The balcony of personal reflection is alive with conversation and information is flowing freely. Like many healthcare professionals with administrative responsibilities, we talk about the challenging task of bringing together and engaging a range of stakeholders on quality projects and initiatives. Recognizing the importance of engagement to quality improvement we ask – at the workplace, at the transition of care points, at the provider and patient interface – do healthcare organizations have:

1. Appropriate forums to express concerns and improvement ideas?; and
2. Appropriate mechanisms for ideas, inputs, feedback and response loops?  

The Ghost of Healthcare Consciousness adds a perspective:

“What I see is this … all too often healthcare providers and patients are presented with opportunities to provide insight into how our healthcare system can be improved but with little or no communication regarding follow-up. While initially engaged and eager to voice improvement ideas, following responses to initial calls for input, patients and providers participating in improvement-oriented activities, such as system reviews, are often removed (purposely or not) from the communication ‘loop.’ When this happens they essentially become but a touch point or tick-box in the improvement process and may never know, for better or worse, what happened to projects and initiatives they worked on and contributed to. This one-way street of communication can and has, in many cases, resulted in a rift between those who are trying to develop and implement solutions to quality and patient safety, and those receiving and delivering care. As a consequence, continued attempts to engage patients and providers are often met with resistance and responses along the lines of ‘why should I participate in a learning review, document safety concerns or provide my input if nothing is going to be done to resolve issues which are identified through these mediums?’”

Sadly, the only response to this is to say that I/we are sorry for past experiences and that in this case I/we will follow up with them to provide updates on the status of initiatives (this time).

In attempts to increase engagement for quality improvement purposes, the Quality and Safety department at Vancouver Island Health Authority (VIHA) holds debriefing sessions with individuals who engage in activities such as reviews and distributes learning summaries for wider organizational learning. They also contribute to departmental and organizational newsletters that are distributed to staff which outline developments and accomplishments. This work aims to close the communication loop, holds long-term benefits in the form of trust, rapport and future access to the hearts and minds of patients and professionals alike.

Taking actions consistent with VIHA’s efforts, which aim to maintain an open, ongoing, timely dialogue with stakeholders (e.g., to keep individuals informed of actions that are being taken to resolve identified issues, and rationale for why actions may be delayed or are not being taken) can help organizations maintain access to the hearts and minds of individuals who are willing, and able, to provide insight and expertise to solve healthcare problems. Without some form of informational bridge, patients and providers may become disengaged with quality efforts and consider them to be little more than an occupational requirement, rather than an opportunity for sharing, learning and improvement.

If organizations are to build an informational bridge between patients, providers and administration, it is important that provider engagement, and especially patient engagement, not simply be viewed as a box that needs to be checked on a project plan, or an activity or even set of activities that needs to be completed for program development or process improvement. Said another way, it needs to be more than a conversation that occurs at one point in time. Rather, engagement needs to be open, ongoing (e.g., two-dimensional with multiple touch points and opportunities for feedback) and at the epicentre of improvement projects. It has been our experience that those organizations that build a passion and commitment for an unrelenting focus upon the patient, and work to engage patients (as well as providers) throughout improvement projects, lead the way in both patient satisfaction and performance outcomes. It is time to place “patient expectations” at the top of the improvement pyramid and at the centre of quality initiatives. 

As you organize improvement efforts, we pose three questions for your consideration:

1. Is the “patient experience” at the top of your improvement pyramid or the centre of your quality initiative?
2. Is there a difference between patient communications, patient conversations and patient voices?
3. Do you accept that patients and families are the “owners” of the healthcare system? If you accept this, what rights do they have as owners?

We close with a passage from the essay, “The Patient Voice A Value Game Changer,” that, similar to this essay, calls for open channels for information to flow, transparency in messaging and continuous engagement:

“One way to speed up the transformation of your organization on the path to patient-centred care is to involve patients (current and former) and their family members on the teams responsible for planning, implementing and evaluating safety and quality initiatives. The insights these volunteers bring to the table can be worth their weight in gold. While it is true that healthcare workers are also patients themselves (or at least potential patients), this role usually takes a back seat when they are at work because of their professional responsibilities and perspectives. Engaging with patients and family members who have been harmed by healthcare can be particularly rewarding because their motivation to partner with your organization is likely to be very strong. Generally the impetus for them to work with healthcare providers is a desire to make sure that what happened to them (or their loved ones) never happens to anyone else. As organizations experiment with new ways to include the patient voice, they may begin to question old ways of doing things and make breakthroughs in improving patient safety and quality. Bottom line: there is simply no better way to ensure that the patient perspective is reflected in your work than to include them, listen to their input and respect their unique contributions.”

Join next week’s conversation titled: “Do You Work Well With Others? It Depends On Who You Ask”

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