Anya de Iongh and Cat Chatfield: #BetterHealthDebate—getting the fundamental relationships right

Joining forces with the Health Foundation, we hosted a Twitter chat last month on how we meaningfully partner with patients to improve healthcare. The chat marked the launch of the BMJ’s Quality Improvement series, in partnership with the Health Foundation, which explores how to improve the quality of healthcare delivery. Health Foundation Improvement Fellow Suzanne Wood (@suzannewTHF) joined us in hosting the chat, which brought together a wide range of people who use and deliver health care services, with over 240 contributors tweeting more than 730 tweets.

As we discuss the themes of the evening, we need to consider improvements in health services through two lenses, both the medical outcomes and the experiences of people using services. These need to be considered from the full range of people who use our services and reflect that diversity.

The debate began by asking how we ensure patients are fully involved in improving healthcare. The key messages were about creating the right environment that feels comfortable and makes involvement meaningful. Putting the necessary things in place, such as planning from the start and genuinely listening requires time. The benefits of this approach to improvement are more readily realised when this investment in time is made to develop the conditions conducive to involvement. Jane Sproat (@janey513) summed this up: “we say we don’t have time, but then we expect others to give up time to be a patient rep supporting improvement work. Need to flip it round so we as professionals value patients time as the driver”

With an eye on the long-term, Mandy Rudczenko (@MandyZenko) tweeted that “co-production is not a one-night stand!!! Build relationships from the start of all projects”. This was also reflected in comments about ensuring training and development support was ongoing for people involved too.

Further comments that highlighted the importance of time included this from Sarah Williams “ongoing relationship, not helicoptering in a consultation on an ‘issue,’” and “Have to have a relationship before you point it at a purpose”

The conversation evolved to consider the specifics of the “ask” of patients, carers, and members of the public when it comes to quality improvement. Mark Brown asked: “What is it you’re expecting patients to actually do? Are you asking for opinions, actions, wisdom, or experiences.”

Jennifer Skillen (@cyberjennifer) summed up the range of things patients could do with their varied assets: “patients aren’t just experts by experience at being patients, they can be experts at management, accounting, research, teaching… patients should be introduced with their full CVs and that outside experience respected.”

While exploring the range of contributions patients bring to the table, conversation turned to what this meant for professionals who also have experience of using services to contribute. It was generally felt that we need professionals to be able to feel confident to share their experiences, but that this often isn’t expected of them, perhaps out of a concern that it could overshadow the patient. However, showing this human vulnerability on both sides is often seen as a foundation for trust for these partnerships. While we strive to not “pigeonhole” patients as being “just” patients, we mustn’t pigeonhole clinicians in the opposite way. Creating the environment where people aren’t defined by their roles and where all contribute more than their respective patient or clinician experiences means a richer discussion as a result. Jennifer Skillen explained the value of this: “I find that when clinicians do bring personal experiences to a consultation it can really help. Even if it is a quick comment about a shared interest in chickens or a mutual love of sport.” Remembering that neither patients nor staff are homogenous groups is crucial. Acknowledging the differences in our perspectives and experiences is important, but often, we should pay more attention to the ways in which we are the same, and grow a sense of equality between all involved. A tweet by the Dalai Lama shared during the chat articulated this clearly: “I’m Tibetan, I’m Buddhist and I’m the Dalai Lama, but if I emphasize these differences it sets me apart and raises barriers with other people. What we need to do is to pay more attention to the ways in which we are the same as other people.

For all the science around improvement and resources, there was a clear message throughout the Twitter chat about getting the fundamental relationships right. We may choose to codify this by using improvement tools or approaches, but often it simply requires common sense and empathy to create improvement in an impactful and meaningful way.

Cat Chatfield, Quality Improvement Editor, The BMJ.

Anya de Iongh is patient editor for the BMJ and works nationally and locally around person-centred workforce development and self-management support services.

Competing interests: Full details here.

Amendment: This opinion piece was edited on 3 July 2018 to change the wording in the first paragraph for editorial reasons.