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Should patients be more involved in assessing quality of healthcare?

What does the literature say?

Several literature reviews (Hubbard, et al., 2007; Wyatt, et al., 2008; Stewart, et al., 2011; Teunissen, et al., 2011; De Wit, et al., 2011), a health technology assessment (Gagnon, et al., 2011), and a Cochrane review (Nilsen, et al., 2010), have been carried out over the last few years, studying patient involvement in the assessment of health care quality. A number of different conclusions were reached in these studies, but one that was almost universal was the need for a cultural change in medical practise to allow for a targeted and effective involvement of patients at various stages of quality assessment. Traditionally, health care quality has been assessed in terms of measures of structure, process and outcome, and has often focused on the perspectives of the care-provider or health care organisation, such as cost, length of stay and patient mortality; few assessments have included the patient’s experience of care.

Multiple actors in a healthcare system

However, if one considers the definition of quality which encompasses the main actors within the health care system, then I believe that patients should definitely play a greater role than they currently do, in assessing quality. Patients can be seen as the end consumers of health care, whether they are paying for it directly, indirectly or not at all. Therefore, just like the guest of a weekend stay in a hotel is in a prime position to judge the value and standard experienced, it is only natural that the consumer of health care is in a key position to evaluate the quality of the care they receive. I also believe that by giving patients an active role in the evaluation of health care, greater emphasis will be placed on risk prevention and there will also be a strengthening of trust in the relationship between citizens and the health system.

The way forward

Over recent years a number of surveys and questionnaires exploring patient satisfaction or experience of health care have become available, as well as a number of patient-reported measures. However these measures are usually condition specific and there are few multi-dimensional measures that are specific to the evaluation of health care quality and of relevance to multiple health conditions (Department of Public Health, 2006). Additionally, there has been limited published evidence of application and measurement or practical properties for reviewed measures. Therefore, I believe there needs to be a greater drive in the creation of validated quality assessment tools to allow patients to contribute towards and improve the process of their health care.

Dr Beppe Micallef-Trigona
Dr Beppe Micallef-Trigona
Dr Beppe Micallef-Trigona is a Maltese psychiatrist who returned to Malta after working as a consultant psychiatrist with the UK Ministry of Defence (Royal Navy), and previously, as a consultant psychiatrist in the UK National Health Service.

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