The role of the patient in healthcare quality

Doctor-listening-to-his-patientHealthcare is changing rapidly, and so is the need for continuous improvement in healthcare quality.

According to the World Health Organization (WHO), the six domains of quality interventions are: Leadership, Information, Regulation & Standards, Organizational Capacity, Models of Care, and Patient & Population Engagement.1

Maintaining quality has been linked to better infrastructure and processes, cutting the cost, and increasing delivery efficiency. Focus has been on what the hospital can provide to the patient.

However, the patients also play a vital role in improving healthcare quality.

It has been stated that “Patients are the most underutilized resource [in healthcare] and they have the most at stake. They want to be involved and they can be involved. Their participation will lead to better medical outcomes at lower costs with dramatically higher patient satisfaction.”2

An emerging literature indicates that patients actively involved in their own healthcare experience better outcomes, are more satisfied with their choices, and may make more cost-effective decisions.3 On the other hand, a non-engaged patient is more likely to suffer poor clinical outcomes, is less satisfied with his or her providers, and is more likely to file malpractice suits.2 A patient who is not actively engaged may lead to the failure of process improvements or other efficiency measures taken by healthcare providers.
[s2If !is_user_logged_in()]…

[/s2If][s2If is_user_logged_in()]
Therefore, patient engagement is critical to quality improvement strategy.

The patient engagement model can be focused on improving health literacy, an attitudinal shift towards self-care, and patient experience with the health system.

Health literacy is fundamental to patient engagement,4 as its purpose is to educate as well as empower the patient in building competence in making health decisions. If people cannot obtain, understand, and use health information, they will not be able to look after themselves adequately or make appropriate decisions about their health.5

Patients lacking in health literacy are inclined to have poorer health status, higher rates of hospital admission, and less likelihood to adhere to prescribed treatments and self-care plans. They also tend to experience more drug and treatment errors and make less use of preventative services.4

Because health literacy is central to enhancing the involvement of patients in their self-care, all strategies to strengthen patient involvement should aim to improve health literacy.4

Self-care has been defined by the Government Department of Health in England as: “the care taken by individuals towards their own health and well-being.”6 Self-management comprises the actions individuals take to lead a healthy lifestyle, meet their social, emotional and psychological needs, care for their long-term conditions, and prevent further illness or accidents.6

For the management of long-term conditions in low-risk patients, self-care is an affordable option. Essentially healthcare professionals need to develop and maintain partnerships with patients to ensure they understand their rights and responsibilities for self-care and the nature and purpose of their therapeutic regimens. Encouraging and training patients to ensure safe and effective medicine-taking is a key feature in facilitating self-care.6 Similarly, the risks and benefits of self-care in minor ailments is also important.

Healthcare as experienced by patients can be just as important as the treatment they receive.

An optimal patient experience is the fulfilment of four psychological elements: confidence in trusting the hospital, integrity in being treated fairly, pride in feeling good about the hospital, and passion for the idea that the hospital is irreplaceable.7 Along with those are the patients’ basic requirements for good service and medical care, such as a clean physical environment, effective communication with the medical staff, and involvement in decision-making.8

Patient engagement, therefore, empowers patients with greater knowledge, gives patients a better experience, makes the best use of healthcare resources, and contributes to improved health behaviours and better health.9

Dr. Shalini Ratan Dr. Shalini Ratan, MD, is Founder and Chief Knowledge Facilitator at Nirvan Life Sciences Pvt Ltd. Mumbai, India.

References (click to show/hide)

  1. Quality of Care-A Process for making Strategic Choices in Health Systems. World Health Organization 2006.
  2. Creating Efficiencies through Patient Engagement. Available at, accessed on 16th October, 2013
  3. William D. Novelli et al. Recognizing an Opinion Findings From the IOM Evidence Communication Innovation Collaborative, JAMA, Published online September 25, 2012, Available at doi:10.1001/jama.2012.13369, Accessed on 9th September, 2013.
  4. Angela Coulter and Jo Ellins. Effectiveness of strategies for informing, educating, and involving patients. BMJ 2007; 335: 24-27.
  5. Health Literacy. Invest in Engagement. Available on
  6. Peter R Noyce. The landscape of selfcare and selfcare. SelfCare 2011;2(4):93-97.
  7. Jennifer Robison. What Is the “Patient Experience”?. Gallup Business Journal. Available at Accessed on 30th September, 2013.
  8. Patient Experience. Invest in Engagement. Available on
  9. Invest in Engagement. Available at Accessed on 30th September, 2013


Log in or register for free to continue reading
Register Now For Free Already Registered? Log In
This entry was posted in Practice Management and tagged , . Volume: .


  1. Posted Oct 2013 at 4:21 pm | Permalink

    Dear Shalini,

    Excellent article.

    Please do look at our book, Decoding Medical Gobbledygook – Promoting Health Literacy to Put Patients First which is available free online at !

    Dr Aniruddha Malpani, MD
    Medical Director
    HELP – Health Education Library for People
    Bombay 400 034
    Tel. No.:65952393/65952394

    Posted Dec 2013 at 4:41 pm | Permalink

    Dear doctor , my appreciation for special articles on health care.
    I feel patient’s health literacy plays a vital role in getting good results of quality care.

    Posted Dec 2013 at 4:53 pm | Permalink

    Thearaputic success depends on patient doctor attitude and related factors. Majority of the times failure to achieve quality of care is non compliance by patient .
    This is achieved by winning the confidence of patients. This is enhanced by proper counselling., ,attitude.
    Compliance is very important factor.

Post a Comment

You must be logged in to post a comment.