Patient as Participant by bum19821

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									Patient as Participant


     European Society for
     Quality in Healthcare
       3rd Spring Workshop
          May 17th 2001
         Balaton, Hungary

                        Stiofan deBurca
                        President ESQH
Participation – The Individual


Enabling an active role in the care process.

Need
Traditional engagement of the ‘subject’ as an ‘object’
in his/her management.
Increasing awareness through multi-media exposure,
education and expectations.
Medico-legal culture of litigation.
Purpose


  Shared ownership of process and outcome.
  Personal responsibility and reducing professional
  liability.
  Informed choices on needs v wants
Action


 Partnership approach:
    shared knowledge and information.
    collaborative decision making.
 Input to care planning and implementation:
    influencing the provider
    consultation and user perspective
 Care pathways.
Intervening Conditions


  Knowledge, skills and power differentials
  User v Expert Provider
  Dependency role and passivity.
  Ownership of illness and intervention.
  Expectations v Realities.
  Audit – quality – governance limitations
Intervention Strategy


Assured information re. condition.
Routine supported access to recorded information – use
of in decision process.
Supportive culture and policies in the health care system
i.e. partnership through positive action and behaviour.
Participation: patients/users


  The Conditional Matrix
  Society and the role of the Professions:
     Power, dominance and control
     Empowerment, ownership
       involvement
       participation
       sharing...
  Participation: patients/users


Conditional Matrix continued…
Clinical autonomy and the professional bureaucracy.
Politics of representation and expert roles
   priorities
   interests
   influences
Distribution – quality and inequality.
Relevance responsiveness and rigour in healthcare systems.
Dimensions of Consumerism
and Advocacy


Individual patient level
Service development level.
Strategic policy level.
National level
Underpinning principles


Citizens rights and responsibilities
  own health and well-being
  worthy of respect.
Facilitated dialogue at every level in the process
  working in partnership: a process of mutual discovery
  and informed consent...
  Underpinning principles continued…


Manage one’s own life and health journey in ever changing
environments
    develop care competencies
    challenge the dominant dependency culture
Co-operation within user and carer groups and across
traditional service boundaries
    flexible co-operation: challenge to blame and shame
    culture. (Sang, 2000).
   WHO: Health for All by the Year 2000

Equity
Health promotion and prevention of disease
Health for all will be achieved by the people themselves.
 A well informed, well motivated and actively participating
community is a key element for the attainment of the common
goal.
Co-ordinated action of all sectors
Focus on primary health care
Consulting Communities


 Qualitative and quantitative    Consumer appraisal/audit
  questionnaire surveys           Patient participation groups
 Interviews                      Consumer panels and health
 Critical incident techniques     forms
 Observation                     Social marketing
 Mystery client                  Community health projects
 Focus groups                    Rapid appraisal techniques
  Change Agents:
  Create and sustain partnerships


Enablers: managers and professionals (authority, control –
power, diversity) new approaches to leadership and
stewardship.
Practitioners: mutual dependency – potential co-workers.
Facilitators: independent development workers.
Influencers: educators, communicators
Change Practice


  Participatory Action Research.
  Consumer Advocacy Group on Clinical
  Trials.
  Long-term medical conditions alliance.
  Cancer-link.
  Patient Partnership Strategy

								
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