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      Coproduction of healthcare service

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          Abstract

          Efforts to ensure effective participation of patients in healthcare are called by many names—patient centredness, patient engagement, patient experience. Improvement initiatives in this domain often resemble the efforts of manufacturers to engage consumers in designing and marketing products. Services, however, are fundamentally different than products; unlike goods, services are always ‘coproduced’. Failure to recognise this unique character of a service and its implications may limit our success in partnering with patients to improve health care. We trace a partial history of the coproduction concept, present a model of healthcare service coproduction and explore its application as a design principle in three healthcare service delivery innovations. We use the principle to examine the roles, relationships and aims of this interdependent work. We explore the principle's implications and challenges for health professional development, for service delivery system design and for understanding and measuring benefit in healthcare services.

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          Patient reported outcome measures in practice.

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            The use of patient reported outcome measures in routine clinical practice: lack of impact or lack of theory?

            This paper applies a theory-driven approach to explore why the use of patient-reported outcome (PRO) measures in clinical practice, in particular, health-related quality of life (HRQoL) instruments, has little or no apparent influence on clinical decision making. A theory-driven approach involves combining knowledge of whether and how an intervention works. It is argued that such an approach is currently lacking within the literature evaluating the effectiveness of feeding back HRQoL information to clinicians. The paper identifies a number of mechanisms that might give rise to the expected outcomes that are currently implicit within the design of the intervention and hypotheses specified within the trials evaluating the use of HRQoL measures in clinical practice. It then examines how far current clinical practice matches these mechanisms and in doing so, a number of possible explanations for the lack of impact of HRQoL on clinical decision making are reviewed. The influence of HRQoL information on clinical decision making depends on a large number of factors related to the design of the intervention, patients' and clinicians' desire to discuss HRQoL issues within the consultation and the legitimacy that clinicians give to HRQoL instruments. To date, knowledge of how the feedback of HRQoL information to clinicians might improve doctor-patient communication or clinical decision making has yet to sufficiently inform an assessment of whether these aspects of patient care are improved. The paper concludes by specifying how the feedback of HRQoL information to clinicians might be modified to maximise its impact on clinical decision making.
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              Relationship-centered care. A constructive reframing.

              All illness, care, and healing processes occur in relationship--relationships of an individual with self and with others. Relationship-centered care (RCC) is an important framework for conceptualizing health care, recognizing that the nature and the quality of relationships are central to health care and the broader health care delivery system. RCC can be defined as care in which all participants appreciate the importance of their relationships with one another. RCC is founded upon 4 principles: (1) that relationships in health care ought to include the personhood of the participants, (2) that affect and emotion are important components of these relationships, (3) that all health care relationships occur in the context of reciprocal influence, and (4) that the formation and maintenance of genuine relationships in health care is morally valuable. In RCC, relationships between patients and clinicians remain central, although the relationships of clinicians with themselves, with each other and with community are also emphasized.
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                Author and article information

                Journal
                BMJ Qual Saf
                BMJ Qual Saf
                qhc
                bmjqs
                BMJ Quality & Safety
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-5415
                2044-5423
                July 2016
                16 September 2015
                : 25
                : 7
                : 509-517
                Affiliations
                [1 ]Department of Medicine, Cambridge Health Alliance , Cambridge, Massachusetts, USA
                [2 ]The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth, Lebanon, New Hampshire, USA
                [3 ]Department of Pediatrics, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio, USA
                [4 ]College of Nursing, University of Colorado , Aurora, Colorado, USA
                [5 ]Department of Pulmonary Medicine, University Hospital Crosshouse , Kilmarnock, East Ayrshire, UK
                Author notes
                [Correspondence to ] Dr Maren Batalden, Department of Medicine, Cambridge Health Alliance, Cambridge, MA 02139, USA; mbatalden@ 123456challiance.org , mbatalden@ 123456gmail.com ,
                Article
                bmjqs-2015-004315
                10.1136/bmjqs-2015-004315
                4941163
                26376674
                4d0fa1cd-3198-438a-b3e7-6d86a0dff71f
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 20 April 2015
                : 26 July 2015
                : 21 August 2015
                Categories
                1506
                Original Research
                Custom metadata
                unlocked

                Public health
                healthcare quality improvement,health professions education,patient-centred care,social sciences,health services research

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