Meerat is passionate about understanding how we can all take an active part in shaping healthcare systems. Her academic background, and career before the NHS, led her to work in countries and climates where she saw the power and passion of strong civil societies, uniting people to fight for their rights and shaping their societies. She feels there is much to be learnt about how this power, passion and the abilities of everyday people can help find solutions to create or improve healthcare systems. Her PhD with NIHR CLAHRC NWL, explores how healthcare professional-patient/public partnerships happen in the healthcare improvement sphere. She hopes the learning can help healthcare professionals and patients/public, to work more effectively and continuously improve healthcare systems. 

openspeechQuality improvement and patient and public involvement, can jointly lead to more responsive improvements and innovations in healthcare. Embodying a quality improvement approach can facilitate patient and public involvement, and patients/public are “active and legitimate improvement agents”1. Yet this way of working is still not achieving its full transformative potential2.

Our experiences and CLAHRC-funded PhD research has shown that the use of specific quality improvement methods, can help design and manage specific environments, which enable healthcare professionals and patients/public to work together to shape better healthcare systems. These partnerships, can achieve ‘value’, such a previously unplanned innovations or new ways of working with patients/public that advance the improvements being made.

Achieving ‘value’ from this way of working can be contentious. Some see involvement as a democratic necessity, a right that should be implemented, regardless of what it may or may not achieve. However, perhaps because of their involvement in improvement initiatives, the healthcare professionals and patients/public who participated in this PhD research, overwhelmingly wanted to “make a difference”. The extent to which they achieved this in practice, was influenced by the wider environments that they were in, and the structures surrounding how and why healthcare professionals and patients/public worked together.

I initiated this PhD research to further explore how healthcare professional-patient/public partnerships, could become more systematic and systemic in the NHS. I entered the healthcare improvement sphere, as a practitioner of patient and public involvement, with questions about its effectiveness and potential. I saw the quality improvement (QI) sphere and methods, offering interesting possibilities to the practical realisation of systematic and systemic PPI.

My previous career was in international development, disaster relief and human rights, working for grassroots organisations because I felt that was where real change could be achieved. The limited resources of these organisations, meant partnership working with local populations or other organisations, was a logical way of achieving more than could have been achieved in silo. It seemed strange to me, that partnership working between healthcare professionals and patients/public, was not commonplace in the NHS.

This research explored this way of working in 6 improvement-focused organisations, through 38 semi-structured interviews with healthcare professionals and patients/public who aimed to make improvements in healthcare. 100 hours of ethnographic observations were conducted in two improvement initiatives in one of the organisations.

It found quality improvement environments can act as ecosystems for healthcare professional-patient/public partnerships. Through embracing quality improvement methods and approaches, they facilitate this way of working, enabling these partnerships to become transformative. This can encourage healthcare professionals and patients/public to continue to work together when improving healthcare in future initiatives.

Going forward, this research will further explore the intricacies of the design of these ecosystems, in order to understand how we could create environments that will nurture such partnership working, and enable it to add value and shape healthcare systems.074489-simple-red-glossy-icon-alphanumeric-quote-close2


  1. Renedo A, Marston CA, Spyridonidis D, Barlow J. Patient and public involvement in healthcare quality improvement: how organisations can help patients and professionals to collaborate. Public Manag Rev. 2014:1-25.
  2. Armstrong N, Herbert G, Aveling E-L, Dixon-Woods M, Martin G. Optimizing patient involvement in quality improvement. Heal Expect. 2013:1-12. doi:10.1111/hex.12039.
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