Patient involvement in training of healthcare students
Overall, 10 respondents (20.8%) involved patients in the training of health students, 7 of whom worked in teaching hospitals. Thirty-four respondents (70.3%) viewed the impact of patient involvement on medical students and residents as positive and 31 (64.5%) viewed this impact as positive on nursing and care assistant students. When asked if patient experience is formative for health students in EDs, 16/20 (80%) respondents from teaching hospitals and 16/28 (57%) from non-teaching hospitals agreed or strongly agreed.
The categories emerging from the perceived advantages sorted by the highest rank to the lowest were: caregiver/patient relationship (40), fresh perspective for caregivers (26), patient experience/comfort (24), observance, acceptance, and understanding of care (17), care quality (15), understanding and targeting the specific needs of the patients (14), improving service organization (12), redefining the place of patients in healthcare (8), education/training of health students (5), better understanding of the patient of healthcare system (5) and improving the influence of caregivers on the institutions (4).
The categories emerging from the perceived disadvantages sorted by the highest rank to the lowest were: difficulties in recruiting patients (26), lack of time (21), poor understanding of issues related to healthcare and healthcare system (19), representativeness of patients (11), ineffectiveness of the patient partnership approach (11), difficulties in setting up the organization (9), lack of methodological support (8), patient compensation and funds allocated (7), temporality and organization of EDs not in favor (6), medical secrecy (6), intervention of patients with a negative attitude (5), acceptance of care professionals (5), communication issues between the caregivers and the patients (4), diverging objectives among patients and caregivers (4).
The results regarding the willingness of respondents to integrate patients as partners are reported in Table
5.
Table 5
Respondents willing to involve patients
Service organization | Teaching hospitals | 12 (60%) |
Non-teaching hospitals | 17 (60.7%) |
Research | Teaching hospitals | 11 (55%) |
Non-teaching hospitals | 5 (17.9%) |
Teaching/training | Teaching hospitals | 15 (75%) |
Non-teaching hospitals | 14 (50%) |
Semi-structured interviews
A total of 12 patients involved in the service re-organization project were contacted, 6 of whom responded (50%). The 6 interviewees were all retired from work, none of them were involved in patient associations. Concerning their ED experience, all had interacted with the ED in different ways. Four had accompanied a relative to the ED, one had a personal experience in an ED, one visited several EDs through his work, and two were followed-up at the same hospital where the ED project was carried out.
When commenting on how the project workshops were carried out, all the interviewees mentioned that they valued the clarity of the explanations and the role of each participant. The convivial setting was highly appreciated. One participant reported feeling more comfortable participating in a small group.
“I expressed my feelings, it was taken into account. We were a person. There was no feeling of being superior or inferior. Everyone played his role, everyone introduced himself and everyone talked about the project in their own way. Bravo. This is a good experience.“ (Interview 2).
50% of the interviewees highlighted that the exchanges with the meeting participants, including the architect, were valuable and interesting. “I found it very interesting to see what was happening from the inside, and to understand why things were not done quickly. It’s easy to say but more difficult to act. (Interview 4)
Two participants particularly appreciated the participation of different professions including doctors, technical staff, and the architect. “All the trades were represented. Even the technical staff. If you have a question to ask, you raise your hand and you can participate.“ (Interview 2).
All the interviewees felt legitimate and able to participate. All but one felt competent enough to participate. All the interviewees but one felt their work valued, although they all recognized a modest, but meaningful contribution. “Between us, mute the sound, my contribution was decisive *laughing*. I assume that everyone’s participation, even the smallest, contributes to develop a project. Small streams make big rivers.“ (Interview 5).
All interviewees recognized a positive role of patient engagement in service organization.
One interviewee said they had no opinion regarding the involvement of patients in medical student training. Another interviewee said they did not feel competent enough to train medical students. The others welcomed the idea. “This is a very technical field but the purpose is always the patients. So it’s a good thing to involve them, but not as potted plants. But the modalities need to be defined. At which level, the medical students from the beginning? The medical residents?…” (Interview 5).
Four out of the six interviewees considered patient involvement in research a good idea. One of them pointing out the necessity of recruiting “selected” patients.
“Of course, when a study is conducted, I think that you need to consider every aspect, not just medical ones. Patient perspectives are interesting, his healthcare pathway, what went well, whether he suffered… My last operation I urinated blood. It was painful. I was expressing myself, I was scared. This aspect is very important too.“ (Interview 2).
Among the facilitators reported for patient engagement, the interviewees first mentioned the desire to improve healthcare. They then mentioned the need of diverse profiles with different perspectives in a healthcare system. Two participants wanted to share their experience. Two interviewees considered the meetings as a means to exchange ideas with different types of people. For two patients, personal curiosity was a driving engine. “The aim is to be constructive, bring his little contribution and enjoy yourself. And meet people too.“ (Interview 5).
For the interviewees, the obstacles to patient engagement included too much personal involvement, a lack of competence, a lack of consideration for patient perspectives, and poor health.
All the interviewees were willing to continue working on the project. Two of the patients reported that they would agree to participate in a future project. One of the interviewees spontaneously volunteered to play a part in other projects.