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Session 2:
Critical Reflection: Policy and Evidence
Foundations in care experience: Module 4
• Introduce theoretical perspectives
• Critically reflect on policy goals
• Consider the availability of research evidence
Session overview
Foundations in care experience: Module 4
Groups 6 X 6 – 10 minutes
How do you understand the policy goals for service user and public participation
in Scotland?
What will successful policy implementation achieve?
What are the challenges in creating and implementing policy?
Learning together
Foundations in care experience: Module 4
History
Foundations in care experience: Module 4
Discrimination and exclusion
Foundations in care experience: Module 4
Approaches to involvement
Foundations in care experience: Module 4
Consumerist:
‘the act of paying gives a
voice’
Emancipatory:
‘to share or transfer
power’
Policy
Foundations in care experience: Module 4
Coulter A (2011) Engaging patients in healthcare. London: Open University Press
Individual – patients
• improve the quality of care and patients’ experience
• ensure appropriate and effective treatment and care
• help people live independently as long as possible
• promote safety and reduce harm
• reduce complaints and litigation
• improve health outcomes
High-level policy goals – the why
Foundations in care experience: Module 4
Collective – citizens
• increase public understanding of health issues
• promote health and reduce inequalities
• increase research based knowledge and encourage innovation
• promote efficient use of resources
• strengthen accountability
• build social capital
Mutuality – co-owners in the NHS
Foundations in care experience: Module 4
1. Health and Care
Experience
2. Person-centred health and
care improvement
programmes
3. Connecting people and
good practice
Foundations in care experience: Module 4
Literature Review
Improving Quality Through Participation
Improve participation practice
Obstacles to effective participation include:
• Lack of clarity of purpose
• Inconsistency
• Participation overload
• Organisational culture and power
relations
Public Value and Participation (2008)
A Literature Review for the Scottish
Government, The Work Foundation
Foundations in care experience: Module 4
Patient or Public?
Problematic in policy development
• Patient involvement - a reaction to
medical paternalism
• Public involvement draws on
democratic theory – a response to
the democratic deficit, voter
apathy and declining trust in
public institutions
Batalden (2018) Getting more health from healthcare: quality improvement must acknowledge
patient coproduction. BMJ Quality and Safety September 2018
Co-production of healthcare services
Foundations in care experience: Module 4
“In some interactions, the focus may be more on the action than
the relationship, such as properly immobilising a fractured limb.
Even within these apparently product dominant interactions,
however, practising within a contextualising “service making”
frame allows professionals to pay attention to the patient’s lived
reality, assets, social support, and aims. These might include a
patient’s caring responsibilities for an elderly parent, or the role
of their stress relieving weekend basketball game.
Attending to such experiences is not simply a matter of courtesy but
recognising what is necessary to do the real, shared work of
limiting the burdens of illness and treatment and optimising
Health”
(Batalden, 2018, p.2)
Evidence
Foundations in care experience: Module 4
Lack of conceptual clarity - impact on practice
Foundations in care experience: Module 4
• Democratic
representation and
representativeness
• Technocratic
• Challenges of achieving
a coherent rationale
• Gap between policy
and practice
Martin G (2009) Public and user participation in public service delivery: tensions in policy
and practice. Sociology Compass 3 (2): 310-26
The need for better evidence
Foundations in care experience: Module 4
• Range of impacts
• No economic analysis
• Limitations in the
reporting of PPI
Mockford C et al (2012) The impact of patient and public involvement on UK NHS health
care: a systematic review. International Journal for Quality in Health Care 24 (1): 28-38
Preferred organisational behaviours
Foundations in care experience: Module 4
• Non-hierarchical,
collaboration across multi-
disciplinary teams
• Model desired behaviours
of recognition and respect
• Commitment to rapid
action
• Constant data collection
and reflection
Renedo A et al (2015) Patient and public involvement in healthcare quality improvement.
Public Management Review 17 (1): 17-34
• There are different rationales that underpin the ‘why’ of
engagement and involvement
• In the UK, there is policy and legislation to support engagement
and involvement
• Policy and evidence are not always connected
Learning points
Foundations in care experience: Module 4
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