Ingram School of Nursing, McGill University, Montreal, QC, Canada.
McGill University Health Centre, Montreal, QC, Canada.
Int J Health Policy Manag. 2022 May 1;11(5):658-669. doi: 10.34172/ijhpm.2020.208.
Individuals with serious mental illness face challenges in managing their health, leading to the need for integrating their needs and preferences in care decisions. One way to enhance collaboration between users and providers is to improve clinical governance; a shared responsibility between managers and providers, supported by healthcare organizations (HCOs), policies, and standards. We applied the concept of clinical governance to understand (1) how managers and providers can enhance the involvement of users in mental health, (2) the contextual and organizational factors that facilitate user involvement in care, and (3) the users' perceptions of their involvement in care.
We conducted two, in-depth case studies from two clinical teams in Canada offering outpatient care for users with acute mental illness. A total of 25 interviews were carried out with managers, and four focus groups were held with providers. A measure of patient-reported experience was used to evaluate the users' perceptions of their involvement in care.
The providers used two methods to involve users in the care planning process: encouraging users to identify their life goals and supporting them to define recovery-oriented objectives. To encourage the adoption of collaborative practices, the managers used various practices such as revising care protocols, strengthening providers' knowledge of best practices and integrating peer-support workers (PSWs) in the team. Compliance with organizational and external commitments/requirements for user involvement, access to specific training and the institutionalization of a culture promoting user involvement facilitated the adoption of collaborative practices. We found that mental health teams that adopt recovery and collaborative practices with users show a high degree of user-perceived involvement in care.
This is the first study to apply the concept of clinical governance to understand how managerial and clinical practices, and other organizational and contextual factors, can enhance the involvement of mental healthcare users.
患有严重精神疾病的个体在管理自身健康方面面临挑战，因此需要将他们的需求和偏好纳入医疗决策中。增强用户与提供者之间协作的一种方法是改善临床治理；这是管理者和提供者的共同责任，由医疗保健组织（HCO）、政策和标准提供支持。我们应用临床治理的概念来理解（1）管理者和提供者如何增强用户在精神健康方面的参与度，（2）促进患者参与护理的背景和组织因素，以及（3）用户对其参与护理的看法。
我们对加拿大两家提供急性精神疾病患者门诊护理的临床团队进行了两项深入的案例研究。共对管理人员进行了 25 次访谈，并对提供者进行了 4 次焦点小组讨论。使用患者报告的体验措施来评估用户对其参与护理的看法。
提供者使用两种方法来参与用户的护理计划过程：鼓励用户确定其生活目标，并支持他们定义以康复为导向的目标。为了鼓励采用协作实践，管理人员采用了各种做法，例如修订护理方案、加强提供者对最佳实践的了解以及将同伴支持工作者（PSW）纳入团队。遵守组织和外部对用户参与的承诺/要求、获得特定培训以及将促进用户参与的文化制度化，促进了协作实践的采用。我们发现，采用与用户一起进行康复和协作实践的精神健康团队表现出高度的用户感知护理参与度。
这是首次应用临床治理概念来理解管理和临床实践以及其他组织和背景因素如何增强精神卫生保健用户的参与度的研究。
