steinsbekk [ 26 ], who investigated the implementation of an organization-wide strategy for patient engagement. A few studies have taken a wider organizational perspective, focusing on the establishment of a structure for the benefit of patient engagement [ 23 , 26 – 29 ]. These studies, however, are not explicit regarding the theoretical foundations on which they rest, a key element when studying the implementation of interventions within healthcare organizations [ 30 ].…”

Patient Engagement: The Quebec Path

“…Another experiment conducted at a CIUSSS and funded by the Canadian Foundation for Healthcare Improvement (CFHI) helped structure patient involvement at all levels of governance of the establishment (Pomey et al 2016). To this end, the organization recruited a patient advisor two days a week, along with a manager, to develop a reference framework for patient involvement at the strategic, tactical and operational levels, as well as tools such as a form to request patient advisor participation and learning material.…”