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Participation: How to give patients/clients a voice?

How to give patients/clients a voice? Patient participation

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Patients/clients must have full confidence in safe and good quality care. Healthcare professionals therefore do everything in their power to avoid unnecessary damage or unnecessary risks for patients/clients. Still, occasionally things go wrong. Unconsciously or unintentionally...

When talking about unsafe care, in general we think of incidents or risky situations. However, for patients/clients many more situations occur that may be unsafe. Inadequate communication, unfair treatment or a bad atmosphere are all factors that may evoke feelings of insecurity. 

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By actively listening to experiences of patients/clients and their relatives the quality and safety of care can be substantially improved, without requiring major change processes. But how do you give patients/clients a voice?

Patient/client satisfaction

The level of safety a patient/client experiences in a healthcare institution can be determined by their assessment of the care received. Matters that are relevant to them include: the way they are welcomed, waiting times, information they receive, the way they are treated by the caregiver as well as the aftercare. Many healthcare institutions therefore prefer to use the term “appreciation of the care received” instead of “customer satisfaction”. Special survey software can help to ease this process of learning from patients.

Patient/client participation

Patients/clients are the only ones who pass through the entire care process. They may provide insight into possible hidden inadequacies within processes, but also about their perception. More and more healthcare institutions therefore involve patients/clients and their relatives in healthcare.

A patient/client may be an individual patient/client, but also a group of patients/clients or patients’/clients’ representatives, like family and relatives.

Patient/client participation allows healthcare institutions to receive vital information for further improvement of internal processes. What do they feel works well in the organization? And where do they see opportunities for improvement of care and service provision?

Forms of patient/clients participation

The ladder of participation is a useful tool to gain insight in the different forms of participation. The steps of the ladder of participation are used to indicate how clients and families can best exert influence. At the same time it clarifies how healthcare institutions and patients/clients and their relatives can collaborate.

In this blog we zoom in on step 2, “Consultation”. Patients, clients and their families should be able to make their voices heard and suggest improvements. There are different forms of participation, but the most appropriate form of participation depends on:

  • The objective of the participation and;
  • The project you want patients/clients to participate in.

Here are some examples of ways the healthcare institution can consult the patient/client:

Patient Reported Outcome Measures (PROMs)

PROMs are relatively short and straightforward questionnaires to measure the effectiveness of the care provided. The use of these questionnaires enhances insight in healthcare outcomes that allow caregivers to evaluate their processes and, if necessary, adjust them. In addition, PROMs provide valuable data for research projects.

As more and more patients/clients want to choose a caregiver who provides good quality care for themselves, hospitals and patients have a growing need for insight in quality and effectiveness of the care provided.

The measurement is carried out before, during and after a treatment and from the patient’s perspective, so not from the doctor’s perspective. This is an important addition as a doctor determines if the operation or treatment has been successful, while the patient/client can also measure the effectiveness based on quality of life, pain level, social functioning and mobility. The interim impact measurement allows for immediate adjustment or modification of patient care, if necessary.

Patient listener

The patient listener is responsible for listening to – and talking with – patients, at all levels within the organization. Patient listeners are deployed in particular in the hospital sector. They mainly ask questions about the treatment, the doctor in charge of the patient’s treatment as well as the care provided by the institution. The patient listener serves as a bridge between clients and the healthcare organization.

Mirror interviews

“Involve patients in matters they consider important, that is what makes it fun. Be creative. We have, for example, given patients a camera and asked them to take photos of us for a day. Those photos are put up in the department and provide an impression of the perspective from the bed or wheelchair. Currently we involve patients in decorating a family room."

Mirror interviews are an enlightening means to learn from patient experiences. Patients who have gone through the same care process are invited to share their experiences under the guidance of a discussion leader. The patients sit in a circle together with the discussion leader and are surrounded by a circle of medical specialists. The mirror effect lies in the observing role of the medical specialists.

On the spot, they are confronted with the experiences and possibly also weak links and moments of insecurity during a care process, but they do not have the opportunity to respond. The first-hand stories confront medical specialists with the consequences of unsafe situations.


“In my department I try to pass on the service concept: address someone who is waiting and ask if you can be of assistance. It is so simple, but the question alone makes that someone feels welcome. And that is what it all comes down to in the end: people need to feel comfortable here."

Security issues and the perception of safety by patients/clients and their relatives can be actively addressed by using surveys. This tool is being developed by the client council and can be used on people’s own initiative. The patient/client council indicates which security issues they consider relevant and want to investigate. Based on the online survey results, the client council discusses appropriate improvement measures. 

Measuring client satisfaction by using different types of surveys:

  • Discharge interviews: Before a patient/client is discharged, the nurse conducts a discharge interview. During this conversation patients/clients and their relatives can describe their experiences with the care process and the result achieved.
  • Website survey: After visiting an outpatient clinic or care area, patients/clients can fill in a questionnaire. This allows institutions to obtain more specific information, allowing them to better deploy improvement actions. The questionnaires can be filled in anonymously.
  • Online surveys: Some departments have internal surveys. These can be filled in online, on the spot. 
  • External surveys: Some departments participate in specific studies on patients’/clients’ opinions. This allows comparisons between different hospitals. This is the case, for instance, with fertility and breast cancer.

Supporting participation initiatives

TPSC software solutions support the use of patient/client participation. By using a variety of tools, patients and clients can easily provide feedback on the care provided, so that it can be discussed in the workplace. Weaknesses within existing processes are highlighted, analysed and optimised.

Online client satisfaction surveys by patients and clients

Any patient or client can evaluate the care received by completing an online form/survey that can be easily filled in and that can be accessed via desktop and mobile devices. The online surveys can be tailored to the individual needs. When a new survey form is submitted, the answers are immediately visible in the back office and are included in real-time reports and dashboards. This way trends become visible and the department or management can initiate specific improvement actions.

Online completing and processing of PROMs

To gain insight in the quality of care from the patient’s/client’s perspective, patients/clients can fill in a questionnaire before, during or after their treatment. This way each institution can measure the effectiveness of treatment at the patient level. The same principle applies as with the client satisfaction surveys, the answers are immediately visible in the back office and are included in real-time reports and dashboards. This way trends become visible and specific improvement actions can be initiated. In addition, the results can be used as input for process evaluation and improvement but also, for example, for marketing purposes. It is up to the care institution which PROMs they want to use.

Patient Participation eBook

Would you like to know more about patient participation and how this can improve the quality and safety of care? Download the eBook 'How to turn regular care into excellent care?'. It describes the different steps of the participation ladder and shows which tools to use to apply this into your organization. 

Download eBook Patient Participation