Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
Public and Patient Engagement Collaborative, McMaster University, Hamilton, Ontario, Canada.
Health Expect. 2024 Dec;27(6):e70083. doi: 10.1111/hex.70083.
Despite widespread calls to involve patients, families and caregivers (PFCs) as partners at all levels of health system planning and design, there is unevenness in how engagement efforts are supported across these settings. The concept of 'engagement-capable environments' offers a way forward to uncover the key requirements for sustainable, high-quality engagement, but more work is needed to identify the specific competencies required to create these environments. We addressed this gap by developing a capability framework for Ontario Health Teams (OHTs), a newly established structure for planning, designing, organizing and delivering care in Ontario, Canada.
The framework was co-developed by a Working Group of OHT staff and leaders, PFC partners, researchers and government personnel. Project activities occurred over four phases: (1) planning, (2) evidence review and surveying of intended users to identify key competencies, (3) framework design and (4) implementation.
An evidence review identified more than 90 potential competencies for this work. These results were contextualized and expanded through a survey of OHT stakeholders to brainstorm potential competencies, supports and enablers for engagement. Surveys were completed by 69 individuals; 689 knowledge and skill competency statements, 462 attitude and behaviour competency statements and 250 supports and enablers were brainstormed. The statements were analysed and organized into initial competency categories, which were reviewed, discussed and iteratively refined by Working Group members and through broader consultations with the OHT community. The final framework includes six competency domains and four support and enabler domains, each with sub-domain elements, mapped across a three-stage maturity model. The framework has been disseminated across OHTs, and its adoption and implementation are now requirements within OHT agreements.
The framework combines a strong conceptual foundation with actionable elements informed by the literature and consultations with the intended users of the framework. Although developed for OHTs, the framework should be broadly applicable to other health system organizations seeking similar health system transformation goals.
Patient, family and caregiver partners were involved at all stages and in all aspects of the work. As end users of the framework, their perspectives, knowledge and opinions were critical.
尽管广泛呼吁让患者、家属和照护者（PFC）作为合作伙伴参与各级卫生系统规划和设计，但在这些环境中支持参与工作的力度参差不齐。“有能力参与的环境”这一概念为揭示可持续、高质量参与的关键要求提供了一种方法，但需要做更多的工作来确定创建这些环境所需的具体能力。我们通过为安大略省健康团队（OHT）制定能力框架来解决这一差距，OHT 是加拿大安大略省新成立的规划、设计、组织和提供护理的结构。
该框架由 OHT 工作人员和领导、PFC 合作伙伴、研究人员和政府人员组成的工作组共同制定。项目活动分四个阶段进行：（1）规划，（2）审查证据并对预期用户进行调查以确定关键能力，（3）框架设计和（4）实施。
一项证据审查确定了这项工作的 90 多项潜在能力。通过对 OHT 利益相关者进行调查，以集思广益参与能力的潜在能力、支持和促成因素，将这些结果进行了背景化和扩展。调查由 69 人完成；提出了 689 项知识和技能能力陈述、462 项态度和行为能力陈述以及 250 项支持和促成因素。对陈述进行了分析和组织，形成了初步的能力类别，由工作组成员进行审查、讨论和迭代完善，并通过与 OHT 社区的更广泛协商进行完善。最终框架包括六个能力领域和四个支持和促成因素领域，每个领域都有子领域元素，映射在一个三阶段成熟度模型上。该框架已在 OHT 中传播，其采用和实施现在是 OHT 协议的要求。
该框架将强有力的概念基础与文献和与框架预期用户协商的可操作要素相结合。尽管是为 OHT 制定的，但该框架应该广泛适用于寻求类似卫生系统转型目标的其他卫生系统组织。
患者、家属和照护者在工作的所有阶段和方面都参与其中。作为框架的最终用户，他们的观点、知识和意见至关重要。
