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Health Expect. 2017 Dec;20(6):1367-1374. doi: 10.1111/hex.12576. Epub 2017 May 31.

Reconciling patient and provider priorities for improving the care of critically ill patients: A consensus method and qualitative analysis of decision making.

Author information

1
Alberta Health Services, Calgary, AB, Canada.
2
Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
3
Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada.
4
W21C Research and Innovation Centre, University of Calgary, Calgary, AB, Canada.
5
Department of Critical Care, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Calgary, AB, Canada.

Abstract

BACKGROUND:

Providers have traditionally established priorities for quality improvement; however, patients and their family members have recently become involved in priority setting. Little is known about how to reconcile priorities of different stakeholder groups into a single prioritized list that is actionable for organizations.

OBJECTIVE:

To describe the decision-making process for establishing consensus used by a diverse panel of stakeholders to reconcile two sets of quality improvement priorities (provider/decision maker priorities n=9; patient/family priorities n=19) into a single prioritized list.

DESIGN:

We employed a modified Delphi process with a diverse group of panellists to reconcile priorities for improving care of critically ill patients in the intensive care unit (ICU). Proceedings were audio-recorded, transcribed and analysed using qualitative content analysis to explore the decision-making process for establishing consensus.

SETTING AND PARTICIPANTS:

Nine panellists including three providers, three decision makers and three family members of previously critically ill patients.

RESULTS:

Panellists rated and revised 28 priorities over three rounds of review and reached consensus on the "Top 5" priorities for quality improvement: transition of patient care from ICU to hospital ward; family presence and effective communication; delirium screening and management; early mobilization; and transition of patient care between ICU providers. Four themes were identified as important for establishing consensus: storytelling (sharing personal experiences), amalgamating priorities (negotiating priority scope), considering evaluation criteria and having a priority champion.

CONCLUSIONS:

Our study demonstrates the feasibility of incorporating families of patients into a multistakeholder prioritization exercise. The approach described can be used to guide consensus building and reconcile priorities of diverse stakeholder groups.

KEYWORDS:

consensus; critical care; health priorities; intensive care; intensive care unit; patient participation; qualitative research; quality improvement; surveys and questionnaires

PMID:
28561887
PMCID:
PMC5689241
DOI:
10.1111/hex.12576
[Indexed for MEDLINE]
Free PMC Article

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