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