Patient and family engagement in hospital planning and improvement enhances health care delivery and outcomes for both patients and hospitals, and ultimately, for hospital users. However, a number of barriers can result in token engagement.
A research team led by Dr. Anna Gagliardi of the Toronto General Hospital Research Institute and funded by the Canadian Institutes of Health Research, studied how to optimize patient/family engagement in hospitals. The two-year, multiple-methods study yielded the following findings:
A cross-sectional survey of Ontario hospitals (n=91, 66% response rate) found that even small hospitals with few dedicated resources achieved high capacity for engagement. This was characterized by engagement in many departments or projects, and greater use of active rather than passive modes of engagement.
Qualitative interviews with 40 patient/family advisors, engagement managers, clinicians and executives from nine hospitals with high patient engagement capacity (2 <100 beds, 4 100+ beds, 3 teaching) identified:
Numerous strategies to support engagement. For example: engage diverse advisors, match advisors to projects, train advisors and staff, involve a critical volume of advisors, quorum for decision-making requires at least one advisor, involve staff champions, and link advisor activities to the Board
Essential components of hospital capacity for engagement: (1) Resources – dedicated funding, people and technology to support engagement; (2) Training – orientation and training for patient/family advisors, and for new and existing staff on how to engage with advisors; and (3) High-level commitment – endorsement from the CEO and Board
Benefits associated with engagement: Nine impacts on hospital capacity for patient engagement (e.g., developed new engagement approaches, staff grew to value and support engagement) and 14 outcomes at the patient (e.g., improved healthcare experience, and decreased wait times, falls and readmissions), clinician (e.g., greater ease for staff in fulfilling job requirements) and hospital level (e.g., new policies and programs).
Three factors led to dissatisfaction and high turnover among advisors: conflicting expectations, overly frequent deployment, and lack of payment. One interviewee noted, "It's a gaping hole in engagement that the only person in the room not being paid to be there is the patient, whose voice is apparently critical to the work. The advisors at my hospital essentially pay to volunteer. They pay their mileage or their time, they take time off work, they may pay for babysitters."
We compiled this knowledge into 50 strategies rated by 22 patient/family advisors and 36 engagement managers, clinicians, executives and researchers, resulting in consensus on 32 strategies across 5 domains: 5 engagement approaches, 4 strategies to integrate patient/family perspectives, 9 strategies to enable meaningful engagement, 9 strategies by which hospitals can champion patient engagement, and 5 essential elements of hospital capacity for patient engagement [under review].
This research culminated in a casebook which highlights key findings and offers 40 one-page, project-specific cases derived from the aforementioned interviews featuring processes, enablers and impacts of patient/family engagement. A summary of the casebook offers a snapshot of the findings.
For more information, please contact anna.gagliardi@uhnresearch.ca.