Role

Topics to include:

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Roles of stakeholders
Identify your stakeholders – are they supportive to your project?
List of stakeholders who will be interested in the results of your project
Promoting stakeholder participation
Possible concerns/barriers from stakeholders
Strategies that you will use to gain support and assistance from your stakeholders
Expectations

Length: 3-4 pages
Format: APA 6th ed.
Research: At least one peer reviewed reference within the last 5 years Role And Engagement Of Stakeholders in Hospitals Essay

Engaging patients in the planning, delivery and evaluation
of health policy and healthcare provision is becoming an
accepted approach to improve healthcare delivery and
increase decision-making transparency1,2,
decision-making, described as a collaborative experience
involving patients and providers, where patients play an
active role in healthcare decisions, supports a healthcare
system to deliver more prompt and safer care
multiple methods and approaches to engage patients in
decision-making that range from basic levels of
involvement (e.g. completion of a survey) to meaningful
and influential levels of engaged participation (e.g.
membership on an advisory committee or council). The
International Association of Public Participation (IA
has defined these levels on a spectrum of participation
They demonstrate five levels of participation progressing
from inform in which little or no active patient participation
occurs (e.g. receiving information via a website, forum or
other source) to empower in which the goal is to place the
decision in the hands of patients (e.g. having an equal vote
on decision-making committees)5
. While no part of the
spectrum is more important than the other, selection of
Spring 2015, pp. 18-28
Spring 2015
. Published in association with The Beryl Institute and Patient Experience Institute
ffective patient engagement: What matters most to
Alberta Health Services, mandy.bellows@albertahealthservices.ca
University of Alberta, kathy.kovacsburns@ualberta.ca
Formerly of Alberta Health Services
Alberta Health Services, brae.surgeoner@albertahealthservices.ca
Alberta Health Services, jennifer.gallivan@albertahealthservices.ca
To determine what resources, preparation, and support are needed for patients, providers, and leaders to meaningfully and
centred health system redesign, researchers sought to learn what really matters to these three
stakeholder groups. A qualitative descriptive design was selected using purposive participant samp
and ‘why’ questions pertaining to stakeholder perceptions about patient engagement in their specific context as
patients, providers or leaders. Four project groups were selected; each group was responsible for a strategic initiative with
Alberta Health Services and represented one of three different levels of the healthcare system (i
structured question guides were used to collect data. Thematic analysis of the transcribed participant
responses revealed eleven major themes: understanding patient engagement; language, communication,
and retention; roles, responsibilities and expectations; reason for being; expen
structure; knowing who’s who; and evaluation. Patients, Role And Engagement Of Stakeholders in Hospitals Essayproviders and leaders agreed to the
importance of communication around the reasons for patient engagement including building trust through collaboration
eir roles and responsibilities. These stakeholder perspectives are needed to inform the
and education materials required to support patient engagement activities tailored to the
needs, understandings and perspectives of stakeholders.
experience, qualitative, thematic analysis
Engaging patients in the planning, delivery and evaluation
of health policy and healthcare provision is becoming an
approach to improve healthcare delivery and
,3
. Shared
making, described as a collaborative experience
ents and providers, where patients play an
active role in healthcare decisions, supports a healthcare
system to deliver more prompt and safer care4
. There are
multiple methods and approaches to engage patients in
making that range from basic levels of
involvement (e.g. completion of a survey) to meaningful
and influential levels of engaged participation (e.g.
membership on an advisory committee or council). The
International Association of Public Participation (IAP2)
has defined these levels on a spectrum of participation5
.
They demonstrate five levels of participation progressing
in which little or no active patient participation
occurs (e.g. receiving information via a website, forum or
in which the goal is to place the
decision in the hands of patients (e.g. having an equal vote
While no part of the
spectrum is more important than the other, selection of
activities is dependent on the goal of patie
or engagement.Role And Engagement Of Stakeholders in Hospitals Essay
Some approaches in service planning are considered by
patients as being tokenistic, where, “most activities are
limited to various forms of consultation, rather than
interactive partnerships as are advocated for treatment
decision making”1
. However, “if healthca
patient-centered, patients must be provided with
opportunities to influence the organization and delivery of
services through involvement in services planning or
evaluation”1
. This paper explores these views with various
stakeholders in one large health system, Alberta Health
Services (AHS) in Alberta, Canada.
patients, healthcare providers and leaders are analyzed
regarding what matters most to them about patients
participating or being engaged in healthcare delivery
decisions.
AHS defines engagement as “a broad practice of two
interaction guided by a set of princi
activities that provide an opportunity for stakeholders to
be involved in meaningful interactions.
considers and incorporates the values and needs of
18
What matters most to
To determine what resources, preparation, and support are needed for patients, providers, and leaders to meaningfully and
to learn what really matters to these three
stakeholder groups. A qualitative descriptive design was selected using purposive participant sampling, focusing on ‘who’,
t in their specific context as
patients, providers or leaders. Four project groups were selected; each group was responsible for a strategic initiative within
Alberta Health Services and represented one of three different levels of the healthcare system (i.e. program, site or
structured question guides were used to collect data. Thematic analysis of the transcribed participant
ication, information; level
and expectations; reason for being; expense; time
Patients, providers and leaders agreed to the
importance of communication around the reasons for patient engagement including building trust through collaboration and
r perspectives are needed to inform the
and education materials required to support patient engagement activities tailored to the
activities is dependent on the goal of patient participation
service planning are considered by
patients as being tokenistic, where, “most activities are
limited to various forms of consultation, rather than
interactive partnerships as are advocated for treatment
However, “if healthcare is to be truly
centered, patients must be provided with
opportunities to influence the organization and delivery of
services through involvement in services planning or
This paper explores these views with various
olders in one large health system, Alberta Health
vices (AHS) in Alberta, Canada. The perspectives of
healthcare providers and leaders are analyzed
regarding what matters most to them about patients
participating or being engaged in healthcare delivery
AHS defines engagement as “a broad practice of two-way
interaction guided by a set of principles, processes and
activities that provide an opportunity for stakeholders to
interactions. Engagement Role And Engagement Of Stakeholders in Hospitals Essay
considers and incorporates the values and needs of
Meaningful and effective patient engagement, Bellows et al.
19 Patient Experience Journal, Volume 2, Issue 1 – Spring 2015
patients, clinicians and communities into health service
decision-making to enhance transparency and
accountability”6
. Within AHS, engagement is supported
and advanced across the province by a Patient
Engagement Department. To further support patient
engagement within AHS, a study7
was conducted to gather
stakeholder insights on what patient engagement means
and what is required to make patient engagement
successful. More specifically, the study sought to
determine what resources (i.e. tools), preparation (i.e.
education), and support (i.e. infrastructure) are needed for
healthcare providers and leaders to meaningfully and
appropriately engage patients in patient-centred health
system design. What does patient engagement mean to
patients, providers and leaders? What assumptions do they
make about patient engagement? What do they feel is
needed to make patient engagement successful and
meaningful? And generally, what really matters to
stakeholders?
Methods
Methodology
A qualitative research design was selected for this study to
understand and describe the ideas, beliefs and experiences
of three stakeholder groups – patients, providers and
leaders. The study was pragmatic, used purposive
participant sampling, focused on ‘who’, ‘what’ and ‘why’
questions pertaining to stakeholder perceptions about
patient engagement in their specific context as patients,
care providers or leaders and was conducive to flexible
coding and thematic data analysis, as well as descriptive
and interpretative analysis8,9. Details of this methodology
are described elsewhere10
.
Setting
The study was conducted in AHS, Canada’s first provincewide, fully integrated health system. The organization
employs over 104,000 staff members and is responsible for
delivering health services to approximately 4 million
people. The mission of the organization is to provide a
patient-focused, quality health system that is accessible and
sustainable for all individuals in the province. Research
ethics committees from the University of Alberta,
University of Calgary and the Community Research Ethics
Board of Alberta approved the study.Role And Engagement Of Stakeholders in Hospitals Essay
Participants
Purposive sampling was used to select four project groups,
each responsible for a strategic initiative within AHS.
Participating project groups were selected based on the
following criteria: have patient, provider and leader
membership; hold regular meetings (continual patient
involvement); and focused at a different organizational
level (i.e. program, site, governance). Additional criteria
included that group sizes would vary, as would their length
of operation. All members of the groups were provided
with a high-level overview of the study and informed of
the time and effort requested of them to participate.
Individual and Group Interviews
Patient, provider and leader participants were given the
option to complete interviews individually or in a group
setting with other similar representatives. Semi-structured
question guides were used to collect data, allowing for
several key open-ended questions while allowing the
interviewer to probe for relevant topics that would
elaborate on specific comments made by participants
during the interviews8,9. Questions focused on initiative
purpose, individual and group characteristics, group
dynamics (i.e. participation, interactions, power, influence),
participants’ definitions of patient engagement including
type or level of engagement, perceptions of supports and
challenges related to patient engagement including
resources and preparation, participants’ roles and
responsibilities within each group and perceptions of
evaluation of engagement of patients members in the
group. Participant consent was obtained before each
interview. The duration of individual interviews ranged
from 30 to 60 minutes while group interviews ranged
between 60 and 90 minutes. A trained interviewer carried
out all interviews, which were audio recorded and
transcribed verbatim.

NOW

Data Analysis
Interview data were coded by one of three members of the
research team using a coding framework. The framework
was developed through a series of steps that began with
the researchers independently coding a few select
interviews, with an eye to identifying underlying concepts.
Next, the researchers met to compare and discuss the
concepts they had identified and then, agreed on which of
these would form the basis of the coding framework. All
interviews were then coded using the coding framework.
Subsequently, thematic analysis within each code allowed
for an exploration of emergent themes and recurring
patterns within each strategic initiative and across
initiatives. Thematic analysis captures meaningful
segments for comparing and contrasting across
initiatives11. To ensure trustworthiness of the data, two
research team members reviewed each data set.
Specifically, data were extracted and analyzed by one team
member and a second team member validated the
emerging themes. Discrepancies were reconciled through
discussion between the two research team members.Role And Engagement Of Stakeholders in Hospitals Essay
Once the analysis of each stakeholder group was
completed, findings were compared across the stakeholder
groups as well as across the four initiatives to understand
commonalities and differences. A final component of
analysis included presenting an account of the analysis
through a written summary and face-to-face discussion
with the larger research team. This allowed for review and
Meaningful and effective patient engagement, Bellows et al.
Patient Experience Journal, Volume 2, Issue 1 – Spring 2015 20
revision of data analysis and contributed to further data
synthesis.
Results
Project groups involved in the study ranged in
membership size from 10 to 40 members; length of
operation from six months to four years; and level of
organization from program, to site, to governance. In
total, 28 participants consented to be interviewed: 17
patients, three providers and eight leaders (see Table 1).
Some participants spoke about the initiative they were
directly participating in while others spoke about patient
engagement generally and described past or ideal
engagement experiences. Thematic analysis of the
transcribed participant responses revealed a number of
common sub-themes and eleven major themes:
understanding patient engagement; language,
communication and information; level and timing of
engagement; recruitment and retention; roles,
responsibilities and expectations; reason for being;
expenses; time commitment; governance and structure;
knowing who’s who; and evaluation. The major themes
and common sub-themes are shown in Table 2.
Understanding Patient Engagement
Participants provided their interpretations of what patient
engagement meant to them using a variety of terms
including, “patient feedback”, “patient experience”, “patient and
family centred care”, “involvement” and “meaningful engagement”.
Some participants used the terms interchangeably whereas
others were very specific in their articulation of the
definition and what assumptions and expectations they
had of patient engagement. Patients generally described
engagement as being free to identify issues or influencing
decisions within the healthcare system and being involved
in the development and evaluation of programs.
Providers viewed patient engagement as a partnership with
patients across the organization and at multiple levels
within the organization:
“It’s making sure that as an organization we
systematically involve people who are receiving our services
in all levels of planning, organizing and delivering at the
point of care. So it’s working on all the different levels,
having patients and families at all those levels. That’s to
me what it is and doing that in a way that promotes really
encouraging those partnership practices across the
organization at all different levels”.
Leaders emphasized that patient engagement needs to be
meaningful and not insincere or tokenistic, “… and not just
giving lip service to setting up an advisory group, but actually
integrating them into interviewing staff, being part of your strategic
planning sessions, all of those kinds of things.”Role And Engagement Of Stakeholders in Hospitals Essay
Language, Communication and
Information
Participants spoke about the use of jargon and the
preferred mode, type and amount of information
provided. Patients focused on the importance of meeting
face-to-face and receiving information ahead of time to
facilitate their preparedness for project meetings. They
also commented on the use of appropriate language:
“Communication skills [are critical] because healthcare
professionals talk in a language that’s sometimes very
different…Very different than what the average [patient]
can understand. They have to let go of the medical jargon
and explain things to people”.
Provider comments focused on meeting individual needs
when communicating and the importance of multiple
forms of communication (e.g. in person, email, phone,
etc.). Providers also spoke about the concept of
confidentiality and discerning what is appropriate to share
with patients:
“These [patient members] have all signed confidentiality
agreements, but I think in the future, at some point, we’ll
need to make a decision about what can we share with
them and what we can’t share with them? Those are still
untested waters in many respects”.
Leaders too, focused on confidentiality and restricting the
use of “health” speak – that is not using jargon or rather,
speaking in a way patients and family members can
understand. They also focused on being conscientious of
what is shared with patients.
Level & Timing of Engagement
Participants were asked about the level and timing of
patient engagement in their project as outlined by the
IAP2 Spectrum of Engagement5
. Generally, comments
focused on specific or clear expectations on the type and
level of involvement to ensure engagement interactions are
meaningful.Role And Engagement Of Stakeholders in Hospitals Essay
Patients focused on whether they felt the timing of their
engagement experience was appropriate as they reflected
on the stage, or timing of events during which they were
brought into the discussions. In contrast, provider
participants concentrated on the task at hand, or what they
needed to have patient input on, before completing that
task. Providers also communicated a concern for short
project timelines, which they felt could contribute to
tokenistic engagement:
“I believe that there are still pockets of being at the
informing [level]. Rubber-stamping… Not on the part of
the leaders involved in this initiative, but on the part of
people trying to approach this group. The challenge is how
to respectfully pushback and say ‘sorry you can’t just come
Meaningful and effective patient engagement, Bellows et al.
21 Patient Experience Journal, Volume 2, Issue 1 – Spring 2015
and expect a green light’; a tick box that you’ve done this
[engaged with patients]”.
Leader comments reinforced the issue of short timelines
and affirmed the importance of being honest with
stakeholders about how their input would be included in
the final decision.
Recruitment & Retention
Participants remarked on the sub-populations represented
within their committees including the individual
characteristics and experiences of members. They also
focused on the length of membership, ensuring that the
work was meaningful and appropriate for the stakeholders
involved.
Patients commented frequently on the demographic
strength or gap of patient stakeholders such as their
ethnicity, age, gender and healthcare experience:
“We know there are people who are not represented, such
as the homeless, First Nations, different ethnic
backgrounds, which doesn’t have to mean race, but just
different experiences (e.g. recent immigrants). So there is
some cross-section missing. Although the group is not firm
and fixed; there is some recruiting that they’re still doing
and that kind of thing”.Role And Engagement Of Stakeholders in Hospitals Essay
Providers similarly suggested having a mixed
representation of stakeholders of varying demographic
background. They also made comments on recruitment
approaches and being conscious of the patient’s individual
healthcare experience. Leaders also focused on recruiting a
mix of members – while ensuring those members can
meaningfully contribute to the issue. Leaders commented
frequently on the need for members to be emotionally and
physically ready to contribute to healthcare improvement:
“The biggest disservice you could do for someone is to
onboard them in an advisory capacity when they are still
really and truly in a grieving reflecting stage over a negative
event that may have happened to them”.
Roles, Responsibilities and Expectations
Patient, provider and leader participants spoke to the
importance of knowing what was required of them and
saw working together to meet a common goal as the key to
the success of any engagement activity. Patients
commented that they felt their role was to represent their
personal opinion and the opinions of community
members or the sub-population they were representing:
“[My role] basically boils down to my opinion; what I feel, based on
what I’ve seen and how I think there’s room for improvement.”
Providers perceived their role to be that of a facilitator or
educator. However, they explained that their role
continues to evolve as the organization learns more about
patient engagement. Providers also commented on the
expectations they have for patients as advisors or in other
engagement activities, suggesting patient members should
be active participants versus passive ones who “just show-up
once a month and eat their sandwiches”.
Leaders discussed their role with engagement as leading by
example and referenced the IAP2 Spectrum of
Engagement5
which AHS uses as a guide for patient and
public engagement:
“Leaders have to model [patient engagement] and what
[it] looks like. It’s not something fluffy. We need to share
the evidence with their teams to support them in engaging
patients and families i.e. you get improved health outcomes
by engaging patients and families. It’s not just about
people being happier. It’s about better care and a better
quality of work life”.Role And Engagement Of Stakeholders in Hospitals Essay
Reason for Being
Comments on this theme focused on the raison d’etre and
using engagement as an opportunity to build confidence
and relationships amongst stakeholders. Patients preferred
knowing the purpose and intent of the engagement work
as it supports working towards a common goal. They felt
building collaborative stakeholder groups facilitates trust:
“This is the kind of thing that may build community
confidence…People actually have a voice to say, these are
our concerns. It’s a real opportunity to be able to ask, ‘do
you guys know what you’re doing? What is happening
inside those doors?’ The more there’s transparency, the
more there’s trust”.
Leaders agreed with patients, as they felt having terms of
reference and organizational direction provides guidance.
Expenses
Expense-related comments centred on travel, lunch and
parking and also touched on support required from an
administrative perspective. Patients focused on factors of
personal reimbursement; receiving compensation when
participating in engagement activities. Providers identified
personnel support as an expense, whereas leaders reflected
on the benefits of involvement far outweighing the
associated expenses.
Time Commitment
Participants articulated the importance of scheduling
dedicated time to complete work associated with the
activity (i.e. email, meetings and meeting preparation).
Ensuring patients are aware of the time commitment is
integral to the success of the engagement opportunity and
expectation of participation. Patients relayed the value of
the work and their willingness to take time away from
work and family to contribute:
Meaningful and effective patient engagement, Bellows et al.
Patient Experience Journal, Volume 2, Issue 1 – Spring 2015 22
“It’s still your own time. Myself, I usually take vacation
time from work to do it, because it’s generally during
business hours that meetings occur. But again, if I want to
have the input, then that’s part of volunteering… there
have been occasions for me where I was not able to get
away from work and it just has to be that way”.
Providers reflected on the time and commitment required
of patient volunteers and the effect of short timelines on
quality and inclusiveness. They also referenced the timing
of engaging patients in project work and the pressures of
project and initiative timelines:Role And Engagement Of Stakeholders in Hospitals Essay
“A lot of [patient engagement] has been here’s what we
developed, can I have your input and feedback and we’ll
come up with a new iteration and we go through a few
rounds of getting their feedback… we need to get at “I’ve
got a blank page. I need your help to build this”.
Leaders expressed that meaningful patient engagement
work does not occur off the side of one’s desk.
Governance & Structure
Responses pertaining to governance and structure centred
on participants’ perceptions of why and how their
committees operate and of recommendations for
improvement (e.g. reduce committee size and reconsider
committee recruitment approaches).
Patients made suggestions to how the committee should
conduct the work. A patient recommended the formation
of small breakout groups to discuss specific topics versus
large committee debates to ease the sense of being
overwhelmed. Providers commented on the ways in which
they try to draw patients into the conversation and
reinforced the importance of hearing from everyone:
“There’s a vocal majority… but through the small group
work and world café, you get to hear the less vocal
[patients] point of view. From a true patient engagement
perspective, if people are saying that they’re going to give
you their time, then we need to make sure that we put
strategies and supports in place where we can hear
everybody’s opinion.”
Leader comments identified the use of breakout teams to
‘do’ the actual work. Seen as a leadership role, chairing a
committee was deemed important to help keep the
committee on track, facilitate focused conversation and
prevent “personal agendas” from taking the conversation
astray.
Knowing Who’s Who
Some participants wanted to know more about the other
members; there was acknowledgement of the importance
of building upon each other’s strengths. Patients expressed
a desire to have members share their names, experiences,
and areas of expertise. They also identified a need to
develop meaningful relationships and meet the
committee’s mandate. Providers recognized that patient
volunteers are devoted people willing to share their stories
to improve the system. Providers also suggested that
knowing the patient and their interests helps to determine
the best fit when selecting patients for engagement
opportunities. Leaders shared that large organizations
struggle with “knowing who’s who” within their programs and
teams.Role And Engagement Of Stakeholders in Hospitals Essay
Evaluation
Participants discussed evaluation with a broad brushstroke; from evaluating AHS as an organization to
evaluating project committee work. Participants
mentioned evaluation strategies including personal
interviews, comment cards and surveys.
Patients focused on evaluating the clinical side of AHS as
well as using formal evaluation strategies for the
committee work they were engaged in:
“[By asking us these questions] you have raised a very
interesting point. It’s time we did an evaluation of our
little group… I think it would be good to have an
evaluation… Every year we go over our terms of reference
and we revise or we talk about it, but to actually do some
kind of evaluation, we haven’t done that”.
Similarly, providers spoke to the importance of doing
evaluations within their operational context and patient
engagement work. Leaders articulated the importance of
evaluating patient engagement endeavours; however most
leaders reinforced that evaluation was not anticipated nor
planned.
Discussion
By conducting the study, we learned what patient
engagement means to the participating stakeholders within
AHS and what assumptions they make about it. Patients,
providers and leaders articulated what really matters to
them. The literature varies in terms of patient engagement
perspectives but our study does confirm some of the same
disparity or disconnect in terms of defining patient
engagement as well as what activities are more meaningful
in terms of patient engagement.
In this study, the ‘patient engagement’ term and definition
was described in a variety of ways by patients, providers
and leaders. Stakeholders used multiple terms
interchangeably which is consistent with the literature as
there is a clear absence of a common language for patient
engagement or consistent understanding of its meaning Role And Engagement Of Stakeholders in Hospitals Essay
.
Patients used the words ‘involvement’, ‘participation’,
‘patient engagement’ and ‘involved’ when asked to
describe their understanding of patient engagement. They
Meaningful and effective patient engagement, Bellows et al.
23 Patient Experience Journal, Volume 2, Issue 1 – Spring 2015
also articulated self-constructed definitions or used
engagement examples to describe what patient engagement
means to them; whereas, providers and leaders applied
‘text book’ like definitions when describing the same.
Concerning the terms used to describe patient
engagement, leaders applied similar terms to that of the
patient group. Although using comparable terms,
providers also spoke to ‘partnership’ amongst all
stakeholders and across all levels of the organization. The
term partnership has a different meaning when compared
to involvement or engagement; partnership can be defined
as a, “collaborative relationship between two or more
parties based on trust, equality and mutual understanding
for the achievement of a specified goal. Partnerships
involve risks as well as benefits, making shared
accountability critical”13. Essentially, partnerships are a
higher level of engagement that closely resembles
empowerment of participants with equal say in decisions Role And Engagement Of Stakeholders in Hospitals Essay
.
Most of the findings in this qualitative study were
confirmed by the literature. Gallivan et al. discussed
definitions for patient engagement as vast and diverse,
wherein over 15 terms were identified and used
synonymously12. Within the literature, there is also an
assumption about the mindsets of stakeholders and the
inhibition of successful collaboration. Van den Heuval,
quoted by Cahill, articulated that patients and providers
have a differing understanding of involvement, where, “one
emerge[s] from the humanistic perspective and the other from the
bureaucratic view of consumerism based on controlling costs, outcome
and efficiency”
14. We expected participants to produce
divergent views on what matters most for meaningful
patient engagement, however this was not the case.
Patients, providers and leaders supported collaborative
approaches to health system and healthcare improvement.
They all believed in a common goal; that being the success
of the groups they belonged to and of the work they were
participating in.
To support group success, representational and
appropriate recruitment as well as defined roles and
responsibilities were key factors identified by all
stakeholders participating in the project. Patients
suggested that they felt some members of the population
were missing from their committee (e.g. homeless, war
veterans, youth, First Nations and other ethnic groups and
individuals with limited mobility, etc.). This sentiment is
supported by the literature and further suggests that
recruitment should be contextually based on the
engagement goals and objectives. Bellows, et al. believe
there are three promising practices for meaningful
stakeholder recruitment, which include using multiple
methods for recruitment, ensuring a diverse mix of
participant and aligning the stakeholder with the
engagement opportunity15. While agreeing that the
recruitment process should identify a representational
group, leaders also articulated the importance of seeking
patient advisors who have dealt with and accepted their
healthcare experience and who are, therefore, emotionally
ready to participate in health system improvement
discussions and decisions in a meaningful way. Happell
agrees that finding a person without ‘an axe to grind’ is a
goal when engaging with patients and family members16 Role And Engagement Of Stakeholders in Hospitals Essay

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.
Once appropriate and mindful recruitment occurs,
patients, providers and leaders can focus on the
importance of enacting roles and responsibilities to enable
the group’s objectives. Some participants articulated that
their project committee employs a terms of reference to
guide individuals and group activities and provide
structure. A patient member articulated that the first thing
to do is to “clearly outline the purpose and roles” to help guide
people; prevent member intimidation and limit the
possibility of someone’s personal agenda taking over the
committee. A leader-participant mirrored this and also
commented that the role of a committee chair is to guide
and focus the discussion to prevent potential
disengagement and scope creep.
Aligned with discerning the roles and responsibilities of
individuals and groups, is the planned assessment of the
groups’ activities and achievements. Patients, providers
and leaders described evaluating engagement efforts as
something that was important, although missing from their
group activities and plans. Leaders articulated the general
support for evaluation, however shared that they had
neither planned for an evaluation nor think their group is
ready to be evaluated. Although the body of literature
pertaining to engagement evaluation is new, Sheedy
recommends evaluation be a step planned for at the
beginning of an engagement endeavour, suggesting, “It may
be too late to properly capture key information and analyze/evaluate
the valued knowledge that has been generated. Integrating these
considerations into the planning process at the outset will save time
and frustration at the end and enable better learning from the process
as it is taking place”
17. Evaluating committee activities
resonated with the patient participants however, they also
focused on the need to evaluate the healthcare system as a
whole, suggesting that “a simple survey like a patient satisfaction Role And Engagement Of Stakeholders in Hospitals Essay
survey” be used to gather feedback and determine if
improvement gains have been made. However Coulter,
referenced by Cayton, argues that it is the patient
experience and not the level of patient satisfaction that
matters, or more so that, “what happened to them, rather than
how satisfied they say they are, is a better measure of success”
18
.
As originally stated, the AHS Patient Engagement
Department set out to determine what resources,
preparation and support are needed to meaningfully and
appropriately engage patients and families. While gaining
patient, provider and leader insights on those areas we
explored some key questions about what patient
engagement means to AHS stakeholders, their
assumptions pertaining to engagement, what they feel is
important in successful meaningful engagement and what
really matters to them. Patient, provider and leader
Meaningful and effective patient engagement, Bellows et al.
Patient Experience Journal, Volume 2, Issue 1 – Spring 2015 24
responses identified a number of thematic codes or subthemes, which were clustered under 11 key themes to
inform the research question. In summary, the concepts
included in Table 3 are what really matter to stakeholders.
Several patients, providers and leaders consistently
identified these concepts when asked what patient
engagement is and what is required to make patient
engagement meaningful. Supported by the Institute for
Patient and Family Centered Care, stakeholders believe
engagement is founded on transparency and partnership
where accessible language free of medical jargon is
utilized19. Legitimate patient engagement requires
dedicated time and resources, which may elongate
decision-making timelines. However, to effectively
increase patient engagement within the health context and
break down barriers to patient involvement, it is suggested
that adequately resourced projects with expanded
timespans be utilized20. Patient representatives should be
prepared and contextually representational to ensure
meaningful contributions to engagement activities.
Although little is known about patient engagement
measurement and evaluation21, stakeholders reinforced the
importance of comprehensive engagement evaluation and
relaying how patients contributed to the decision-making
process Role And Engagement Of Stakeholders in Hospitals Essay
. Reinforced by the literature stakeholder insights
shed light on the commonalities and multi-factorial
requirements of successful genuine patient engagement.
Limitations
Choosing the right type of projects to provide insights on
‘what really matters’ is important when evaluating projects
for how effectively and meaningfully they engage patients.
The study team utilized project committees that were
already formed and available versus creating new
committees involving a diverse group of stakeholders.
Utilizing the IAP2 Public Participation Spectrum, a
committee is one engagement method, which has a
predetermined level of decision influence and impact. As
there are multiple engagement methods that fall along the
participation spectrum, choosing the right one to support
the engagement objective is integral to achieving success.
One way to address this limitation is to expand to other
types of engagement methods (e.g. workshop, survey,
citizens’ jury) and compare participant perceptions of
these other types of engagement activities with those of
committee participants.
Although the numbers of participants in the three groups
– patients, providers and leaders – could be viewed as a
limitation in deducing any conclusions or making
inferences for generalizations, this sample size is not
unusual for qualitative studies. It is more important to
search for common theme saturation across responses. In
this study, the findings of similar perspectives within
groups and between groups suggest that there was
saturation obtained in the responses and even with larger
sample sizes, there would only be stronger confirmation of
these similar perspectives.
Conclusion
The intent of the project was to determine what
stakeholders needed and wanted to meaningfully
participate in or implement patient engagement.
Informing the project with patient, provider, and leader
insights supported by literature provide a strong
collaborative foundation for future stakeholder
engagement. We have found within this study and the
literature, that a strong collaborative approach and
foundation for meaningful patient engagement is required.
This means that patient’ experiences and stories are not
only heard but also acknowledged or appreciated and
utilized to inform improvements or changes in care
programs, practices and policies. This collaboration can
only happen when there is a common understanding of
what patient engagement means to all stakeholders within
initiative contexts. This includes transparency regarding
information shared and used, consideration of time and
volunteer costs, patient engagement planning and
evaluation and above all, providing stakeholders with what
matters most to them – having the necessary orientation
and education, supports and tools for patient engagement
that results in positive outcomes for the patient and for all
levels within the organization.Role And Engagement Of Stakeholders in Hospitals Essay

Who are the stakeholders in the healthcare system? For the purposes of our discussion we define stakeholders as those entities that are integrally involved in the healthcare system and would be substantially affected by reforms to the system. The major stakeholders in the healthcare system are patients, physicians, employers, insurance companies, pharmaceutical firms and government. Insurance companies sell health coverage plans directly to patients or indirectly through employer or governmental intermediaries. Pharmaceutical firms develop and then market medications which are prescribed by doctors to treat patients. Typically they receive remuneration through insurance or governmental drug-benefit plans. Many employers offer health insurance coverage with varying deductibles and co-pays for their employees. Physicians are the providers of medical care; patients are the recipients. And government subsidizes healthcare for the elderly, the disabled and the poor. All stakeholders have duties and responsibilities.

Clearly the interrelationship among the stakeholders in the healthcare system is rather complex. Two of the stakeholders, pharmaceutical firms and insurance companies, are publically owned corporations listed on the stock exchange. Their primary responsibility is to maximize stockholder wealth. Likewise, the primary goal of employers is to make money; however, their provision of health insurance for employees is a benefit, not a source of profit. Unlike the other stakeholders physicians have direct fiduciary duties and responsibilities towards their patients. Although they receive remuneration for their services, the doctor-patient relationship is a sacred trust that transcends monetary reward. Patients have rights, duties and responsibilities. Finally, democratic government has duties and responsibilities towards its citizens, but how they are defined in regard to the provision of healthcare is an evolving American story.Role And Engagement Of Stakeholders in Hospitals Essay

Insurance Industry

Currently rising premiums and strict requirements are keeping many people from obtaining health insurance. The insurance companies remain profit driven, but the nature of their service should not be profit focused. Adequate healthcare is becoming harder to obtain due to financial hardship. The insurance companies need to find an appropriate balance between their responsibilities towards both shareholders and patients. Quarterly reports for stockholders encourage the companies to focus more on profits than affordability. This causes insurance companies to have tight regulations against preexisting conditions so that mostly healthy individuals are selected for their plans. Such patients will not utilize costly procedures as often as individuals with chronic illnesses. However, this is unethical of insurance companies because it reduces healthcare to a profit centered industry, and prevents those in need from receiving care.

Pharmaceutical Companies

Pharmaceutical companies also play a key role in the healthcare system because many patients rely on their products. The prices for drugs are rising, and there are no caps to prevent them from reaching extravagant prices. The argument that the pharmaceutical companies need to charge ever higher prices to cover research costs is simply not true. Although PHARMA spent $43 billion on R&D in 2006, it spent nearly twice as much on promotion, and it consistently has profit margins far above those of most Fortune 500 companies.Role And Engagement Of Stakeholders in Hospitals Essay

Whether or not you argue that pharmaceutical companies have a moral responsibility to ensure that people can afford their products, at the very least they have the duty to be honest and practice fair marketing. Marcia Angell, previously an editor of the New England Journal of Medicine, has written extensively about the unethical behaviors of pharmaceutical companies. Let me cite one example. Through personal experience the author who had an office practice since the early 1980s, witnessed a sinister change in the way pharmaceutical companies market their products to physicians. Previously they sent pharmacists with depth of knowledge about their products to objectively educate the physician about the benefits and risks of a particular brand medication. However, since the late 1980s pharmaceutical firms send young attractive representatives with no formal training to market their drugs by establishing a social relationship with the physician and by offering incentives to prescribe their product. Many physicians whose prescribing practices are unduly influenced by pharmaceutical representatives share the blame. They tend to respond to conversation about certain drugs rather than reading the biomedical literature.Role And Engagement Of Stakeholders in Hospitals Essay

Physicians

Physicians play a key role in ensuring that their patients receive adequate healthcare, but also in controlling the rising costs of healthcare. They have to find a balance between having a gatekeeper role for the insurance companies and being an advocate for the patient. Assigning a gatekeeper role to primary care physicians had the intention of lowering healthcare costs because fewer tests and referrals would be made. However, this is not working and it may be best to re-evaluate the role a primary care physician has in regards to referring patients. A coordinator role may be more beneficial than gatekeeper status. Also, since primary care physicians have increased the number of patients seen in a day to compensate for their decrease in revenue, this causes an increase in defensive diagnostic testing. The doctors do not have adequate time to review the chart or spend time with the patient, so they order more tests to reduce their liability risks. These actions cause healthcare spending to increase as well. By placing the physician between these two roles, a conflict of interest is created. Ethically, the doctor has a fiduciary duty to protect the interests of his patient, but in the current managed care environment, insurance companies give incentives to physicians to order fewer referrals and to cram more patients into each workday. Edmund Pellegrino stated, “What our health policies do to the individual patient serves as a reality check to what values we hold most dear and the ethical foundation of the policies we develop and impose”. It appears that money is at the center of our values.Role And Engagement Of Stakeholders in Hospitals Essay

Physicians also have obligations to patients independent of insurance companies. A physician has an obligation of beneficence to do whatever is necessary to benefit his patient. However if he acts independently (“doctor knows best”) without taking into account the desires of his patient, he is practicing paternalism. Thus, the obligation of beneficence must be balanced by the principle of patient autonomy. Each patient is unique and has the right to participate completely in decisions about his health.

Patients

Patients also have an ethical responsibility towards their own health and towards controlling costs. While it would be impossible to implement a program that forced people to live healthy lifestyles, it is reasonable to assume that healthier living would lead to lower healthcare costs. Some companies, such as Wal-Mart and the WHO, have stopped hiring employees that smoke to reduce healthcare related costs. Often doctors are accused of over prescribing diagnostic tests, but this practice may be the result of patients who demand multiple tests even if some are unnecessary. As technology increases patients with insurance want the newest, most advanced, and expensive treatments that their insurance plan will cover, and oftentimes physicians succumb to their requests. The most expensive treatments are not necessarily the best, and the patient has a duty to participate with the physician in making reasonable and cost-effective choices.Role And Engagement Of Stakeholders in Hospitals Essay

Government

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable rights that among these are Life, Liberty and the pursuit of Happiness”. The Declaration of Independence seems to juxtapose two rights: the right to equality and the right to liberty. Equalitarians emphasize the former; libertarians, the latter. Equalitarians hold that healthcare is a human right; libertarians hold that healthcare is a commodity. Equalitarianism emphasizes the role of government and is more appealing to democrats; libertarianism emphasizes the role of free market and is more appealing to republicans. The fundamental chiasm between these two contrasting ideologies which are operative in American culture remains an impediment to healthcare reform in the United States Role And Engagement Of Stakeholders in Hospitals Essay

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