liu.seSearch for publications in DiVA
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Patient Involvement: A Service Perspective
Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
2014 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

For a long time, patients were seen as weak and passive recipients of care, whose only role was to provide information and comply with doctors’ orders. This is beginning to change, and patients are more seen as autonomous, active, and involved collaborators in care, co-creating value with service providers and others. In parallel, the healthcare sector is changing due to an aging population, advances in technology, medical knowhow, and the prevalence of chronic diseases, which all call for a more involved patient. During the last decade, patient involvement in healthcare has been recognized as important to provide more efficient, integrated, patient-focused healthcare. Despite this recent gain in attention, there is a gap between rhetoric’s and practice, since the meaning and benefits of patient involvement are unclear both in theory and practice. This thesis takes an alternate perspective on patient involvement, departing from service theory on value creation and customer involvement. It aims to understand and explore patient involvement and how patients can be involved in both the use, and development, of healthcare services.

This thesis is based on three different studies using both qualitative and quantitative research methods. The first study is a systematic literature review of healthcare research, addressing the topic of patient involvement and related concepts. Based on a total of 125 reviewed empirical articles, this study serves as an introduction and orientation to the diverse field. It aims to contribute to the knowledge base in the growing research field of patient involvement. The second study addresses and explores lead-user theory as a method to identify highly innovative patients who can be suitable for involvement in healthcare development. The third study explores how patients, depending on disease, care process and context, can take different roles in healthcare development.

The results indicate that patient involvement is not an isolated activity but influences the whole healthcare system. This extends the view of patient involvement from just decision-making and isolated encounters to patients potentially being substantially involved in all aspects of healthcare. This is also important in involvement in use. The patient’s individual experiences, context, and type of illness play an important role in development initiatives. Patients should be selected carefully, for involvement in healthcare development, depending on the goal of the initiative. The type of illness and the patient’s context are key factors to the kind of contributions patients can make. Depending on the type of illness, and if it shows up mostly at home or at the care provider’s, patients develop different contributions.

This thesis contributes to understanding patient involvement by taking a service perspective on co-creation and customer involvement. This approach to patient involvement extends the traditional view by proposing that patients should be involved in all stages of healthcare. Understanding how individuals create value and manage their health is important for individuals, healthcare providers, and government. Much of  a patient’s value creation takes place outside the patientprovider sphere, and is therefore unknown to the healthcare provider. By actively involving patients in both use and development, healthcare providers can apply a whole-person perceptive.

Abstract [sv]

Förutsättningarna för vården har förändrats under de senaste decennierna. Anledningar till dessa förändringar utgörs av bland annat en åldrande befolkning, teknisk och medicinsk utveckling och en ökad förekomst av kroniska sjukdomar. Traditionellt har patienter setts som passiva mottagare av vård, vars roll endast varit att svara på frågor samt följa läkarens ordination av behandling. På senare tid har detta dock börjat förändras. Patienter börjar att i högre grad ses som självständiga, engagerade och deltagande i vården. Enligt detta nya betraktningssätt kan patienter bidra aktivt till värdeskapande, tillsammans med vårdpersonal och andra resurser. Under det senaste decenniet har patientinvolvering setts som en allt viktigare del för att kunna leverera en mer effektiv, integrerad och patientfokuserad vård.

Trots detta ökande intresse, finns det en skillnad mellan retorik och praktik. Patientinvolvering och fördelarna med patientinvolvering är oklara både i teori och praktik – bland forskare, sjukvårdspersonal och patienter. Denna licentiatsavhandling utgår från ett tjänsteperspektiv på patientinvolvering och syftar till att förstå och undersöka hur patienter kan vara involverade i användandet och utvecklingen av vården.

Avhandlingen bygger på tre olika studier med både kvalitativa och  kvantitativa forskningsmetoder. Resultaten av studierna tyder på att patientinvolvering inte är en isolerad process utan istället kan ses som något som påverkar alla delar av sjukvården. Detta utökar synen på vad patientinvolvering kan vara. Istället för att se patientinvolvering som kopplat till att patienten ger information och är involverad i beslutsfattande, kan patienten vara involverad i alla aspekter av sjukvården, både i själva utförandet och utvecklingen. Men det är också viktigt att patientens individuella erfarenheter och preferenser, sammanhang och sjukdomsbild spelar en stor roll för hur mycket och vilken typ av involvering som är lämplig. Vid patientinvolvering i utvecklingen av vården, bör patienter väljas noggrant beroende på mål med utvecklingen och vilken typ av involvering det rör sig om. Även sammanhang och typ av sjukdom är viktiga faktorer för vilken typ av bidrag som kan förväntas av patienter. Beroende på typ av sjukdom och kontext, kan patienter förväntas bidra på olika sätt.

Denna avhandling bidrar till en ökad förståelse för patienters involvering i vården genom att ta utgångspunkt ur ett tjänsteperspektiv men fokus på värdeskapande och patienters engagemang. Detta förhållningsätt till patientinvolvering utökar den traditionella synen på involvering genom att föreslå att patienter ska vara involverade i alla steg och aktiviteter i vården. Mycket av patientens värdeskapande sker utanför vården, i den privata sfären, och är därför dolt för vårdgivaren. Att förstå hur patienter skapar värde och sköter sin hälsa är grundläggande för att kunna förbättra vården och stödja patientens egna ansträngningar. Genom att aktivt involvera patienter både i den egna vården men även i utvecklingen av vården i stort är det möjligt att gemensamt skapa en bättre vård.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2014. , 55 p.
Series
Linköping Studies in Science and Technology. Thesis, ISSN 0280-7971 ; 1651
National Category
Engineering and Technology
Identifiers
URN: urn:nbn:se:liu:diva-105930DOI: 10.3384/lic.diva-105930ISBN: 978-91-7519-371-7 (print)OAI: oai:DiVA.org:liu-105930DiVA: diva2:712316
Presentation
2014-04-25, ACAS, A-huset, Campus Valla, Linköpings universitet, Linköping, 13:15 (English)
Opponent
Supervisors
Available from: 2014-04-14 Created: 2014-04-14 Last updated: 2014-05-27Bibliographically approved
List of papers
1. The Antecedents and Consequences of Patient Involvement: A Systematic Review and Thematic Analysis
Open this publication in new window or tab >>The Antecedents and Consequences of Patient Involvement: A Systematic Review and Thematic Analysis
2013 (English)Conference paper, Oral presentation only (Other academic)
Abstract [en]

Background: A literature review was conducted to explore the concept of patient involvement and to integrate the findings of existing research.

Methods: A database search was conducted (in Pubmed, CINAHL, Academic Search Premier, EconLit and PsycINFO) for articles in the field of patient involvement in health care published between 1990 and 2012. Out of 3,402 references, 125 articles were eligible for this review. We analyzed our sample using thematic analysis.

Results: Nine themes for patient involvement emerged. These themes concerned enablers, activities, and consequences of patient involvement. The themes are synthesized into a tentative model of patient involvement.

Conclusions: Patient involvement can be enabled by factors such as patient education and empowerment, staff training, and organizational systems. Positive effects on costs, satisfaction, and health are indicated as outcomes of patient involvement. Care providers should apply a system perspective on patient involvement in which factors relating to staff, patients, and organizational structures are considered when implementing patient involvement practices.

Keyword
Patient Involvement, participation, health care, patient empowerment, shared decision making
National Category
Engineering and Technology
Identifiers
urn:nbn:se:liu:diva-105926 (URN)
Conference
HELIX Conference, Innovative Practices in Work, Organisation and Regional Development - Problems and Prospects, June 12-14, Linköping, Sweden
Available from: 2014-04-14 Created: 2014-04-14 Last updated: 2014-05-19Bibliographically approved
2. Patient involvement in healthcare service development: Who to involve and why
Open this publication in new window or tab >>Patient involvement in healthcare service development: Who to involve and why
2013 (English)Conference paper, Oral presentation only (Other academic)
Abstract [en]

This article explores how the most innovative users can contribute to healthcare service development through cocreation. Despite the widely acknowledged need to innovate and create more user-centered healthcare services, the role of the patient in service development is by tradition passive, and innovation is technology-centered. Drawing on the lead-user methodology, we examine the contributions and behaviors of the most innovative participants in a healthcare service development initiative through patient diaries. With openness, insight, and ingenuity, these patients combine capabilities for innovation with strong relational capabilities to suggest solutions for specific problems. While typical lead users are enthusiasts and lead trends, the examined patients have unmet needs and are often driven by affinity with the care provider and co-patients. We suggest a four-step approach to identifying and involving the most creative and engaged patients.

Keyword
Co-creation, service development, user innovation, healthcare
National Category
Engineering and Technology
Identifiers
urn:nbn:se:liu:diva-105927 (URN)
Conference
The 13th International Research Symposium on Service Excellence in Management, QUIS13 June 10-13, Karlstad, Sweden
Available from: 2014-04-14 Created: 2014-04-14 Last updated: 2014-05-19Bibliographically approved
3. The Influence of Disease and Context on Patient Participation in Healthcare Service Development
Open this publication in new window or tab >>The Influence of Disease and Context on Patient Participation in Healthcare Service Development
2013 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: The experience that patients have gained from their own care and disease makes them a potentially valuable resource in healthcare service development. While service developers in other domains frequently involve users, this practice remains uncommon in healthcare. An initial step for increasing patient participation in healthcare service development is to determine which patients to involve and how. This study aims to clarify the various roles a patient may have in healthcare service development and examine how type of disease (episodic/chronic) and context (home/care provider) influence what forms of patient participation are suitable in healthcare service development.

Methods: Fifty-three patients participated in a healthcare service development project in which patients submitted ideas and reflections in diaries. From the diaries, we identified 360 ideas that we coded according to their types, characteristics and sources. We used logistic regression to investigate how the characteristics and sources of the ideas depended on the type of disease and context of the patients.

Results: Patients’ ideas concerned a large variety of topics and depended on context and disease. Patients were better at identifying solutions in the home than at the care provider (p<0.01). In terms of the patient’s role in executing ideas, there were differences regarding context (p<0.01) and an interaction effect between context and type of disease (p<0.01). Chronic patients mostly suggested ideas for themselves. Negative experiences were important to the generation of ideas, with differences regarding both the type of disease (p<0.01) and the context (p<0.01). Chronic patients’ ideas often stemmed from negative incidents; for episodic patients at home, from positive events. There were differences regarding the idea’s appearance for type of disease (p<0.01); for chronic patients ideas emerged from continuous problems, for episodic patients from new situations.

Conclusions: Based on the type of disease (episodic/chronic) and context (home/care provider), we have identified four different roles that a patient can have in healthcare service development: feedback provider, problem solver, co-developer, and expert. We suggest different methods for patient participation in healthcare service development for each role. By doing so, this article helps care provider’s select appropriate methods to support patient participation in healthcare service development.

Keyword
Patient participation; healthcare service development; patient centred care, diaries
National Category
Engineering and Technology
Identifiers
urn:nbn:se:liu:diva-105928 (URN)
Conference
HELIX Conference, Innovative Practices in Work, Organisation and Regional Development - Problems and Prospects, June 12-14, Linköping, Sweden
Available from: 2014-04-14 Created: 2014-04-14 Last updated: 2014-05-19Bibliographically approved

Open Access in DiVA

Patient Involvement: A Service Perspective(3034 kB)680 downloads
File information
File name FULLTEXT01.pdfFile size 3034 kBChecksum SHA-512
a425652ee3b96b006a4b6f83b3ee72d65427ad301e6988fb1469e7db7a203ee87bc066034c93cb0760a7b4ffa868f04b865c251c9b2d9366fd65236f70750596
Type fulltextMimetype application/pdf
omslag(109 kB)23 downloads
File information
File name COVER01.pdfFile size 109 kBChecksum SHA-512
37a2fdb1a74b0c2b48a6e8fe6daaf8976ba217f33a1b0b1a00482990106491c52e1922dfe3475992eda3a23aa43d98bcc87c501624fdf3722a00643be4513785
Type coverMimetype application/pdf

Other links

Publisher's full text

Authority records BETA

Snyder, Hannah

Search in DiVA

By author/editor
Snyder, Hannah
By organisation
Quality Technology and ManagementThe Institute of Technology
Engineering and Technology

Search outside of DiVA

GoogleGoogle Scholar
Total: 680 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
isbn
urn-nbn

Altmetric score

doi
isbn
urn-nbn
Total: 761 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf