ISQUA18-1336Patient Involvement as Expert in Healthcare Workers Practices: A First Assessment in a French University Hospital

Abstract

Objectives: Patient involvement as expert has become a key element in the redefinition of power relationships within the health care system. In hospitals, healthcare workers (HCW) develop numerous informal and self-ruling partnership strategies with patients. These initiatives are often unknown from the others HCW and administrations, even working in the same hospital, and there is a lack of recognition for patients' activities. Our objective was to conduct a survey in the Nantes university hospital (NUH) (France) in order to describe HCWs' individual and collective initiatives for involving patients as experts. The aim was to share the results with all HCWs and administrative professionals to value and help developing these practices. Methods: Data were collected through an on-line questionnaire addressed by email to every hospital practitioners (medical doctors, dental surgeons, pharmacists), midwifes and nurse managers working in the NUH. Medical and paramedical students were excluded. The questionnaire consisted in 119 items clustered in 4 main parts: care and its support, students', professionals' and other patients' training, healthcare quality and safety improvement and research. For each part, an introducing question aimed at knowing if the respondent was engaged into the implementation of partnership projects with patients or their representatives, with several proposals for answering. If the professional answered positively, he had to detail his/her practice through additional questions. A part of the questionnaire attempted to describe perceived difficulties and opportunities for setting up such practices. Lastly, final questions aimed at collecting demographic data and knowing in which care unit the professional worked. Results: Of the 1263 professionals targeted, 213 (17%) answered the questionnaire. Most of them were hospital practitioners. A total of 80 respondents (37%) do not involve any patient in their professional practice whereas 133 (63%) have at least one modality for patient involvement. The main reasons reported for not involving patients were: lack of time, lack of financial and logistical resources and patients' cognitive incapacity for participation. Among the 133 professionals who answered positively, 402 activities for patients' involvement were quoted: 31% concerned care and its support, 14% of them concerned students' and professionals' training, 40% were related to healthcare quality and safety improvement and 15 % concerned research. In the field of care and its support, 38% of the total quoted activities related to peers' participation to therapeutic education programs development and 31% to psychological supporting for other patients. Most of the time, participants were recruited from patients' associations and did not follow any training for these voluntary activities. Concerning the field of training, the repartition was rather balanced between in-house professionals training (29%), first-course students training (31%), which particularly concerned medicine students, and peers training (33%). Conclusion: HCWs are very concerned about patients' involvement within the scope of a real partnership. More than 400 collaborative activities have been quoted, related in particular with therapeutic education development and quality and safety improvement. Administrative managers and public health institutions could use such inventories to support HCWs to formalize their initiatives. A relevant perspective would be to extend this survey to other hospitals.