Co-produced capability framework for successful patient and staff partnerships in healthcare quality improvement: results of a scoping review

Equity in action: a scoping review and meta-framework for embedding equity in quality improvement

BACKGROUND

There are increasing efforts to include equity in all quality improvement (QI) initiatives. A comprehensive framework to embed equity in QI has been lacking, which acts as a barrier to the QI community from taking action to reduce healthcare inequities.

OBJECTIVES

The objectives of this scoping review were to: (1) map and summarise available equity frameworks for QI and (2) create a 'meta-framework' for QI leaders and practitioners, with engagement of people with lived experience of health inequities.

METHODS

Articles were identified with searches of four databases (MEDLINE, Embase, PsycInfo and CINAHL) and review of reference lists from included articles. Articles that reported how equity can be meaningfully integrated into QI were included. A qualitative inductive thematic analysis and community member engagement and consultation were completed to clarify recommended strategies for embedding equity in QI.

RESULTS

The search strategy yielded 2776 unique articles, with 40 meeting the inclusion criteria. A meta-framework for embedding equity in QI was created that has two enablers: broadening theoretic underpinnings and organisational culture, structures and leadership. The meta-framework also has six domains: (1) engage with people with lived experience of health inequities; (2) define the equity problem and aim; (3) diversify and train the QI team; (4) examine broader root causes; (5) intervene to reduce inequities; and (6) measure impacts on equity. The community member consultation identified key facilitators and common pitfalls in involving community members in QI.

CONCLUSION

This meta-framework is a comprehensive resource to integrate equity into all aspects of QI practice. Further study of its implementation is recommended. Revisions to QI guidelines and training curricula are also needed to drive and sustain the embedding of equity in QI.

Development of a capability framework for Allied Health research careers in health services

BACKGROUND

Engaging health services in research is important for ensuring a strong practice-relevant evidence base. To achieve this, health service staff must be equipped with the necessary research capabilities. Despite growing research engagement by Allied Health (AH) professionals within services, career frameworks that enable staff to map research capabilities are currently lacking. Pre-existing frameworks focus largely on research capabilities within the academic context, and do not adequately capture the specific capabilities required of AH research roles in health services. Equally, existing frameworks assume a career progression that moves from clinical practice, through a PhD and then onto a research academic path, and hence have limited relevance for other types of research roles that exist within health services. Hence, this study aimed to develop a research career capability framework for AH research careers within health services, using the specific setting of Queensland Health, a state-wide Australian public health service.

METHODS

This research involved four sequential phases: 1) A rapid review to identify potential capabilities for inclusion in the framework; 2) Refinement of the rapid review findings into an initial set of capabilities and domains by a Project Reference Group (PRG); 3) An e-Delphi survey with a broad range of stakeholders to gain consensus on included capabilities; and 4) A survey of and consultation with the PRG to refine capabilities and develop final framework elements.

RESULTS

Twelve articles yielding 2,125 capability statements were identified in the rapid review. These were synthesized into 73 capabilities by the PRG, which went forward to a 2-round e-Delphi with 48 participants. The resulting framework consisted of 61 capabilities under five domains: Research knowledge and skills; Research impact and translation; Clinical and healthcare research context; Research leadership and strategy; and Research capacity building and mentorship.

CONCLUSIONS

Using a multi-phase approach, a research capability framework which represented the diversity of AH research careers within health services was developed. The framework can be used to guide professional development of AH researchers and to support their career development processes. Although developed within a specific health context, the work has application to other locations, as well as professions outside Allied Health.

Exploring a Co-Designed Approach for Healthcare Quality Improvement-Learning Through Developmental Evaluation

BACKGROUND

Healthcare setting teams were challenged to understand how and what to measure regarding healthcare quality improvement (HQI), who should be involved, and what approach to apply. We aimed to determine if a generic co-design approach involving patients/families, multi-disciplinary care providers, and other staff was feasible to apply for HQI across diverse care settings. Developmental evaluation embedded in the co-design approach would determine its effectiveness, challenges, and other experiences across care settings and teams.

METHODS

Twenty-two acute and community care settings agreed to participate in applying a phased co-design approach to their HQI initiatives, including developmental evaluation. Each care setting team received co-design orientation and support. Semi-structured interviews and focus groups were conducted with patient/family advisors (PFAs) and care setting staff/care providers to gather their experiences with the co-design approach applied to their phased HQI work. Transcripts were thematically analyzed and triangulated with observation notes of care setting team discussions. Experiences were gathered from 17 PFAs and 68 staff/care providers across the 22 participating healthcare settings.

RESULTS

Themes for the orientation and each phase emphasized the importance of participants' understanding, engagement, and ongoing open communication throughout the HQI co-design process. The orientation was viewed as key to facilitating good outcomes. Participants valued working together, gathering real-time experiences to "make a difference", and having PFA voices involved in co-designing the HQI initiatives. Challenges were identified, including time commitment.

CONCLUSIONS

Based on the overall developmental evaluation findings, there was consensus that a generic co-design of HQI initiatives was effective, feasible, and sustainable across care settings.

Supporting the continuous development and use of a patient partnership framework in European rare disease networks (ERNs): a scoping review of frameworks in the scientific literature

The European Reference Networks (ERNs) for rare and complex diseases offer significant potential for building, maintaining and evaluating patient partnership, for which the recently developed ERN Patient Partnership Framework may serve as guidance. This scoping review aims to identify and describe relevant frameworks published in scientific literature, capturing key learning points to inform future updates of the ERN Patient Partnership Framework and promote its use in practice. MEDLINE, Embase, and the Web of Science Core Collection were searched to identify recently published frameworks (2013-2023) focused on patient partnership and aligned with at least one core ERN activity. Framework characteristics were summarised and information pertaining to their content, structure and practical use was extracted. Twelve relevant frameworks were identified, presenting practical approaches, conceptual understandings or both. Five frameworks focused on areas aligned with specific core ERN activities; others had an overarching scope. Frameworks presented various engagement approaches and employed heterogeneous terminology and development methods. Frameworks differed in their content and structure and presented key considerations for use. Our review underscores the importance of providing clear definitions and explanations of patient partnership. It provides insight into how meaningful, and inclusive patient partnership can be promoted within our diverse ERN context and sheds light on the importance of framework implementation as a prerequisite to structured evaluation. Learning points generated from this review will be used to inform future updates of the ERN Patient Partnership Framework and promote its implementation in practice.

A Practical Approach for Developing Shared Decision-Making Knowledge, Skills, and Capability for Busy Health Care Practitioners

BACKGROUND

There has been substantial development of shared decision-making (SDM) methods and approaches in the past few decades, but despite this, building capability and scaling application of SDM in clinical practice remains a challenge. Here the authors describe the development and initial experience with a new virtual Practical Approach continuing education program for busy practicing clinicians who care for people with complex, chronic, and costly conditions who are frequently faced with preference-sensitive decisions. This program was designed to provide plain language training in SDM for real-world clinical practice using an easy 4-step approach that does not require prior training or formal education in SDM theory or methods.

METHODS

The authors describe the development of the Practical Approach program using established evidence-based principles. The program was piloted in 4 different settings across 2 chronic conditions. Qualitative interviews of program participants were conducted to observe SDM attitudes and observed performance in repeated case-based simulation role-play exercises to assess knowledge and skills performance.

RESULTS

The authors observed improved and more realistic SDM attitudes in qualitative interviews with program participants after exposure to the program compared to baseline, and they similarly observed improved knowledge and skills demonstrated in sequential simulations conducted as participants were exposed to the program. Post-program focus groups revealed that participants perceived the program to be feasible, acceptable, and useful.

CONCLUSIONS

Initial experience with the Practical Approach program suggests that it may beneficially affect basic SDM knowledge, skills, and attitudes in busy practicing clinicians who are novices in SDM. It also has demonstrated initial feasibility, utility, and acceptability.

The Perspectives of Healthcare Professionals and Managers on Patient Involvement in Care Pathway Development: A Discourse Analysis

BACKGROUND

The WHO advocates patient and public involvement as an ethical imperative, due to the value of the lived experience of patients. A deeper understanding of the shared meanings and underlying beliefs of healthcare professionals and managers for and against including patients in care pathway development.

OBJECTIVE

To explore the considerations of healthcare professionals and managers on the involvement of patients and public in care pathway development.

METHODS

In a medical rehabilitation centre we conducted a single case study that was part of a 2-year action research programme on blended care pathway development. Following 14 semistructured interviews with healthcare professionals and managers, we analysed their discourses on the value of patient involvement as well as the potential threats and opportunities.

RESULTS

We identified four discourses. Patient as expert frames involvement as relevant, as adding new perspectives and as required to fully understand the patient's needs. Skills and representation is based on the construct that obtaining valuable insights from patients requires certain skills and competences. Self-protection focusses on personal, interprofessional objections to patient involvement. Professional knows best reveals expertise-related reasons for avoiding or postponing involvement.

CONCLUSION

These discourses explain why patient and public involvement in care pathway development is sometimes postponed, limited in scope and level of participation, and/or avoided. The following strategies might minimise the paralysing effect of these discourses: strengthen the capabilities of all stakeholders involved; use a mix of complementary techniques to gain involvement in distinct phases of care pathway development; and create/facilitate a safe environment. Put together, these strategies would foster ongoing, reciprocal learning that could enhance patient involvement.

PATIENT OR PUBLIC CONTRIBUTION

This study belonged to an action research programme on blended care pathway development (developing an integrated, coordinated patient care plan that combines remote, digital telehealth applications, self-management tools and face-to-face care). Multidisciplinary teams took a quality collaborative approach to quality improvement (considering patients as stakeholders) to develop 11 blended care pathways. Although professionals and managers were instructed to invite patients onto their teams and to attend care pathway design workshops, few teams (3/11) actually did. Unravelling why this happened will help improve patient and public involvement in care pathway development.

'Safety is about partnership': Safety through the lens of patients and caregivers

INTRODUCTION

Creating safer care is a high priority across healthcare systems. Despite this, most systems tend to focus on mitigating past harm, not creating proactive solutions. Managers and staff identify safety threats often with little input from patients and their caregivers during their health encounters.

METHODS

This is a qualitative descriptive study utilizing focus groups and one-to-one interviews with patients and caregivers who were currently using (or had previously used) services in health systems across Canada. Data were analysed via inductive thematic analysis to understand existing and desired strategies to promote safer and better quality care from the perspectives of patients and caregivers.

FINDINGS

In our analysis, we identified three key themes (safety strategies) from patients' and caregivers' perspectives and experiences: Using Tools and Approaches for Engaging Patients and Caregivers in their Care; Having Accountability Processes and Mechanisms for Safe Care; and Enabling Patients and Caregivers Access to Information.

CONCLUSIONS

Safety is more than the absence of harm. Our findings outline a number of suggestions from patients and caregivers on how to make care safer, ranging from being valued on teams, participating as members of quality improvement tables, having access to health information, having access to an advocate to help make sense of information and having processes in place for disclosure and closure. Future work can further refine, implement and evaluate these strategies in practice.

PATIENT OR PUBLIC CONTRIBUTIONS

An advisory group guided the research and was co-chaired by a patient partner. Members of the advisory group spanned patient and caregiver organizations and health sectors across Canada and included three patient partners and leaders who work closely with patients and caregivers in their day-to-day work. In the research itself, we engaged 28 patients and caregivers from across Canada to learn about their safety experiences and learn what safer care looks like from their perspectives.

Task Shifting and Task Sharing Implementation in Africa: A Scoping Review on Rationale and Scope

Numerous studies have reported task shifting and task sharing due to various reasons and with varied scopes of health services, either task-shifted or -shared. However, very few studies have mapped the evidence on task shifting and task sharing. We conducted a scoping review to synthesize evidence on the rationale and scope of task shifting and task sharing in Africa. We identified peer-reviewed papers from PubMed, Scopus, and CINAHL bibliographic databases. Studies that met the eligibility criteria were charted to document data on the rationale for task shifting and task sharing, and the scope of tasks shifted or shared in Africa. The charted data were thematically analyzed. Sixty-one studies met the eligibility criteria, with fifty-three providing insights on the rationale and scope of task shifting and task sharing, and seven on the scope and one on rationale, respectively. The rationales for task shifting and task sharing were health worker shortages, to optimally utilize existing health workers, and to expand access to health services. The scope of health services shifted or shared in 23 countries were HIV/AIDS, tuberculosis, hypertension, diabetes, mental health, eyecare, maternal and child health, sexual and reproductive health, surgical care, medicines' management, and emergency care. Task shifting and task sharing are widely implemented in Africa across various health services contexts towards ensuring access to health services.

'Learning and growing together': exploring consumer partnerships in a PhD, an ethnographic study

BACKGROUND

Consumer and community involvement (CCI) in health research is increasingly recognised as best practice and is closely linked with calls for epistemic justice and more transparent university collaborations with consumers. Given doctoral candidates play a key role in the future of co-production, examination of consumer partnerships in PhDs is important. This study aimed to describe and evaluate consumer partnerships in a PhD from the perspective of the consumer co-researchers, the PhD candidate, and the academic supervisors including optimal approaches, impacts, and benefits and challenges.

METHODS

This prospective, co-produced ethnographic study was conducted over 33 months. Data collection included field notes, a monthly online log of partnership experiences and time spent, interviews or a focus group every six months, and a PhD student reflexive diary. Qualitative data were analysed using reflexive thematic analysis.

RESULTS

The student, two academics, and four consumer co-researchers were involved. A mean of 11.10 h per month were spent on CCI. The student spent the most time (mean 15.86 h per month). Preparation for dissemination of findings was the most frequent partnership activity. The two overarching themes emphasised that a PhD promotes a rich partnership ethos with the student at the centre and that the partnership was a worthwhile but challenging process. The four sub-themes highlighted that developing a collegial and supportive environment with regular meetings combined with a multi-faceted and responsive co-learning approach were core to success. Additionally, there were benefits for individuals, research processes and outcomes, and for driving change in consumer-academic research partnerships. Recruiting to and forming the partnership, maintaining the collaboration through inevitable changes and challenges, and an ethical and supportive closure of the research team were critical.

CONCLUSIONS

This longitudinal ethnographic study demonstrated that doctoral research can create a rich ethos for research and knowledge co-production which evolved over time. Equalising power dynamics through relationship building and co-learning was critical. Additionally, a focus on supportively ending the partnership was essential, and CCI may reduce PhD student isolation and procrastination. Enhanced university incentivisation of co-production in health research is recommended to address gaps in consumer remuneration and student support.

The experience of patient partners in research: a qualitative systematic review and thematic synthesis

CONTEXT

Patient engagement in research consists in involving patients as partners across the research cycle. This practice has quickly become an international standard, with funding bodies actively encouraging it. As the increased incentive to engage patients can lead to tokenistic partnerships, it is important to consider the experiences of patient-partners.

OBJECTIVE

To synthesize the qualitative literature on the experience of patients as partners in research.

DESIGN

A systematic review of the literature with thematic synthesis was realized, guided by the framework developed by Thomas and Harden (Bmc Med Res Methodol 8: 45, 2008).

DATA COLLECTION

A search strategy was developed to encompass keywords relating to patient-partners in research, their experience, and the qualitative nature of the target studies. 10 databases were searched using the EBSCO-host engine, along with the Scopus engine to include EMBASE. The search results were screened for the following inclusion criteria: articles written in English; articles reporting on the experience of patient-partners in research; qualitative studies or mixed-methods studies with a distinct qualitative section.

ANALYSIS

Included articles were charted for general information. The CASP qualitative checklist was used for critical appraisal. The "results" section of each article was coded line by line. Codes were aggregated inductively to form descriptive themes and analytical themes, in order to synthesize the ideas found in the selection of articles.

RESULTS

The initial search yielded 10,222 results. After the removal of duplicates, 5534 titles and abstracts were screened, 88 full-text reports were evaluated, and 41 studies were included. Articles reporting on these studies were published between 2005 and 2020. Seven themes emerged from the analysis: "motivations to engage in research", "activities in patient engagement", "structure", "competence", "team dynamics", "impacts on broader life", and "illness". Articles reported varying degrees of perceived impact on research and satisfaction concerning the level of engagement. The importance of power differentials and team dynamics were widely stated.

CONCLUSIONS

Findings provide an in-depth view of the experiences of patient-partners in research. Most articles reported a generally positive experience, but challenges and pitfalls of patient engagement were identified. This will serve research teams by highlighting good practices and possible improvements.

Refining a capability development framework for building successful consumer and staff partnerships in healthcare quality improvement: A coproduced eDelphi study

BACKGROUND

The capability of consumers and staff may be critical for authentic and effective partnerships in healthcare quality improvement (QI). Capability frameworks describe core knowledge, skills, values, attitudes, and behaviours and guide learning and development at individual and organizational levels.

OBJECTIVE

To refine a capability framework for successful partnerships in healthcare QI which was coproduced from a scoping review.

DESIGN

A two-round eDelphi design was used. The International Expert Panel rated the importance of framework items in supporting successful QI partnerships, and suggested improvements. They also rated implementation options and commented on the influence of context.

PARTICIPANTS

Seven Research Advisory Group members were recruited to support the research team. The eDelphi panel included 53 people, with 44 (83%) and 42 (77. 8%) participating in rounds 1 and 2, respectively. They were from eight countries and had diverse backgrounds.

RESULTS

The Research Advisory Group and panel endorsed the framework and summary diagram as valuable resources to support the growth of authentic and meaningful partnerships in QI across healthcare contexts, conditions, and countries. A consensus was established on content and structure. Substantial rewording included a stronger emphasis on growth, trust, respect, inclusivity, diversity, and challenging the status quo. The final capability development framework included three domains: Personal Attributes, Relationships and Communication, and Principles and Practices. The Equalizing Decision Making, Power, and Leadership capability was foundational and positioned across all domains. Ten capabilities with twenty-seven capability descriptions were also included. The Principles and Practices domain, Equalizing Decision Making, Power, and Leadership capability, and almost half (44.4%) of the capability descriptions were rated as more important for staff than consumers (p < .01). However, only the QI processes and practices capability description did not meet the inclusion threshold for consumers. Thus, the framework was applicable to staff and consumers.

CONCLUSION

The refined capability development framework provides direction for planning and provision of learning and development regarding QI partnerships.

PATIENT OR PUBLIC CONTRIBUTION

Two consumers were full members of the research team and are coauthors. A Research Advisory Group, inclusive of consumers, guided study execution and translation planning. More than half of the panel were consumers.

Different in so many ways: Exploring consumer, health service staff, and academic partnerships in a research advisory group through rapid ethnography

INTRODUCTION

Consumer and community involvement (CCI) encompasses the range of consumer engagement activities across the research cycle. Research advisory groups (RAGs) are a common method of CCI that may empower the consumer voice in research. However, there is limited evaluation of RAGs to guide occupational therapists considering this as a CCI strategy in research. The aim of this study was to explore the processes and outcomes of a RAG partnership for an eDelphi study.

METHODS

Rapid ethnography enabled a rich, thick description of the RAG through triangulation of field notes, a monthly research team log, focus groups, and an individual interview. Data were analysed using reflexive thematic analysis. Recruitment targeted consumers, health service staff, and academics with experience in CCI to enhance the diversity of perspectives guiding the eDelphi study. The RAG met four times over 4 months.

FINDINGS

Seven diverse RAG members were recruited resulting in a RAG of 12 members, including the research team that included two consumers. Reflexive thematic analysis resulted in an overarching theme: Different in so many ways, which reinforced that authentic CCI in research continues to be rare even for stakeholders with experience in CCI. There were four subthemes: Set up for success, Authentic and capable facilitation, Structures and strategies for genuine partnerships, and A ripple effect of benefits. Findings added to the limited research regarding RAGs and highlighted that a short-term RAG with 12 diverse stakeholders was an effective strategy to foster mutually beneficial and meaningful collaboration. Partnering with two consumer co-researchers in RAG planning, implementation, and evaluation was central to success.

CONCLUSION

Findings demonstrated that with careful co-planning and recruitment, capable facilitation with support of a committed research team (inclusive of consumers), and empowering meeting processes and structures, a short-term RAG resulted in many benefits to participants and enhanced research outcomes.