Is Patient Involvement the Key to Improvement?

Would you recommend this hospital to your friends and family?

One of the suggestions which came from the recent enquiry into Mid-Staffordshire was that patients be asked for feedback on their experiences. The value of this would in theory be to help identify areas of under-performance. Although this measure has been introduced without a great deal of evidence to back it, on the surface it appears sensible. Patient experience in hospital is of course likely to vary enourmously from patient to patient, but this method could pick up trends and help to highlight areas needing improvement.

But what if we take this a step further. What if the solution to improving healthcare is by asking patients what they want to get out of their interaction with the medical services. The old 'ideas, concerns and expectations' set of questions was drilled into us at medical school (although from personal experience it is all to often left out of consideration). The focus of the BMJ this week is on this concept, empowering patients to take responsibility in working in partnership with doctors.

Working in collaboration with our patients is by no means a new idea, but perhaps a fresh reminder is necessary. Social media and networking could be one way of doing this - examples are given of patients who are able to reach thousands with their blogs describing their experiences. For example 'rheumatoid arthritis warrior' Kelly Young shares her online blog rawarrior.com with almost 2% or patients with RA in the US. 

Patient support groups are plentiful, and are able to connect patients to share experiences, and perhaps more doctors should be engaging with these communities. Where the patient brings the value of their personal experience, the doctor can bring their knowledge of medicine and treatment. A doctor for example could help to prevent conversations from going down incorrect paths and share up to date knowledge of treatments (allowing information to filter down from clinical research to the lay person).

Engaging patients in decision making could also help to reduce costs through unnecessary over-investigation. Choosing Wisely (www.choosingwisely.com) is an initiative which has been set up in the US which aims to reduce over-investigation of patients and encourages patients and doctors to work together to come up with solutions.

All of these ideas fit perfectly with the GMC guidance on Good Medical Practice and agree with the ethical principles which doctors abide by. I'm pleased to read that this concept is being given increased attention and hope that some of these ideas could help to develop the NHS which I want to be a part of in years to come.