Patient And Family Engagement: A Framework For Understanding The Elements And Developing Interventions And Policies
01 Feb 2013-Health Affairs (Project HOPE - The People-to-People Health Foundation, Inc.)-Vol. 32, Iss: 2, pp 223-231
TL;DR: The levels at which patient engagement can occur across the health care system are discussed, from the direct care setting to incorporating patient engagement into organizational design, governance, and policy making.
Abstract: Patient and family engagement offers a promising pathway toward better-quality health care, more-efficient care, and improved population health. Since definitions of patient engagement and conceptions of how it works vary, we propose a framework. We first present the forms engagement can take, ranging from consultation to partnership. We discuss the levels at which patient engagement can occur across the health care system, from the direct care setting to incorporating patient engagement into organizational design, governance, and policy making. We also discuss the factors that influence whether and to what extent engagement occurs. We explore the implications of our multidimensional framework for the development of interventions and policies that support patient and family engagement, and we offer a research agenda to investigate how such engagement leads to improved outcomes.
Citations
More filters
TL;DR: An extended model of the SEIPS, SEIPS 2.0 is a new human factors/ergonomics framework for studying and improving health and healthcare that describes how sociotechnical systems shape health-related work done by professionals and non-professionals, independently and collaboratively.
Abstract: Healthcare practitioners, patient safety leaders, educators and researchers increasingly recognise the value of human factors/ergonomics and make use of the discipline's person-centred models of sociotechnical systems. This paper first reviews one of the most widely used healthcare human factors systems models, the Systems Engineering Initiative for Patient Safety (SEIPS) model, and then introduces an extended model, 'SEIPS 2.0'. SEIPS 2.0 incorporates three novel concepts into the original model: configuration, engagement and adaptation. The concept of configuration highlights the dynamic, hierarchical and interactive properties of sociotechnical systems, making it possible to depict how health-related performance is shaped at 'a moment in time'. Engagement conveys that various individuals and teams can perform health-related activities separately and collaboratively. Engaged individuals often include patients, family caregivers and other non-professionals. Adaptation is introduced as a feedback mechanism that explains how dynamic systems evolve in planned and unplanned ways. Key implications and future directions for human factors research in healthcare are discussed.
773 citations
Cites background from "Patient And Family Engagement: A Fr..."
...Various models are emerging that conceptualize and promote patient, family, and citizen engagement (Carman et al., 2013; Health Canada, 2000; Hibbard, Stockard, Mahoney, & Tusler, 2004)....
[...]
TL;DR: The coproduction principle is used to examine the roles, relationships and aims of this interdependent work, and the principle's implications and challenges for health professional development, for service delivery system design and for understanding and measuring benefit in healthcare services.
Abstract: Efforts to ensure effective participation of patients in healthcare are called by many names—patient centredness, patient engagement, patient experience. Improvement initiatives in this domain often resemble the efforts of manufacturers to engage consumers in designing and marketing products. Services, however, are fundamentally different than products; unlike goods, services are always ‘coproduced’. Failure to recognise this unique character of a service and its implications may limit our success in partnering with patients to improve health care. We trace a partial history of the coproduction concept, present a model of healthcare service coproduction and explore its application as a design principle in three healthcare service delivery innovations. We use the principle to examine the roles, relationships and aims of this interdependent work. We explore the principle's implications and challenges for health professional development, for service delivery system design and for understanding and measuring benefit in healthcare services.
682 citations
TL;DR: Current models of PPI are too narrow, and few organisations mention empowerment or address equality and diversity in their involvement strategies, and these aspects of involvement should receive greater attention.
Abstract: Background There have been repeated calls to better involve patients and the public and to place them at the centre of healthcare. Serious clinical and service failings in the UK and internationally increase the urgency and importance of addressing this problem. Despite this supportive policy context, progress to achieve greater involvement is patchy and slow and often concentrated at the lowest levels of involvement.
Methods A selective narrative literature search was guided by the authors’ broad expertise, covering a range of disciplines across health and social care, policy and research. Published systematic literature reviews were used to identify relevant authors and publications. Google and hand searches of journal articles and reference lists and reports augmented identification of recent evidence.
Results Patients and the wider public can be involved at most stages of healthcare, and this can have a number of benefits. Uncertainty persists about why and how to do involvement well and evaluate its impact, how to involve and support a diversity of individuals, and in ways that allow them to work in partnership to genuinely influence decision-making. This exposes patient and public involvement (PPI) to criticisms of exclusivity and tokenism.
Conclusions Current models of PPI are too narrow, and few organisations mention empowerment or address equality and diversity in their involvement strategies. These aspects of involvement should receive greater attention, as well as the adoption of models and frameworks that enable power and decision-making to be shared more equitably with patients and the public in designing, planning and co-producing healthcare.
571 citations
TL;DR: Patient engagement can inform patient and provider education and policies, as well as enhance service delivery and governance.
Abstract: To identify the strategies and contextual factors that enable optimal engagement of patients in the design, delivery, and evaluation of health services. We searched MEDLINE, EMBASE, CINAHL, Cochrane, Scopus, PsychINFO, Social Science Abstracts, EBSCO, and ISI Web of Science from 1990 to 2016 for empirical studies addressing the active participation of patients, caregivers, or families in the design, delivery and evaluation of health services to improve quality of care. Thematic analysis was used to identify (1) strategies and contextual factors that enable optimal engagement of patients, (2) outcomes of patient engagement, and (3) patients’ experiences of being engaged. Forty-eight studies were included. Strategies and contextual factors that enable patient engagement were thematically grouped and related to techniques to enhance design, recruitment, involvement and leadership action, and those aimed to creating a receptive context. Reported outcomes ranged from educational or tool development and informed policy or planning documents (discrete products) to enhanced care processes or service delivery and governance (care process or structural outcomes). The level of engagement appears to influence the outcomes of service redesign—discrete products largely derived from low-level engagement (consultative unidirectional feedback)—whereas care process or structural outcomes mainly derived from high-level engagement (co-design or partnership strategies). A minority of studies formally evaluated patients’ experiences of the engagement process (n = 12; 25%). While most experiences were positive—increased self-esteem, feeling empowered, or independent—some patients sought greater involvement and felt that their involvement was important but tokenistic, especially when their requests were denied or decisions had already been made. Patient engagement can inform patient and provider education and policies, as well as enhance service delivery and governance. Additional evidence is needed to understand patients’ experiences of the engagement process and whether these outcomes translate into improved quality of care. N/A (data extraction completed prior to registration on PROSPERO).
467 citations
Cites background from "Patient And Family Engagement: A Fr..."
...While the nature of patient engagement may vary from including patients as members of a board to time-limited consultation with patients on service redesign, its aims are consistent— to improve the quality of care [11, 13, 14]....
[...]
...Frameworks of patient involvement have been developed that move from the traditional view of the patient as a passive recipient of a service to an integral member of teams re-designing health care [8, 11]....
[...]
...’s [11] frameworks on patient engagement (Fig....
[...]
...describes various levels of engaging patients and families in health and health care, from consultation or involvement to partnership and shared leadership in various activities including direct care, organizational design, and governance to policy-making [11]....
[...]
...The red box indicates the level of engagement along the continuum that is the focus of our studies included in our review [11]....
[...]
TL;DR: This assessment provides explicit guidance for better alignment of engagement's promised benefits with evaluation efforts and identifies specific areas for development of evaluative measures and better reporting processes.
Abstract: Despite the growing demand for research that engages stakeholders, there is limited evidence in the literature to demonstrate its value - or return on investment. This gap indicates a general lack of evaluation of engagement activities. To adequately inform engagement activities, we need to further investigate the dividends of engaged research, and how to evaluate these effects. This paper synthesizes the literature on hypothesized impacts of engagement, shares what has been evaluated and identifies steps needed to reduce the gap between engagement's promises and the underlying evidence supporting its practice. This assessment provides explicit guidance for better alignment of engagement's promised benefits with evaluation efforts and identifies specific areas for development of evaluative measures and better reporting processes.
298 citations
References
More filters
TL;DR: C Coulter and Ellins as mentioned in this paper argue that any strategy to reduce health inequalities must promote health literacy and evidence that strategies to strengthen patient engagement are effective is substantial, argue Angela Coulter and Jo Ellins.
Abstract: Evidence that strategies to strengthen patient engagement are effective is substantial, argue Angela Coulter and Jo Ellins, but any strategy to reduce health inequalities must promote health literacy
931 citations
TL;DR: The evidence in support of the most promising interventions designed to help patients play an effective role in their own health care is outlined.
Abstract: The recent focus on patient engagement acknowledges that patients have an important role to play in their own health care. This includes reading, understanding and acting on health information (health literacy), working together with clinicians to select appropriate treatments or management options (shared decision making), and providing feedback on health care processes and outcomes (quality improvement). Various interventions designed to help patients play an effective role have been evaluated in trials and systematic reviews. This article outlines the evidence in support of the most promising interventions.
378 citations
TL;DR: Spanish-speaking patients are at a double disadvantage in encounters with English-speaking physicians: these patients make fewer comments, and the ones they do make are more likely to be ignored, which may result in lower adherence rates and poorer medical outcomes among Spanish- speaking patients.
214 citations
TL;DR: The findings indicate that activation is linked with the experience of positive and negative emotion in daily life and effective educational efforts should focus on improving self-efficacy and the individual's self-concept as a self-manager.
203 citations
TL;DR: Family-centered multidisciplinary rounds is a method of conducting inpatient hospital rounds that fosters teamwork and empowers hospital staff and its impact on staff satisfaction and the family's ability to participate in their care is significant.
Abstract: OBJECTIVE. The objective of this study was to determine the impact of family-centered multidisciplinary rounds on an inpatient pediatric ward. We hoped to (1) gain a better understanding of the patient and family experience with family-centered multidisciplinary rounds, (2) measure hospital staff satisfaction with family-centered multidisciplinary rounds compared with conventional rounds, and (3) understand the time commitment for family-centered multidisciplinary rounds and conventional rounds. METHODS. A quasi-experimental design was undertaken during a 2-week period. During the first week, the hospital staff conducted conventional rounds. Families were surveyed daily, and the staff were surveyed at the end of the week regarding their experiences. During the second week, newly admitted patients received family-centered multidisciplinary rounds at the bedside. Again, both families and staff were surveyed. Observers recorded the interactions between families and staff and measured the time required to conduct rounds. RESULTS. A total of 27 patients were admitted during the 2-week study period. No significant differences were found in family satisfaction between conventional rounds and family-centered multidisciplinary rounds. A total of 53 surveys were collected from staff members. The staff reported better understanding of the patients9 medical plans, better ability to help the families, and a greater sense of teamwork with family-centered multidisciplinary rounds compared with conventional rounds. It required an additional 2.7 minutes per patient during rounds for family-centered multidisciplinary rounds. With family-centered multidisciplinary rounds, the family affected the medical decision-making discussion in 90% of cases. CONCLUSIONS. Family-centered multidisciplinary rounds is a method of conducting inpatient hospital rounds that fosters teamwork and empowers hospital staff. The patient and family are engaged in and are the focal point of the rounds. Staff members are able to hear everyone9s perspective and give input. The impact on staff satisfaction and the family9s ability to participate in their care is significant.
150 citations