Patient and public involvement in hospital policy-making: Identifying key elements for effective participation.

The involvement of patients and the public in healthcare decisions becomes increasingly important. Although patient involvement on the level of the individual patient-healthcare worker relationship is well studied, insight in the process of patient and public involvement on a more strategic level is limited. This study examines the involvement of patient and public (PPI) in decision-making concerning policy in six Flemish hospitals. The hospitals organized a stakeholder committee which advised the hospital on strategic policy planning. A three-phased mixed- methods study design with individual questionnaires (n = 69), observations (n = 10) and focus groups (n = 4) was used to analyze, summarize and integrate the findings. The results of this study indicate that: (1) PPI on hospital level should include the possibility to choose topics, like operational issues; (2) PPI-stakeholders should be able to have proper preparation; (3) PPI-stakeholders should be externally supported by a patient organization; (4) more autonomy should be provided for the stakeholder committee. Additionally, the study indicates that the influence of national legislation on stakeholder initiatives in different countries is limited. In combination with the growing importance of PPI and the fact that the recommendations presented are not claimed to be exhaustive, more transnational and conceptual research is needed in the future.