Open AccessPatient, carer and public involvement in major system change in acute stroke services: The construction of value
Author(s) -
McKevitt Christopher,
Ramsay Angus I.G.,
Perry Catherine,
Turner Simon J.,
Boaden Ruth,
Wolfe Charles D.A.,
Fulop Naomi J.
Publication year - 2018
Publication title -
health expectations
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.314
H-Index - 74
eISSN - 1369-7625
pISSN - 1369-6513
DOI - 10.1111/hex.12668
Subject(s) - ambiguity , value (mathematics) , public involvement , clinical governance , corporate governance , public relations , nursing , medicine , patient participation , service delivery framework , public sector , psychology , health care , service (business) , business , political science , marketing , linguistics , finance , machine learning , philosophy , computer science , law
Background Patient and public involvement is required where changes to care provided by the UK National Health Service are proposed. Yet involvement is characterized by ambiguity about its rationales, methods and impact. Aims To understand how patients and carers were involved in major system changes ( MSC s) to the delivery of acute stroke care in 2 English cities, and what kinds of effects involvement was thought to produce. Methods Analysis of documents from both MSC projects, and retrospective in‐depth interviews with 45 purposively selected individuals (providers, commissioners, third‐sector employees) involved in the MSC . Results Involvement was enacted through consultation exercises; lay membership of governance structures; and elicitation of patient perspectives. Interviewees’ views of involvement in these MSC s varied, reflecting different views of involvement per se, and of implicit quality criteria. The value of involvement lay not in its contribution to acute service redesign but in its facilitation of the changes developed by professionals. We propose 3 conceptual categories—agitation management, verification and substantiation—to identify types of process through which involvement was seen to facilitate system change. Discussion Involvement was seen to have strategic and intrinsic value. Its strategic value lay in facilitating the implementation of a model of care that aimed to deliver evidence‐based care to all; its intrinsic value was in the idea of citizen participation in change processes as an end in its own right. The concept of value, rather than impact, may provide greater traction in analyses of contemporary involvement practices.