Chapter 7: The Role of the Patient in Continuous Quality Improvement Contents Introduction and background Patient involvement in healthcare improvement overview Rationale for Patient Involvement in CQI Methods for Involving Patients in CQI Factors Affecting Patient Involvement The MAPR Model of Patient Involvement Partners to Owners Conclusion Introduction The primary function of health systems is to care for the health and wellbeing of populations in an effective and efficient way. A range of mechanisms exist for measuring the quality of care provided by health systems The role of the patient, family, and caregivers is much less clear History, policy, and causality are conflicted on the role of and outcomes from the patient in CQI Background Most CQI systems value the involvement of the client in systemic change and development Patient safety inquiries show that patients and carers often flagged problems first but were ignored These inquiries were not isolated to one part of the health system – problems are diverse in type and location of occurrence How can CQI help avoid these problems, halt their recurrence and improve systemic approaches? Patient Involvement in Healthcare Improvement Overview Patients are expected to be involved in health care as health systems have developed – CQI is a part of this Social and health sector changes have contributed to the call for patient involvement The dominance of medicine has been questioned by patients, advocates and health practitioners The HIV/AIDS epidemic has been a major force for change in traditional health system approaches Technological shifts have/are having a huge impact e.g. knowledge base, global contacts, volunteers for trials etc. Rationale for Patient Involvement in CQI Greater knowledge of health has increased knowledge of errors in the media and public domains High profile cases continue to get major news coverage e.g. The Shipman Inquiry in the U.K. Health systems have been forced to acknowledge the patient/client/carer perspectives CQI is part of the shift to patient-centered health care e.g. Insurance systems, co-payments etc. also make patients customers Methods for Involving Patients in CQI Three important levels of patient involvement in CQI: Micro-level involvement – active patient involvement as acknowledged in the concept of the self-managing patient; Meso-level involvement – patients involved in health service or even whole system planning, management and evaluation; Macro-level involvement – here patients are involved in national/international safety activities e.g. The WHO London Declaration Factors Affecting Patient Involvement The evidence base for patient involvement is small but growing Patient willingness to participate is affected by several factors e.g. self-efficacy in the role, health literacy, shift/changes required in role Inhibitory factors include e.g. type/severity of condition, SES factors (minority social position), the health setting and ...