Key messages
-Power imbalances between health providers and consumers can limit consumer participation in health service planning, delivery and evaluation.
-Power imbalances in the partnership may happen because of the ways consumers are recruited, how meetings are run, and how decisions are made.
-To have successful partnerships with consumers, health providers need to address these power imbalances.
-Some consumers and health providers believed that partnerships improved the culture and environment of the health service, as well as how health services were planned and developed.
Why is it important that consumers and health providers work together to plan, deliver and evaluate health services?
In the past, health providers decided how health services were planned, delivered and evaluated. More recently there has been a focus on designing services to better meet the needs, preferences and values of consumers. This has led to consumers partnering with health providers to design, deliver and evaluate health services. Often partnerships between consumers and health providers happen in formal group formats, such as committees, hospital boards or working groups.
What did we want to find out?
We wanted to explore the views and experiences of consumers and health providers working in partnership to plan, deliver and evaluate health services. We also wanted to identify best practice principles for partnering in formal group formats.
What did we do?
We conducted a qualitative evidence synthesis (QES) to understand the views and experiences of health providers and consumers working in partnership. A QES brings together and analyses the results from individual qualitative studies. Qualitative studies use data that are collected through interviews, focus groups, questionnaires and observations.
The QES was conducted with a Stakeholder Panel of consumers and health providers. The Panel worked with the research team to decide which questions to answer, what studies should be included, whether the analysis was comprehensive and to develop the best practice principles.
We searched databases for qualitative studies that explored consumers’ and health providers' views and experiences of partnering in formal group formats. We searched for studies published from January 2000 to October 2018. We also searched websites of organisations involved in person-centred care, and asked experts to share relevant studies.
From these searches we selected 33 studies for in-depth analysis. The studies were from different countries and settings (e.g. hospital or community clinics) and involved different people (including under-represented patients) and different types of formal group partnerships (e.g. committees or steering groups).
We combined the results of the studies and looked for common themes. These themes became our findings. We rated our confidence in each of the findings based on the relevance, quality and quantity of the data. We grouped the findings into categories.
What did we find?
Our analysis identified 19 findings, which we grouped into the following five categories.
Contextual factors influencing partnerships: government policy, processes, funding, and the organisational context of the health service influenced partnering.
Consumer recruitment: consumer recruitment occurred in various ways. In a few studies consumers managed the recruitment process. Some people (particularly health providers) felt consumers should reflect the range of people who used the health service. Some health providers thought that the experience of some consumers did not reflect the broader population. Consumers sometimes found it difficult to represent a broad range of community views.
Partnership dynamics and processes: positive relationships between health providers and consumers improved partnerships. Formal meetings and being unclear about the consumer role could limit consumers’ involvement. Health providers’ professional status, technical knowledge, and use of jargon could be intimidating for consumers. Consumers sometimes felt their knowledge was not valued. Consumers could become frustrated when they lacked decision-making power, and when health providers dominated the meeting agenda.
Perceived impacts on partnership participants: formal partnerships could affect health providers and consumers in both positive and negative ways.
Perceived impacts on health service planning, delivery and evaluation: people perceived formal partnerships may improve health service culture and the physical environment of the health service. They also felt partnerships may improve health service design and delivery.
How can these findings be put into practice?
Best practice principles for partnering in formal group formats were developed from the findings. Principles included leadership and health service culture; diversity; equity; mutual respect; shared vision and regular communication; shared agendas and decision-making; influence and sustainability.
What are the limitations of the evidence?
Most of the findings in this review are rated as "high" or "moderate" confidence, which means the evidence for the findings is strong. However, one finding that showed people perceived formal partnerships improved health service evaluation, was rated as "very low" confidence because it was based on weaker evidence.
How up to date is this evidence?
This evidence is up to date to October 2018. The review took longer than usual to complete because co-produced research takes time, and the review was completed during the COVID-19 pandemic. Because most of the findings are rated "high" or "moderate" confidence, we believe an updated search may not substantially change the results.