Quality improvement (QI) relates to a systematic and formal framework that entails the continuous and organized actions that result in quantifiable improvement in general health care services as well as the health status of patients. QI aims to standardize structure and processes to lessen variation, attain predictable outcomes, and enhance healthcare facilities, systems, and patients. In the recent past, patient engagement has been presented as vital to enhancing the healthcare sector’s quality of care. Globally, numerous healthcare facilities engage patients as an effective quality improvement measure. Patient engagement relates to the engagement of patients, their representatives, or families, in working collaboratively with healthcare professionals at different levels across the entire healthcare system to enhance healthcare services and patient care outcomes. Bergeron et al.’s “Patient involvement in quality improvement –a tug of war or a dialogue in the learning process to improve healthcare” seeks to explore what might influence Quality Improvement efforts in which patients are allowed to participate, as experienced by the healthcare providers and patients involved (2020).
According to the article, healthcare givers and patients pose significant experiences of the overall healthcare system, resulting in QI and improved patient healthcare outcomes. Therefore, service co-design and co-production are presented as increasingly significant healthcare development approaches, and that healthcare facilities are required to engage appropriate Microsystems in Quality Improvement interventions. The article puts forward the rights bestowed on patients in association with QI in the healthcare system in various levels: societal, organizational, group and individual. To support this privilege, the article highlights the Swedish Patient Act, which strengthens and regulates patients’ positions and pushes healthcare facilities through healthcare providers to work more enthusiastically with novel approaches to enhance safety and quality at various levels.
The article examines how improvement science focuses on how to carry out Quality Improvement with intentions of narrowing the existing gap between the current QI practices and the best probable practices. It majors on the practices or approaches that work to improve the quality of healthcare services. As presented in the article, improvement science entails constant and systematic actions, which result in quantifiable improvements, making it compatible with the enhancement efforts of healthcare systems. This research is based on the assumption that healthcare systems comprise clinical Microsystems. Formulated around everyday needs or objectives, Bergerum et al. (2020) assert that clinical Microsystems represent the smallest, functional units in which healthcare givers and patients come together and exchange their ideas, thoughts, and concerns in association with Quality Improvement efforts. Patients, their representatives or families, and healthcare givers engaged in the QI efforts are presented in the article as mutually dependent, exchanging information and working collaboratively to co-produce cost, safety, and quality results at the frontier of healthcare.
The article puts forward that Clinical Microsystems are grouped into overarching macro-systems, thereby making clinical macro-system results dependent on clinical Microsystems results. Consequently, to uphold and improve quality in the multifaceted healthcare system, vital influential points are at the clinical Microsystems level clinical Microsystems (Bergeum et al. 2020). In this research, the clinical Microsystems entail patents, representatives of the patients, next of kin, and healthcare givers such as nurses who mutually engage in healthcare Quality Improvement efforts in a healthcare facility.
Quality Improvement can be difficult when engaging patients at different levels of the healthcare system. The article puts forward a gap in literature featured by a comparative lack of literature evidence about how patient involvement may work when employed in Quality Improvement. This clarifies the need for Quality Improvement facilitation, asserting that they should be sensitive and flexible to every context of interventions at the group and individual levels. Consequently, the study seeks to explore what may manipulate inter-departmental hospital process Quality Improvement teams when engaging patients in QI strategies or measures as similarly experienced by other members.
This study adopts a qualitative research design based on the constructivist grounded theory model, which has its roots sourced from the original Strauss and Glaser grounded theory research design. The authors focus more on exploring the current practice concerning quality improvement and the interactive and comparative representation of the constructivist grounded theory methodology, allowing for instantaneous gathering and analysis of data to obtain answers to the study questions. Bergeron et al.’s is founded on field notes acquired from 53 Quality Improvement team meetings and twenty-four personal interviews that are semi-structured with partaking patients, their representatives, next of kin, and healthcare providers (2020).
In a middle-sized regional healthcare facility in Sweden, a patient process institution serves as the study’s context. The healthcare facility used as the setting for the study offers healthcare services in different areas of specialties. The patient process institution refers to an approach adopted for patients with regular, critical illnesses; relies on the cooperation of various healthcare professionals across different levels in the healthcare facility and between other healthcare facilities. The objective of every patient process is typically to enhance patient healthcare processes. Consequently, Quality improvement efforts are conducted at organizational and group levels. The healthcare facility under study entailed 12 patient processes with patients in different levels being engaged in Quality Improvement groups consisting of 6 out of the total processes
The researchers used a purposive sampling approach to identify interview informers, enabling the sampling strategies’ flexibility throughout the study process. Six patient processes were preferred for the research. One of the researchers attended team meetings with three of the total selected patient processes. Patients, their representatives, and their next of kin took part actively in eight Quality Improvement meetings attended by one of the researchers. Healthcare givers who attended the Quality Improvement meetings included; speech therapists, physicians, counselors, team secretaries, and development leaders. Healthcare givers and patients from the six selected Quality Improvement teams took part in the personal interviews.
The study’s data collection entailed field notes spontaneously written during team meetings, with the main focus being on patient engagement in decision procedures, considerations, communication, and social interaction. One of the researchers interacted with the Quality Improvement efforts. The field notes were used in complementing the interviews conducted, providing information used in the data analysis process. The interviews were carried out in different settings according to the convenience of the study participants. Some of the patients who took part in the study were interviewed at the healthcare facility, and some patients were interviewed in their homes. Each interview had an average time limit of 48 minutes. Healthcare professionals were interviewed at their places of work.
The data analysis process was carried out in the Swedish language and written out in English. The information obtained from the interviews was transcribed and read out by the researchers to offer a complete view of the data. An Excel sheet was used in the coding process of data and information coded. Data were categorized and converted into three different concepts to comprehend what may influence Quality Improvement efforts to engage patients in a healthcare facility patient process organization. The study results indicate that the healthcare providers’ and patients’ expressions of what may affect Quality Improvement efforts involving patients were comparable in different ways.
The article emphasizes on the significance of organizational culture and structure. The article highlights that Quality Improvement teams acknowledge collaborative thinking and regular dialogue through exchanging preferences and experiences between healthcare providers and patients as significant for attaining suitable matches between patient requirements and healthcare facilities in their Quality Improvement efforts. Essential cultural and structural aspects of conducting QI in healthcare facilities are presented in the article as some of the hindrances to improved health outcomes.
Bergerum, C., Engström, A. K., Thor, J., & Wolmesjö, M. (2020). Patient involvement in quality improvement–a ‘tug of war or a dialogue in a learning process to improve healthcare?. BMC health services research, 20(1), 1-13.