Jon Engström

Co‐creation and learning in health‐care service development

Purpose - The purpose of this study is to develop and evaluate a model for patient co-creation and learning based on diaries for use in health-care service development. In particular, the study aim ...

The Antecedents, Forms and Consequences of Patient Involvement : A Narrative Review of the literature

OBJECTIVES Despite the centrality of patient involvement in the policy and rhetoric of health care, the theoretical and empirical basis for patient involvement is lacking at the micro-level of practice. The purpose of this narrative review is to provide an overview and synthesize the current empirical research related to patient involvement at the micro-level of health care. DESIGN Narrative review. DATA SOURCES A database search was conducted (in PubMed, CINAHL, Academic Search Premier, EconLit and PsycINFO) for articles published between 1990 and April 2015 in the field of patient involvement in health care. Out of 4238 references, 214 articles were eligible for this review. REVIEW METHODS We analyzed our sample using thematic analysis. RESULTS The reviewed articles revealed nine themes for patient involvement, concerning enablers; empowerment, patient education, communication for involvement, staff training, service systems, types; decision making, delivery, development, and consequences of patient involvement. The themes were synthesized into a tentative model that described patient-involvement research. CONCLUSIONS Our narrative review includes a wide variety of empirical studies on patient involvement in decision-making, delivery and development, and provides an integrative perspective suggesting that patient involvement should be viewed not only as isolated activities, but also as a result of educating and preparing patients, staff and systems.

A self-determination theory perspective on customer participation in service development

Purpose – The purpose of this paper is to explore what motivates patients to participate in service development and how participation may influence their well-being. Health-care providers are increasingly adopting practices of customer participation in such activities to improve their services. Design/methodology/approach – This paper builds on an analysis of data from a service development project in which lung cancer patients contributed by sharing their ideas and experiences through diaries. Out of the 86 lung cancer patients who were invited to participate, 20 agreed to participate and 14 fully completed the task. The study builds on participants’ contributions, in-depth interviews with six participants and the reasons patients gave for not participating. Findings – This paper identifies a number of motives: non-interest in participating, restitution after poor treatment, desire for contact with others, volunteerism, desire to make a contribution and the enjoyment of having a task to complete. A self-...

Does Lean healthcare improve patient satisfaction? A mixed-method investigation into primary care

Background Lean healthcare is claimed to contribute to improved patient satisfaction, but there is limited evidence to support this notion. This study investigates how primary-care centres working with Lean define and improve value from the patients perspective, and how the application of Lean healthcare influences patient satisfaction. Methods This paper contains two qualitative case studies and a quantitative study based on results from the Swedish National Patient Survey. Through the case studies, we investigated how primary-care organisations realised the principle of defining and improving value from the patients perspective. In the quantitative study, we compared results from the patient satisfaction survey for 23 primary-care centres working with Lean with a control group of 23 care centres not working with Lean. We also analysed changes in patient satisfaction over time. Results Our case studies reveal that Lean healthcare implementations primarily target efficiency and little attention is paid to the patients perspective. The quantitative study shows no significantly better results in patient satisfaction for primary-care centres working with Lean healthcare compared with those not working with Lean. Further, care centres working with Lean show no significant improvements in patient satisfaction over time. Conclusions Lean healthcare implementations seem to have a limited impact on improving patient satisfaction. Care providers need to pay more attention to integrating the patients perspective in the application of Lean healthcare. Value needs to be defined and value streams need to be improved based on both the knowledge and clinical expertise of care providers, and the preferences and needs of patients.

The role of customers in the development of public organizations

In this chapter we focus on the role of customers in the development of public organizations. We aim to illustrate how customer involvement can be used not only to learn about customer needs, but also to create a tension for change. Following Van de Ven (1986), we view tension for change as dissatisfaction with current conditions that trigger change. Success for public organizations is dependent on their ability to satisfy the needs of their stakeholders (Bryson, 2004). As a consequence, key stakeholders are increasingly being considered an important resource in public sector reforms and change initiatives (Bingham et al., 2005; Tritter and McCallum, 2006). The customer – who receives private value at an agency’s business end – is conceived of as a stakeholder of vital importance for renewal and change (Osborne et al., 2014). The image of the citizen or customer as someone who is passive and submissive is gradually being replaced by someone who is active and engaged (Nordgren, 2008).