Patient Participation Boosts Physician Practice Quality Efforts

Quality improvement teams at physician practices generate gains from including patient partners in the efforts. 

Including patient representatives in quality improvement efforts at physician practices benefits both the patient partners and the practices, according to research being published next month.

For patient partners, three quarters of those surveyed reported that they were better advocates for their own healthcare, two thirds reported being more in tune with their health, and more than half reported that being a patient partner improved their caregiving for family members.

For physician practices, 8 out of 10 quality improvement team leaders surveyed reported that patient partners made improvement efforts more patient-centered, 43% of respondents reported that patient partners impacted the implementation of new policies and initiatives, and 35% of respondents reported that patient partners had made suggestions to improve practice communication with patients.

The research, which is being published in The Joint Commission Journal on Quality and Patient Safety, is based on data collected from 2011 to 2016, mainly from patient partners and quality improvement team leaders. The data includes focus groups, in-depth interviews, and online surveys.

The primary focus of the research, titled "How Patient Partners Influence Quality Improvement Efforts," is the patient partner program at Aligning Forces for Quality-South Central Pennsylvania. AF4Q SCPA is a healthcare improvement organization originally funded by the Robert Wood Johnson Foundation and supported now by WellSpan Provider Network, an ACO where most of the AF4Q SCPA patient partners volunteer.

In 2011, AF4Q SCPA started its patient partner program with 14 volunteers in seven physician practices. Last year, there were 77 patient partners working with 45 practices.

AF4Q SCPA is based in York, Pennsylvania, and has patient partners at physician practices spread across four counties: Adams, Lancaster, Lebanon, and York.

Having Impact

The researchers found there are three primary methods for patient partners to impact quality improvement efforts:

• Providing feedback
• Making suggestions
• Symbolism associated with being part of the team

About 91% of patient partners reported being asked for feedback on written materials for patients, which often involved review of draft informational or educational documents. The same percentage of patient partners reported being asked for feedback on new policies or initiatives at a practice.

The researchers found patient partners most often made suggestions in four areas: practice communication with patients, educational materials, physical space, and clinical care processes.

The most common area of suggestion was improving communication with patients, such as the welcoming of patients. "Several patient partners encouraged staff to acknowledge patients when they entered, even if they were on the phone; to be friendlier; and to be clear with patients when they have an extended wait," the researchers wrote.

There is powerful symbolism in having patients represented at office meetings or during conference calls, quality improvement team leaders reported.

"The discussion changes when you have a patient in the room because then it really re-centers you on what you should be doing," an improvement team leader told researchers.

Lessons Learned

The researchers drew three lessons from the study:

• Quality improvement team leaders reported that patient participation in improvement efforts was essential to incorporate the patient perspective. Patient partners also advocate for broad patient interests and serve a symbolic role in patient-centered care.
   
• Development of patient partner programs requires time and support. For patient partners, it can take time to learn medical vocabulary. For improvement team leaders, integrating patient partners into decision making is new and unfamiliar, including transparency with patients about troubled areas.
   
• Effort is required to recruit patient partners who are demographically representative of a physician practice's patient population.