Department of Health Sciences, University of Leicester, Leicester, UK.
Health Expect. 2013 Sep;16(3):e36-47. doi: 10.1111/hex.12039. Epub 2013 Feb 3.
Patient and public involvement in healthcare planning, service development and health-related research has received significant attention. However, evidence about the role of patient involvement in quality improvement work is more limited. We aimed to characterize patient involvement in three improvement projects and to identify strengths and weaknesses of contrasting approaches.
Three case study quality improvement projects were purposively sampled from a broader programme. We used an ethnographic approach involving 126 in-depth interviews, 12 weeks of non-participant observations and documentary analysis. Data analysis was based on the constant comparative method.
The three projects differed in the ways they involved patients in their quality improvement work, including their rationales for including patients. We characterized three very different models of patient involvement, which were each influenced by project context. Patients played distinctive roles across the three projects, acting in some cases as intermediaries between the wider patient community and clinicians, and sometimes undertaking persuasive work to convince clinicians of the need for change. We identified specific strategies that can be used to help ensure that patient involvement works most effectively and that the enthusiasm of patients to make a difference is not dissipated.
Patient involvement in quality improvement work needs careful management to realize its full potential.
患者和公众参与医疗保健规划、服务开发和与健康相关的研究已经受到了广泛关注。然而，关于患者参与质量改进工作的证据则更为有限。我们旨在描述患者在三个改进项目中的参与情况，并确定不同方法的优缺点。
从更广泛的计划中，我们有针对性地选择了三个案例研究质量改进项目。我们采用了一种民族志方法，包括 126 次深入访谈、12 周的非参与观察和文献分析。数据分析基于恒定性比较方法。
这三个项目在患者参与其质量改进工作的方式上存在差异，包括他们让患者参与的理由。我们描述了三种非常不同的患者参与模式，这些模式都受到项目背景的影响。患者在三个项目中扮演着独特的角色，在某些情况下充当更广泛的患者群体和临床医生之间的中间人，有时则采取说服性工作来使临床医生相信变革的必要性。我们确定了一些具体的策略，可以用来帮助确保患者参与最有效地发挥作用，并且患者改变现状的热情不会被消耗殆尽。
患者参与质量改进工作需要精心管理，以充分发挥其潜力。
