Enabling public, patient and practitioner involvement in co-designing frailty pathways in the acute care setting
Abstract Background Although not an inevitable part of ageing, frailty is an increasingly common condition in older people. Frail older patients are particularly vulnerable to the adverse effects of hospitalisation, including deconditioning, immobility and loss of independence (Chong et al, J Am Med...
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-11-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12913-019-4626-8 |
| _version_ | 1818408111501737984 |
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| author | Deirdre O’Donnell Éidín Ní Shé Mary McCarthy Shirley Thornton Thelma Doran Freda Smith Barry O’Brien Jim Milton Bibiana Savin Anne Donnellan Eugene Callan Eilish McAuliffe Simone Gray Therese Carey Nicola Boyle Michelle O’Brien Andrew Patton Jade Bailey Diarmuid O’Shea Therese Cooney Marie |
| author_facet | Deirdre O’Donnell Éidín Ní Shé Mary McCarthy Shirley Thornton Thelma Doran Freda Smith Barry O’Brien Jim Milton Bibiana Savin Anne Donnellan Eugene Callan Eilish McAuliffe Simone Gray Therese Carey Nicola Boyle Michelle O’Brien Andrew Patton Jade Bailey Diarmuid O’Shea Therese Cooney Marie |
| author_sort | Deirdre O’Donnell |
| collection | DOAJ |
| description | Abstract Background Although not an inevitable part of ageing, frailty is an increasingly common condition in older people. Frail older patients are particularly vulnerable to the adverse effects of hospitalisation, including deconditioning, immobility and loss of independence (Chong et al, J Am Med Dir Assoc 18:638.e7–638.e11, 2017). The ‘Systematic Approach to improving care for Frail older patients’ (SAFE) study co-designed, with public and patient representatives, quality improvement initiatives aimed at enhancing the delivery of care to frail older patients within an acute hospital setting. This paper describes quality improvement initiatives which resulted from a co-design process aiming to improve service delivery in the acute setting for frail older people. These improvement initiatives were aligned to five priority areas identified by patients and public representatives. Methods The co-design work was supported by four pillars of effective and meaningful public and patient representative (PPR) involvement in health research (Bombard et al, Implement Sci 13:98, 2018; Black et al, J Health Serv Res Policy 23:158–67, 2018). These pillars were: research environment and receptive contexts; expectations and role clarity; support for participation and inclusive representation and; commitment to the value of co-learning involving institutional leadership. Results Five priority areas were identified by the co-design team for targeted quality improvement initiatives: Collaboration along the integrated care continuum; continence care; improved mobility; access to food and hydration and improved patient information. These priority areas and the responding quality improvement initiatives are discussed in relation to patient-centred outcomes for enhanced care delivery for frail older people in an acute hospital setting. Conclusions The co-design approach to quality improvement places patient-centred outcomes such as dignity, identity, respectful communication as well as independence as key drivers for implementation. Enhanced inter-personal communication was consistently emphasised by the co-design team and much of the quality improvement initiatives target more effective, respectful and clear communication between healthcare personnel and patients. Measurement and evaluation of these patient-centred outcomes, while challenging, should be prioritised in the implementation of quality improvement initiatives. Adequate resourcing and administrative commitment pose the greatest challenges to the sustainability of the interventions developed along the SAFE pathways. The inclusion of organisational leadership in the co-design and implementation teams is a critical factor in the success of interventions targeting service delivery and quality improvement. |
| first_indexed | 2024-12-14T09:38:32Z |
| format | Article |
| id | doaj.art-042e8f8b27434fbba0f32cfad49083a6 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-14T09:38:32Z |
| publishDate | 2019-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-042e8f8b27434fbba0f32cfad49083a62022-12-21T23:07:52ZengBMCBMC Health Services Research1472-69632019-11-0119111110.1186/s12913-019-4626-8Enabling public, patient and practitioner involvement in co-designing frailty pathways in the acute care settingDeirdre O’Donnell0Éidín Ní Shé1Mary McCarthy2Shirley Thornton3Thelma Doran4Freda Smith5Barry O’Brien6Jim Milton7Bibiana Savin8Anne Donnellan9Eugene Callan10Eilish McAuliffe11Simone Gray12Therese Carey13Nicola Boyle14Michelle O’Brien15Andrew Patton16Jade Bailey17Diarmuid O’Shea18Therese Cooney Marie19School of Nursing, Midwifery and Health Systems, University College DublinSchool of Nursing, Midwifery and Health Systems, University College DublinExpert by Experience Representing the Older People’s Empowerment NetworkExpert by Experience Representing Family Carer’s IrelandExpert by Experience Representing the Older People’s Empowerment NetworkExpert by Experience Representing Sage AdvocacyExpert by Experience Representing Sage AdvocacyExpert by Experience Representing Sage AdvocacySage AdvocacyExpert by Experience Representing Glór and Age Action IrelandExpert by Experience Representing the Disability Federation of IrelandSchool of Nursing, Midwifery and Health Systems, University College DublinSt. Vincent’s University HospitalSt. Vincent’s University HospitalSt. Vincent’s University HospitalSt. Vincent’s University HospitalSt. Vincent’s University HospitalSchool of Medicine, University College DublinSt. Vincent’s University HospitalSt. Vincent’s University HospitalAbstract Background Although not an inevitable part of ageing, frailty is an increasingly common condition in older people. Frail older patients are particularly vulnerable to the adverse effects of hospitalisation, including deconditioning, immobility and loss of independence (Chong et al, J Am Med Dir Assoc 18:638.e7–638.e11, 2017). The ‘Systematic Approach to improving care for Frail older patients’ (SAFE) study co-designed, with public and patient representatives, quality improvement initiatives aimed at enhancing the delivery of care to frail older patients within an acute hospital setting. This paper describes quality improvement initiatives which resulted from a co-design process aiming to improve service delivery in the acute setting for frail older people. These improvement initiatives were aligned to five priority areas identified by patients and public representatives. Methods The co-design work was supported by four pillars of effective and meaningful public and patient representative (PPR) involvement in health research (Bombard et al, Implement Sci 13:98, 2018; Black et al, J Health Serv Res Policy 23:158–67, 2018). These pillars were: research environment and receptive contexts; expectations and role clarity; support for participation and inclusive representation and; commitment to the value of co-learning involving institutional leadership. Results Five priority areas were identified by the co-design team for targeted quality improvement initiatives: Collaboration along the integrated care continuum; continence care; improved mobility; access to food and hydration and improved patient information. These priority areas and the responding quality improvement initiatives are discussed in relation to patient-centred outcomes for enhanced care delivery for frail older people in an acute hospital setting. Conclusions The co-design approach to quality improvement places patient-centred outcomes such as dignity, identity, respectful communication as well as independence as key drivers for implementation. Enhanced inter-personal communication was consistently emphasised by the co-design team and much of the quality improvement initiatives target more effective, respectful and clear communication between healthcare personnel and patients. Measurement and evaluation of these patient-centred outcomes, while challenging, should be prioritised in the implementation of quality improvement initiatives. Adequate resourcing and administrative commitment pose the greatest challenges to the sustainability of the interventions developed along the SAFE pathways. The inclusion of organisational leadership in the co-design and implementation teams is a critical factor in the success of interventions targeting service delivery and quality improvement.http://link.springer.com/article/10.1186/s12913-019-4626-8Co-designPublic and patient involvementFrailtyOlder peopleHealth systemPerson-centred care |
| spellingShingle | Deirdre O’Donnell Éidín Ní Shé Mary McCarthy Shirley Thornton Thelma Doran Freda Smith Barry O’Brien Jim Milton Bibiana Savin Anne Donnellan Eugene Callan Eilish McAuliffe Simone Gray Therese Carey Nicola Boyle Michelle O’Brien Andrew Patton Jade Bailey Diarmuid O’Shea Therese Cooney Marie Enabling public, patient and practitioner involvement in co-designing frailty pathways in the acute care setting BMC Health Services Research Co-design Public and patient involvement Frailty Older people Health system Person-centred care |
| title | Enabling public, patient and practitioner involvement in co-designing frailty pathways in the acute care setting |
| title_full | Enabling public, patient and practitioner involvement in co-designing frailty pathways in the acute care setting |
| title_fullStr | Enabling public, patient and practitioner involvement in co-designing frailty pathways in the acute care setting |
| title_full_unstemmed | Enabling public, patient and practitioner involvement in co-designing frailty pathways in the acute care setting |
| title_short | Enabling public, patient and practitioner involvement in co-designing frailty pathways in the acute care setting |
| title_sort | enabling public patient and practitioner involvement in co designing frailty pathways in the acute care setting |
| topic | Co-design Public and patient involvement Frailty Older people Health system Person-centred care |
| url | http://link.springer.com/article/10.1186/s12913-019-4626-8 |
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