Learning from patients: constructions of knowledge and legitimacy in hospital-based quality improvement programmes

Abstract

ABSTRACTHealth services organisations are increasingly incorporating patient engagement strategies as a form of quality improvement. Such strategies take form in programmes where organisations partner with patients in order to learn from their experiences and thereby change how services are designed, delivered, and implemented. In this study, we examined the enactment of patient engagement programmes within an academic health science organisation in Canada. This was accomplished through an exploration of the various constructions of patient participants’ legitimacy, credibility, and expertise as manifesting through participation in the various practices associated with the programmes. Analysis was based on a selection of international, national, and organisational texts, as well as interviews with patient participants (n = 20) and hospital staff members (n = 6). Through this analysis, we argue that organisations are not learning from patients per se, but are learning from particular constructions of patient subjectivities in the form of patient advisers. We argue that if patient engagement programmes are premised upon opportunities to learn from patients, these programmes require a coherent theory of workplace learning. We suggest attention to the politics of knowledge production as a fruitful way to conceptualise how clinicians and administrators might learn from patients at the organisational level.