The Role of Quality Healthcare Through Patient Participation

Introduction

Over the last decade, patient engagement has been considered critical to improving the quality of care provided by the healthcare system.  Patient engagement can be defined as involvement of patient, their family and representatives, in working actively with health professionals at various levels across the health care system to improve health and health care services. It is the active involvement of the patient in planning, delivery, monitoring and evaluation of their own care. A patient is an individual receiving healthcare care services from an organization providing healthcare.

The scientific studies suggests that patient engagement has become a cornerstone for quality of care improvement and is also a frequently stated goal for healthcare organizations level, there are growing efforts to integrate patients in many area to improve or redesign service delivery, by incorporating their experiences and experiential knowledge, not only concerning chronic diseases but also the services delivered by the system and the healthcare organization.

Patient’s perspective is unique. Given the first-hand experience of every stage of the care pathway, they are legitimately positioned to evaluate the care and services received, in terms of whatever their needs and perspectives which were remarkably different, were not usually well understood.   

Patient-As-Partner:

For 20 years, paternalistic healthcare approaches have gradually given way to patient-oriented approaches that take into account patients’ differences, values, and experiences. Healthcare organizations, institutions, and universities around the world are increasing their efforts to involve patients and make their participation active using different forms of engagement and various means of motivation. However, recent initiatives such as shared decision-making and some therapeutic education approaches, maintain the healthcare provider’s monopoly on determining the course and outcomes of treatment.

Patients can be partners in many ways.

For example, in healthcare patients-as-partners interact and share the knowledge, acquired by their experience of living with the disease and its impact on their lifestyle, with multidisciplinary teams. They also wish to share their experience with other patients to help them get through their episode of care. Such patients are here called resource patients; they are willing to use their experience to improve the organization of the health system.

Partnership in Care Program:

To implement this new paradigm, a unit for patient collaboration and partnership (Direction collaboration partenariat patient - DCPP) was created in the context of these healthcare service activities developed by the DCPP, the ‘Partnership in Care Program’ (PCP) aims to develop a continuous quality improvement process through the implementation of interdisciplinary committees for continuous quality improvement (CQI), each including professionals and at least two resource patients. CIC means Continuous Improvement Committee.

The PCP consists of five phases that occur in sequence :

Phase A : Preparation of Health Institutions

During this phase, the PCP is submitted to the Executive Committee of each institution to obtain a commitment from senior management. In addition, members of the CIC are selected and a doctor–nurse team is identified to coordinate the CIC. Team members consist of professionals and patients.

Professionals are representatives of different professions (physicians, nurses, physiotherapists, social workers, etc.) who have been chosen on a voluntary basis. Patient participants are selected by the DCPP from a list of names suggested by their departments, according to special criteria applied to patients with chronic illness.

Phase B: Team diagnosis for collaborative practices in patient partnership

The DCPP drafts a report on the department where the CIC is implemented, using standardized tools to identify strengths and opportunities for clinical teams in regard to quality of care and ‘partnership-oriented’ practices.

Phase C: Definition of goals for quality Improvement

During the CQI second meeting, members comment on the report, make recommendations, and are invited to submit their suggestions for improvement based on their experience within the team and on principles of healthcare partnership.

Phase D: Implementation of action

The CQI carries out the processing activities described in the action plan. A third meeting is held six to eight weeks after the second meeting of the Committee, to ensure monitoring and follow-up of activities. The specific topics covered include: input from a resource patient, distribution of tasks, work progress, inclusion of healthcare partnership dimensions, and coordination between members.

Phase E: Assessment of the impact of actions and preparation of a new cycle of improvement

In a time frame of eight to ten weeks following the CIC's third meeting, the team pursues and completes its transformation activities. Four months after the first meeting (phase B), a fourth meeting of the committee is held to assess achievement of goals and share members’ comments on their experience in the committee, in a focus group format. Topics covered during this assessment include: facilitating factors (conditions promoting strong inclusion of patients in the committee); obstacles encountered during this cycle and how they have been addressed; learning acquired; direct and indirect impacts of the project; participants’ satisfaction and opportunities for improvement. At the end of the cycle, an official certificate of acknowledgment of the team’s achievement is handed out in recognition of members’ work and as an incentive to continue with improvement cycles. In addition, preparation for the following cycle is initiated.

Contribution of patients to the teams

All the patients perceived CIC as a structured entity that was not demanding and was centered on the search for practical solutions, mainly to improve communication with healthcare professionals through the development of simple and effective tools. They also found that the participation of professionals in this process of continuous quality improvement led to a better understanding of patients’ expectations and highlighted the interdependence of various professionals within a given situation. The most valuable thing that patients got from participating in the CIC was sharing their vision and experiences regarding the care process and having them taken into account in various ways.

Learning Acquired by Patients

The main learning acquired by patients concerned their personality and behavior, in addition to learning about their disease and care procedures employed. Their participation also allowed them to improve their communication with professionals.

Challenges of participation

The main barrier to participation noted by all patients was the time factor. Indeed, they commented not only on the difficulty in finding time for the activities but also on the slowness of decision-making in healthcare facilities.

Outcomes of quality care through patient participation

The outcomes related to quality care include a reduction in Mortality rate, Readmission rate, Length of stay, Hospital acquired infection rate; improved adherence to treatment regimes; decreased adverse events; reduced operating costs and decreased malpractice claims. It also optimizes self-management of patients with chronic illness and improve patient adherence to health care practices.

Conclusion

The aim of this study is to gain an understanding of patients’ experience as partners in quality improvement committees, by presenting their perceptions of their contribution to quality teams, of their learning, and of the challenges encountered during the process.

It is interesting to note that, although patients had different healthcare experiences and came from different health facilities, there were no significant differences in their perceptions, which led to reaching theoretical saturation quickly. However, a limitation of this study is that it focuses only on patients' perceptions.

Written by:

Shipra Damir

Senior Advisory of Ingenious Healthcare Consultants Pvt. Ltd.

Director of Society for Hospital Administrators

B. Pharm, MBA in Pharmacy Business Management, Industry Integrated Diploma in Pharma Management, MBA in Hospital Administration, B.Ed

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