CLAHRC NWL currently have a series of posters being presented at The Past, Present and Future of Medicine SAM & RCPE Conference in Edinburgh at the Edinburgh International Conference Centre. The posters will be orally presented to the audience with an opportunity for some one on one comments, questions and thoughts.

Engaging patients in quality improvement: Applying the National Involvement Standards

Liz Evans, Jenny Trite, Sandra Jayacodi, Stuart Green, Bill Tiplady, Rachel Matthews



National and local policy supports involvement of patients at all levels in the design, delivery and improvement of health services.  Guidance supporting involvement has been described and disseminated, including the National Involvement Standards (4Pi), but their use is rarely reported (1). This works outlines how 4Pi provided a framework (Table 1) for the meaningful involvement of patients engaged in a quality improvement (QI) initiative (2).


A QI initiative within an acute mental health unit was established between September 2014-March 2016 to improve the physical health of inpatients. The multi-disciplinary team included psychiatrists, psychologists, nurses, managers and allied-health professionals. The initiative used a range of  QI methods to explore local problems and identify and test potential solutions. The team reflected on how 4Pi was used to support the involvement of patients in the work and the impact this had on the outcome.


4Pi provided an opportunity to structure the involvement of patients in a QI initiative.  The team fully embraced the principles of involvement, patients had an agreed purpose for their involvement and a necessary presence at all stages of the initiative. Furthermore, processes of communication and engagement within the team were transparent and helped flatten the traditional clinical hierarchy, benefiting all those involved in the project and enriching the quality of discussion and generation of solutions. Finally, the impact of patient involvement was realised through a tool developed by patients through co-design with healthcare professionals, to facilitate discussion and shared-decision making with inpatients’ about their physical health.


Identifying ’what works’ for  patient involvement is crucial to move beyond policy rhetoric or tokenistic involvement (3). Involvement in QI initiatives brings benefits to patients, services and staff (4). Whilst 4PI is recognised as a useful framework for involvement, few examples exist of its practical application and positive impact.

Table 1: Operationalisation of National Involvement Standards (4Pi)

4PI Concepts Operationalised definitions
Principles Clear and shared principles and values
Purpose Agreed purpose of involvement linked to the improvement of services and service user/patient experience
Presence Involvement of service users at all levels and stages of an initiative
Process Communication and support to ensure engagement with patients and the public
Impact Assessment of the effect of involvement on both the individuals and the initiative



  1. Mockford C, Staniszewska S, Griffiths F, Herron-Marx S. The impact of patient and public involvement on UK NHS health care: a systematic review. Int J Qual Heal care. 2012;24(1):28–38.
  2. Faulkner A, Crepaz-Keay D, Kalathil J, Griffiths R, James N, Perry E, et al. 4Pi-National Involvement Standards. London; 2015.
  3. Esmail L, Moore E, Rein A. Evaluating patient and stakeholder engagement in research: Moving from theory to practice. J Comp Eff Res. 2015;4(2):133–45.
  4. Renedo A, Marston CA, Spyridonidis D, Barlow J. Patient and Public Involvement in Healthcare Quality Improvement: How organizations can help patients and professionals to collaborate. Public Manag Rev. Routledge; 2015;17(1):17–34.

Did you get a chance to view this poster and speak to one of the CLAHRC NWL team? We welcome feedback and insight of your view.


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Throughout the next couple of days, we will be displaying all of the CLAHRC NWL posters presented at the SAM and RCPE Conference 2016 on our blog with supporting text from our authors and presenters.