Engaging Patients at the Front Lines of Primary Care Redesign: Operational Lessons for an Effective Program

https://doi.org/10.1016/S1553-7250(14)40069-2Get rights and content

Article-at-a-Glance

Background

The lack of patient engagement in quality improvement is concerning. As part of an enterprisewide initiative to redesign primary care at UW Health, interdisciplinary primary care teams received training in patient engagement.

Methods

Organizational stakeholders held a structured discussion and used nominal group technique to identify the key components critical to fostering a culture of patient engagement and critical lessons learned. These findings were augmented and illustrated by review of transcripts of two focus groups held with clinic managers and 69 interviews with individual microsystem team members.

Results

From late 2009 to 2014, 47 (81%) of 58 teams have engaged patients in various stages of practice improvement projects. Organizational components identified as critical to fostering a culture of patient engagement were alignment of the organization’s vision that guided the redesign with national priorities, readily available external experts, involvement of all care team members in patient engagement, integration within an existing continuous improvement team development program, and an intervention deliberately matched to organizational readiness. Critical lessons learned were the need to embed patient engagement into current improvement activities, designate a neutral point person(s) or group to navigate organizational complexities, commit resources to support patient engagement activities, and plan for sustained team-patient interactions.

Conclusions

Current national health care policy and local market pressures are compelling partnering with patients in efforts to improve the value of the health care delivery system. The UW Health experience may be useful for organizations seeking to introduce or strengthen the patient role in designing delivery system improvements.

Section snippets

Definitions

We define patient engagement as “an active process of ensuring that our patients’ experience, wisdom and insight are infused into individual care and the design and refinement of our care systems.”14 For the purposes of this article, the term patient engagement represents both patient and family engagement. We describe a program in which the focus of engagement was on practice redesign at the microsystem level. The microsystem is defined as a small care unit consisting of a care team, its panel

Key Organizational Components

Five components were identified as being key for fostering a culture of patient engagement: (1) alignment of the organization’s vision guiding the redesign with national patient engagement priorities, (2) readily available external experts, (3) involvement of all care team members in patient engagement, (4) integration within an existing continuous improvement team development program, and (5) an intervention deliberately matched to organizational readiness. We now describe these components.

Discussion

In this article, we describe our experience in incorporating patient engagement into an ambitious primary care redesign initiative involving 47 academic and community primary care clinics located in the state of Wisconsin. National priorities driven by emerging redesign models4., 5., 7. and public policy8 have brought the need to involve patients in primary care QI to the forefront. We also identify key organizational components critical for fostering a culture of patient engagement and

Conclusion

Current national health care policy and local market pressures are compelling partnering with patients in efforts to improve the value of the health care delivery system. Health care delivery systems across the country are responding to national requirements to demonstrate patient engagement and measure the patient experience, and many systems are engaged in efforts to redesign primary care. We found that patients provided unique and essential contributions to the redesign process. We also

References (25)

  • E.C. Nelson

    Microsystems in health care: Part 1. Learning from high-performing front-line clinical units

    Jt Comm J Qual Improv.

    (2002)
  • Primary Care: America’s Health in a New Era

    (1996)
  • T. Bodenheimer et al.

    A lifeline for primary care

    N Engl J Med.

    (2009 Jun 25)
  • B. Starfield et al.

    Contribution of primary care to health systems and health

    Milbank Q.

    (2005)
  • R.A. Berenson

    A house is not a home: Keeping patients at the center of practice redesign

    Health Aff (Millwood)

    (2008)
  • P.A. Nutting

    Initial lessons from the first national demonstration project on practice transformation to a patient-centered medical home

    Ann Fam Med.

    (2009)
  • E.H. Wagner

    Improving chronic illness care: Translating evidence into action

    Health Aff (Millwood)

    (2001)
  • Standards and Guidelines for NCQA’s Patient-Centered Medical Home (PCMH) 2011

    (2011)
  • US Department of Health & Human Services, Centers for Medicare & Medicaid Services. 42 CFR Part 425. Medicare Program;...
  • S.H. Scholle

    Engaging Patients and Families in the Medical Home

    (Jun 2010)
  • K. Luxford et al.

    Promoting patient-centered care: A qualitative study of facilitators and barriers in healthcare organizations with a reputation for improving the patient experience

    Int J Qual Health Care

    (2011)
  • D. Schaller

    Patient-Centered Care: What Does It Take?

    (Oct 2007)
  • Cited by (22)

    View all citing articles on Scopus
    View full text