Interpersonal relationships and communication as a gateway to patient and public involvement and engagement

Internationally, healthcare systems and organizations are constantly endeavouring to improve performance, enhance patient and carer experience and achieve better patient outcomes. To facilitate this, health and social care professionals are increasingly involving patients and the public in a range of decisionmaking processes, personcentred care planning,1,2 development of clinical guidelines and care delivery systems, research strategies and protocols and organizational and government policies. Engagement with patients and carers, no matter whether specific or general, requires good communication skills and trusting interpersonal relationships. These core skills apply not only to the patientpractitioner relationship, but also to interprofessional relationships and team communications. Increasing patient involvement (PI) in care decisions and greater partnerships between patients and healthcare professionals (HCPs) will help ensure improved patient safety and enhanced patient satisfaction. To facilitate this, guidelines3 and frameworks can be helpful, whilst acknowledging and respecting the need for flexibility depending on the care context. The papers included in this issue of HEX highlight the variety of ways in which patients and public can, and do, contribute to service and policy development, influence the nature and conduct of research and participate in decision making from individual care planning to guidelines and frameworks. Highlighted in most papers is the importance of interpersonal relationships and good communication skills. Patient and public involvement (PPI) in both system and organization development is described in the papers of Hindi et al, Souliotis et al, Perez et al and Russell et al, each employs a different approach, demonstrating the importance of mapping the method of enquiry to purpose. Hindi et al conducted a United Kingdom (UK)based systematic review of evidence on patient and public perspectives regarding existing community pharmacy services, extended pharmacist roles and strategies used to raise awareness of pharmacy services. The authors present a detailed account of factors facilitating the use of pharmacy services and how physicians can influence public perception of pharmacy services. When wanting to engage the public regarding opinions on excessive use of unwarranted medical care, Perez et al employed a civic engagement approach based on social values. Unwarranted medical care is a concern for healthcare policymakers, but strategies to reduce overuse may threaten aspects of healthcare delivery valued by the public. In groups, and using case scenarios, the public were asked to address the problem of medicines overuse and requested to choose the most acceptable reduction strategy. Most of the perspectives offered were congruent with those already being initiated or discussed at provider level. Engaging the public in the decisionmaking process creates a sense of ownership increasing the likelihood of successful implementation. Souliotis et al, working with a Europeanwide cancer patient organization (CPO), choose an online selfreport questionnaire when exploring the degree and impact of CPO participation in health policy. As a previously understudied area, with a small number of mainly countryspecific qualitative studies suggesting that, despite the growing number of patient organizations in Europe and their increasing involvement in policy issues, political influence was limited. Souliotis et al obtained similar results, reinforcing the position that a higher degree of patient participation does not necessarily translate into greater impact, although interlinked. The paper by Russell et al forms a link between community engagement and PPI in research. Again, with a European focus and using case study methodology, this study focussed on the development of drugs to treat autism. A consortium, funded to explore the underpinning biological mechanisms of autism, used the knowledge generated to develop effective pharmacological and other interventions to treat autism. A promotional video, of interviews with scientists working on biomedical studies as part of the consortium, was used at two PPI events. The video acted as a prompt to solicit comments about the consortium’s project agenda. Data, in the form of open comments, were collected either during or after these events. This study highlights that “selective PPI” is not advisable. When wanting to increase patients’ awareness of research and encourage recruitment to projects, organizations can employ a variety of approaches. Using case study methodology, Wienroth et al describe how one clinical department piloted an initiative where a research statement was inserted in letters requesting patients to attend an outpatient appointment for the first time. Considerable thought was given to the wording of the statement by both staff and lay members with extensive PPI experience in research. Using a prepost intervention survey, the findings suggest that, despite the attention given to the construction of the statement, only a tiny minority found it very clear. The statement was not thought to explain the concept of research and of little help in encouraging research participation. Findings indicate that a simple, single solution is not the answer to either raising patients’ awareness of research or increasing patientinitiated recruitment.