title: Subjective experience or objective process: understanding the gap between values and practice for involving patients in designing patient-centred care.
abstract: OBJECTIVE
  Patient-centred care and patient involvement are increasingly central concepts in health policy in the UK and elsewhere. However, there is little consensus regarding their definition or how to achieve "patient-centred" care in everyday practice or how to involve patients in service redesign initiatives. The purpose of this paper is to explore these issues from the perspective of key stakeholders within National Health Service (NHS) hospitals in the UK.
  
  
  METHODS
  Semi-structured interviews, covering a range of topics related to service redesign, were conducted with 77 key stakeholders across three NHS Trusts in the West Midlands. In total, 20 of these stakeholders were re-interviewed 18 months later. Data were managed and analysed using the Framework Method.
  
  
  RESULTS
  While patient-centred care and patient involvement were regularly cited as important to the stakeholders, a gap persisted between values and reported practice. This gap is explained through close examination of the ways in which the concepts were used by stakeholders, and identifying the way in which they were adapted to fit other organizational priorities. The value placed on positive subjective experience changed to concerns about objective measurement of the patients as they move through the system.
  
  
  CONCLUSIONS
  Increased awareness and reflection on the conceptual tensions between objective processes and subjective experiences could highlight reasons why patient-centred values fail to translate into improved practice.
  
  
  CONCLUSIONS
  The paper describes and explains a previously unarticulated tension in health organisations between values and practice in patient centred care and patient involvement in service redesign.
authors.forename: Laura
authors.initials: L
authors.lastname: Lord
authors.forename: Nicola
authors.initials: N
authors.lastname: Gale
mesh_terms: D001291:Attitude of Health Personnel; D006740:Hospital Administrators / Q000523:psychology; D006779:Hospitals, Public; D006801:Humans; D008505:Medical Staff, Hospital / Q000523:psychology; D010358:Patient Participation; D018802:Patient-Centered Care / Q000458:organization & administration*; D016730:Program Development; D019727:Proxy / Q000523:psychology; D036301:Qualitative Research; D013222:State Medicine; D006113:United Kingdom