The Milbank Memorial Fund is an endowed operating foundation that publishes The Milbank Quarterly, commissions projects, and convenes state health policy decision makers on issues they identify as important to population health.
We focus on a number of topic areas identified by state health policy leaders as important to population health.
The Center for Evidence-based Policy at Oregon Health & Science University is a national leader in evidence-based decision making and policy design.
Keep up with news and updates from the Milbank Memorial Fund. Get the latest from thought leaders, including Christopher F. Koller, president of the Fund.
We publish The Milbank Quarterly, as well as reports, issues briefs, and case studies on topics important to population health.
June 2014 (Volume 92)
June 2014 | Antoine Boivin, Pascale Lehoux, Jako Burgers, Richard Grol | Original Investigation
Context: In the past 50 years, individual patient involvement at the clinical consultation level has received considerable attention. More recently, patients and the public have increasingly been involved in collective decisions concerning the improvement of health care and policymaking. However, rigorous evaluation guiding the development and implementation of effective public involvement interventions is lacking. This article describes those key ingredients likely to affect public members’ ability to deliberate productively with professionals and influence collective health care choices.
Methods: We conducted a trial process evaluation of public involvement in setting priorities for health care improvement. In all, 172 participants (including 83 patients and public members and 89 professionals) from 6 Health and Social Services Centers in Canada participated in the trial. We videorecorded 14 one-day meetings, and 2 nonparticipant observers took structured notes. Using qualitative analysis, we show how public members influenced health care improvement priorities.
Findings: Legitimacy, credibility, and power explain the variations in the public members’ influence. Their credibility was supported by their personal experience as patients and caregivers, the provision of a structured preparation meeting, and access to population-based data from their community. Legitimacy was fostered by the recruitment of a balanced group of participants and by the public members’ opportunities to draw from one another’s experience. The combination of small-group deliberations, wider public consultation, and a moderation style focused on effective group process helped level out the power differences between professionals and the public. The engagement of key stakeholders in the intervention design and implementation helped build policy support for public involvement.
Conclusions: A number of interacting active ingredients structure and foster the public’s legitimacy, credibility, and power. By paying greater attention to them, policymakers could develop and implement more effective public involvement interventions.
Author(s): Antoine Boivin, Pascale Lehoux, Jako Burgers, Richard Grol
Download the study
Read on Wiley Online Library
Volume 92, Issue 2 (pages 319–350)
Published in 2014
How Successful Is Medicare Advantage?
The Role of Stigma in Access to Health Care for the Poor