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BMJ Qual Saf. 2014 Apr;23 Suppl 1:i90-4. doi: 10.1136/bmjqs-2013-002782.

The interdependent roles of patients, families and professionals in cystic fibrosis: a system for the coproduction of healthcare and its improvement.

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The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth, , Lebanon, New Hampshire, USA.


A quality healthcare system is coproduced by patients, families and healthcare professionals working interdependently to cocreate and codeliver care. Cystic fibrosis (CF) patients and families rely on healthcare professionals to provide the best possible care and timely, accurate information. They know that the care at home and in clinical settings needs to be seamless, using shared information and decisions. A parent's journey of better care begins with her son's diagnosis and moves to her involvement to improve the systems and processes of care for others. She reflects on this work and identifies five elements that contributed to the coproduction of improved care: (1) mental and emotional readiness to engage; (2) curiosity and the search for insight; (3) reframe challenges into opportunities for improvement; (4) listen and learn from everyone, bringing home what is relevant; and (5) personal participation. Joined with the reflections of an improvement scientist, they note that chronic care relies on informed, activated patients and prepared, proactive healthcare professionals working together and that it is more than 'patient-centric'. They propose a model for the coimprovement of systems of care.


Chronic disease management; Clinical microsystem; Continuous quality improvement; Patient-centred care; Quality improvement

[Indexed for MEDLINE]

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