title: Optimizing patient involvement in quality improvement.
abstract: BACKGROUND
  Patient and public involvement in healthcare planning, service development and health-related research has received significant attention. However, evidence about the role of patient involvement in quality improvement work is more limited. We aimed to characterize patient involvement in three improvement projects and to identify strengths and weaknesses of contrasting approaches.
  
  
  METHODS
  Three case study quality improvement projects were purposively sampled from a broader programme. We used an ethnographic approach involving 126 in-depth interviews, 12 weeks of non-participant observations and documentary analysis. Data analysis was based on the constant comparative method.
  
  
  RESULTS
  The three projects differed in the ways they involved patients in their quality improvement work, including their rationales for including patients. We characterized three very different models of patient involvement, which were each influenced by project context. Patients played distinctive roles across the three projects, acting in some cases as intermediaries between the wider patient community and clinicians, and sometimes undertaking persuasive work to convince clinicians of the need for change. We identified specific strategies that can be used to help ensure that patient involvement works most effectively and that the enthusiasm of patients to make a difference is not dissipated.
  
  
  CONCLUSIONS
  Patient involvement in quality improvement work needs careful management to realize its full potential.
authors: Department of Health Sciences, University of Leicester, Leicester, UK. na144@le.ac.uk
authors: Natalie
authors: N
authors: Armstrong
authors: Georgia
authors: G
authors: Herbert
authors: Emma-Louise
authors: EL
authors: Aveling
authors: Mary
authors: M
authors: Dixon-Woods
authors: Graham
authors: G
authors: Martin
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000628:therapy; D003142:Communication; D006801:Humans; D009369:Neoplasms / Q000628:therapy; D019982:Organizational Case Studies; D010358:Patient Participation / Q000379:methods*; D058996:Quality Improvement / Q000458:organization & administration*; D011787:Quality of Health Care / Q000458:organization & administration; D051436:Renal Insufficiency, Chronic / Q000628:therapy
keywords: United Kingdom; patient and public involvement; patient and public participation; patient safety; qualitative research; quality improvement
references: J Public Health Policy. 2002;23(1):12-32
references: 12013713
references: Soc Sci Med. 2008 Dec;67(11):1757-65
references: 18922611
references: BMJ. 2012 May 10;344:e3164
references: 22577188
references: J Health Organ Manag. 2012;26(2):158-74
references: 22856174
references: Soc Sci Med. 2002 May;54(10):1471-80
references: 12061482
references: Qual Saf Health Care. 2002 Mar;11(1):76-80
references: 12078376
references: Int J Qual Health Care. 2008 Dec;20(6):373-4
references: 18836184
references: Sociol Health Illn. 2008 Jan;30(1):35-54
references: 18254832
references: Health Expect. 2008 Mar;11(1):72-84
references: 18275404
references: Milbank Q. 2011 Jun;89(2):167-205
references: 21676020
references: J Health Serv Res Policy. 2010 Jan;15 Suppl 1:11-6
references: 20075122
references: J Health Serv Res Policy. 2010 Jan;15 Suppl 1:17-25
references: 20075123
references: Ann Intern Med. 2011 May 17;154(10):693-6
references: 21576538
references: Sociol Health Illn. 2011 Nov;33(7):1050-65
references: 21668454
references: Qual Saf Health Care. 2008 Apr;17(2):82-3
references: 18385398
references: Cochrane Database Syst Rev. 2006 Jul 19;(3):CD004563
references: 16856050
references: Qual Saf Health Care. 2010 Dec;19(6):e33
references: 21127092
references: BMJ Qual Saf. 2012 Oct;21(10):876-84
references: 22543475
references: BMJ. 2007 Jan 20;334(7585):129-32
references: 17235094
references: Soc Sci Med. 2003 Jul;57(2):239-51
references: 12765705
references: BMJ. 2008 Feb 9;336(7639):286-7
references: 18230645
references: Soc Sci Med. 2004 May;58(10):1973-84
references: 15020013
references: BMJ. 2008 Feb 9;336(7639):313-7
references: 18230646