Abstract
Amidst statutory and non-statutory calls for effective patient and public involvement (PPI), questions continue to be raised about the impact of PPI in healthcare services. Stakeholders, policy makers, researchers, and members of the public ask in what ways and at what level PPI makes a difference. Patient experience is widely seen as an important and valuable resource to the development of healthcare services, yet there remain legitimacy issues concerning different forms of knowledge that members of the public and professionals bring to the table, and related power struggles. This paper draws on data from a qualitative study of PPI in a clinical commissioning group (CCG) in the UK. The study looked at some of the activities in which there was PPI; this involved researchers conducting observations of meetings, and interviews with staff and lay members who engaged in CCG PPI activities. This paper explores power imbalances when it comes to influencing the work of the CCG mainly between professionals and members of public, but also between different CCG staff members and between different groups of members of public. The authors conclude that a hierarchy of power exists, with some professionals and public and lay members afforded more scope for influencing healthcare service development than others—an approach which is reflected in the ways and extent to which different forms and holders of knowledge are viewed, managed, and utilized.
Highlights
It is widely accepted that quality in the delivery of healthcare is more than purely good clinical care
Whilst our study showed no evidence of professionals questioning the legitimacy of lay members, the more marginal role of lay members in the work of the clinical commissioning group (CCG) suggests an unequal balance of potential to influence and of power between professionals and lay members
We suggested in our introduction that modern day changes to the way healthcare services are sought, delivered and have facilitated the growth of Patient and public involvement (PPI) might have narrowed the power gap between professionals and lay and public members
Summary
It is widely accepted that quality in the delivery of healthcare is more than purely good clinical care. The experience and voice of the patient has increasingly become integrated as a core dimension of health care consultation and planning. The idea is that patient and public involvement will improve quality and implementation of healthcare services, address population expectations and needs and foster healthcare choices and shared decision-making (Boivin et al, 2010). Patient and public involvement (PPI) in healthcare services has become an international phenomenon over recent years in western and developing countries (Oliver et al, 2007). A PPI working group created in 2007 by the Guideline International Network Patient and Public Involvement Working Group (G-I-N PUBLIC) aims to support PPI globally in the development
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