Optimizing patient partnership in primary care improvement: A qualitative study

Abstract

BACKGROUND: The need to expand and better engage patients in primary care improvement persists. PURPOSE: Recognizing a continuum of forms of engagement, this study focused on identifying lessons for optimizing patient partnerships, wherein engagement is characterized by shared decision-making and practice improvement co-design. METHODOLOGY: 23 semi-structured interviews with providers and patients involved in improvement efforts in seven U.S. primary care practices in the Academic Innovations Collaborative (AIC). The AIC aimed to implement primary care improvement, emphasizing patient engagement in the process. Data were analyzed thematically. RESULTS: Sites varied in their achievement of patient partnerships, encountering material, technical, and sociocultural obstacles. Time was a challenge for all sites, as was engaging a diversity of patients. Technical training on improvement processes and shared learning ‘on the job’ were important. External, organizational and individual-level resources helped overcome sociocultural challenges: the AIC drove provider buy-in; a team-based improvement approach helped shift relationships from providers and recipients towards teammates; and individual qualities and behaviors that flattened hierarchies and strengthened interpersonal relationships further enhanced ‘teamness’. A key factor influencing progress towards transformative partnerships was a strong shared learning journey, characterized by: frequent interactions; proximity to improvement decision-making; learning together from the ‘lived experience’ of practice improvement. Teams came to value not only patients’ knowledge, but changes wrought by working collaboratively over time. CONCLUSION: Establishing practice improvement partnerships remains challenging, but partnering with patients on improvement journeys offers distinctive gains for high quality patient-centered care. PRACTICE IMPLICATIONS: Engaging diverse patient partners requires significant disruption to organizational norms and routines, and the trend toward team-based primary care offers a fertile context for patient partnerships. Material, technical and sociocultural resources should be evaluated not only for whether they overcome specific challenges, but also for how they enhance the shared learning journey.