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Sylvie Touveneau, leader of the Patients as Partners project
With nearly 60,000 hospitalizations and 100,000 consultations in 2015, the partnership with the HUG is a shared concern.Collaboration with patients and caregivers in discussions, decisions, and actions related to their care becomes essential (FOPH Health Policy: Priorities of the Federal Council/Health Report 2020, January 23, 2013). The partnership is expressed through a change in the relationship, favoring a close collaboration between patients, their caregivers, and professionals. This approach has already been successfully adopted at the HUG in several sectors.As part of the 20/20 strategy, the “Patients as Partners” program is one of the key measures for improving quality of services. The goal is to promote this relationship model at each step of patient care, in all care specialties, as well as in areas such as hospitality, teaching, or governance.The brainchild of a team of multidisciplinary professionals and patients, the conceptual framework of the partnership is the first step of this project. It will be the tool for identifying areas and developing actions, for which patients and caregivers are recognized as stakeholders in the healthcare sector.It should be noted that the project team, which initially focused on care outcomes, subsequently integrated representatives from other areas of activity outside of healthcare.
Promotion of the HUG “Patients as Partners” model involves a paradigm shift. Today, the relationship mode is still too often paternalistic (The “Montreal model”: the challenges of a partnership relationship between patients and health professionals). Under the pressure of patients, increasingly well informed, and health professionals themselves, it moves towards a relationship based on trust, listening, dialog, mutual respect, and shared decision making. Everyone has their place and role in the same team.This development requires a repositioning of roles: the patient knows better than anyone what their symptoms are and how they experience these symptoms. Their view of the hospital and its services is that of a client. We can only treat the patient and make progress with them. The professional, for their part, no longer makes decisions alone, but instead seeks to collaborate with the patient.The partnership is consequently based on respect of the other, on a reciprocal recognition of skills and knowledge and of the experience of each partner. This synergy of the expertise of different stakeholders enables care and hospital stays to be improved.
In this collaborative context, patients are given legitimacy in their position as “stakeholders in health,” which most often (but not solely) materializes as “stakeholder in their own health.”In some cases, patients and their caregivers develop knowledge about the disease and decide to share this knowledge with other patients (through mentoring, speaking at a medical or association conference, etc.). In other cases, they are led to share their experience for the benefit of professionals (role play with medical students, colleague in a health care team, etc.) or even to join bodies to give their opinions. The spectrum of the partnership is indeed broad and opportunities to be a “stakeholder in the healthcare system” are growing quickly (participation in associations, lobbying in parliament, focus groups, inclusion in management committees, etc.).
Since cooperation between patients and professionals can be embodied in different ways, the partnership approach encouraged at the HUG aims to be flexible.The diagram below illustrates this dynamic, multi-dimensional process:
The degree of involvement, personal capabilities, and the area of activity concerned are all elements that influence the nature of the partnership. However, the “recipe” can be adjusted depending on situations and given moments. The components of the collaboration are combined over the course of the relationship and do not necessary follow a specific order.
For health professionals, the patient partner is a patient, patient expert, patient citizen, and a peer practitioner. The same person can embody these different roles at different moments in their care pathway.
The patient partner works with professionals to seek solutions adapted to problems concerning their health and their care plan or issues of health strategy. Certain conditions are necessary for this participation, such as patient-accessible quality information and an environment suitable for the expression of their experience, needs, and expectations.
Beside the patient, other people may be involved in the partnership relationship at one time or another.
The nature and level of involvement varies depending on the moment or the patient’s situation. The patient can get involved at all levels of the institution, spontaneously or in response to an invitation, and intervene in care processes or societal issues.
Far from a narrow standardized approach, the proposed HUG Patients as Partners design is flexible, to embrace the diversity of situations. It focuses on the variability of relationship dynamics and possibilities for application. This openness and this design flexibility directly encourage professionals, from all fields of activity, to engage in this approach. They allow creative and “tailor-made” forms of collaboration.Promotion of the HUG Patients as Partners design is undoubtedly a way to enhance the participatory approaches undertaken by the professionals of the HUG. It also allows the transition from a traditional relationship approach toward a partnership approach to be assessed.
By committing to such an approach, professionals contribute to an open relationship and improved communication. Finally, the actions implemented create meaning and humanity for the patient.