Accountability and Public Reporting

Patient engagement is based on the assumption that making patients co-producers of their health might enhance their satisfaction and responsibility with the healthcare system and it strictly linked with the health provider choice. Making patients active participants in their healthcare is considered a crucial component of high-quality healthcare services. Quality of care is a central concern for health systems: accountability, transparency, and public reporting are some key factors in promoting healthcare improvement. In the healthcare field, public reporting is one of the major tools in supporting patients' decisions making process, by providing structure, process and outcome measures. We performed a web-based analysis of the major initiatives of public reporting in order to highlight their main characteristics: properties (public or private), data source (health providers, ad hoc surveys, etc.), general information reported (i.e. size, language spoken, amenities), doctors' information, patients' ratings (satisfaction /experience), clinical indicators.

The Value of Measuring Patient Engagement in Healthcare

The concept of patient engagement offers a unique opportunity to inform our understanding of patients' ability to be active in managing their care. However, unless promoting the active role of patients is today identified as a priority to promote care quality, a wide debate still exists on how to translate this principle into practice and how to assess initiatives aimed at increasing the level of patient participation in their care. Measuring patient engagement along the care course might ensure that the medical care truly serves patients' needs, priorities, and preferences. Unless the measurement of patient engagement is today a big issue for policy makers and healthcare practitioners, only few scientifically validated assessment tools currently exist to identify patients' level of involvement in their healthcare. In this chapter authors review the main validated tools currently available in the scientific community devoted to assess the patients' ability and availability to be actively engaged in their care, with a particular focus on the recently developed Patient Health Engagement Scale, specifically designed to assess the emotional and psychological adaptation of patients along their care process and their level of engagement in the healthcare management.

The Light Side of Preterm Behavioral Epigenetics

Preterm infants need long-lasting hospitalization in the Neonatal Intensive Care Unit (NICU). On the one hand, the NICU stay constitutes an early adverse experience, due to highly stressful experiences. On the other hand, Developmental Care (DC) interventions, including caregiver engagement, can exert neuro-protective effects for preterm infants. Recent evidence in the field of behavioral epigenetics is revealing the biochemical pathways through which adverse and care experiences are embedded in early human development through epigenetic mechanisms. Nonetheless, the application of behavioral epigenetics to preterm birth and NICU stay is still at its beginning. In the present chapter, insights are provided for the application of behavioral epigenetics to the study of the biochemical underpinnings of NICU-related stress and care, with a specific focus on caregiver engagement. This contribute should be intended as a preliminary roadmap to guide future behavioral epigenetic research on the adverse and protective effects of early NICU care of preterm infants.

The Patient-Centered Medicine as the Theoretical Framework for Patient Engagement

The present contribution will describe the origin, development and main characteristics of the patient-centered medicine; the literature on patient-centeredness, in particular in the field of chronic disorders, will be discussed and the importance of this approach underlined; arguments about the importance of patient-centered medicine as theoretical frame founding and supporting the concept of patient engagement will be highlighted, considering that only within this medical epistemology the patient's engagement can find a full and complete expression.

Engagement in Health and Safety at the Workplace

Dramatic changes in the age structure of the population have led to a rise in the age of retirement. An ageing working population may be a problem for companies and for their health and safety services that must face the long-term management of active, chronically ill workers. For sustainability reasons the discipline of occupational medicine must be replaced by occupational health, which not only combats occupational diseases, but actively works to promote the health of older workers. More in general, occupational health has a strong interest in promoting engagement in professional activities. Shifting from a reactive to a proactive logic will take time and require a big effort on the part of employers, employees and health and safety staff in order to develop participatory ergonomics and best health promotion practices in the workplace.

No Entry

The chapter investigates the dynamic of encounters between staff and patients in two case studies on hospital organisation, taking special account of the emotional and psychological aspects associated with practices in the use of organisational space. By drawing on two empirical cases set in different hospital contexts (the waiting rooms of two outpatients wards and an emergency unit), analysis is made of two examples of practices which represent express violations of the rules on the use of space by patients and their relatives. Violations that could be analysed as demand of engagement - by patients and relatives - in the process of care. In these empirical cases the governance defensive reaction strategies used by hospital staff in their interaction with waiting patients is shown in light of the rules that define the behaviour acceptable for patients and relatives. The study is based on a qualitative methodological approach using the techniques of observation and in-depth interviews with hospital staff, patients and relatives.

The Patient Centered Organizational Model in Italian Hospitals

The concepts of patient-centered care and patient engagement are often used interchangeably in health policy debates. In fact, it is frequently – and implicitly – assumed that putting patients at the centre of care will more or less spontaneously lead to fully engaged patients. This chapter questions these assumptions. By focusing on the hospital's patient-centered reform in Italy, the chapter discusses the overlaps but also the discrepancies between the practices of putting patients at the centre and those of engaging patients. Discrepancies may appear at three levels: the new hospital model may challenge the establishment of a close alliance between patients and professionals, the new hospital spaces may not be perceived as a catalyst for improving patients' experiences, and the inter- and intra- professional struggles derived from the new configuration of hospital teams at an early stage may hinder patient care delivery. The chapter proposes some strategies for patient-centered hospitals to increase their capacity to engage patients and families in the management of their care plan.

Why do Patients Protest? Collective Action Processes in People with Chronic Illnesses

Despite the relevance of the topic, an exhaustive psychosocial reflection on the processes that may facilitate patients' protest is still missing. The chapter provides a theoretical and empirical overview of psychosocial pathways for patients' collective action. Five core factors are reviewed: perceived injustice, group efficacy, group identification, moral convictions and social embeddedness. Each of them provides a different explanation of collective action processes and is examined for its potential impact among patients. The chapter closes suggesting some core elements for a theoretical explanation of patients' collective action and its relationship with patient engagement. Practical and theoretical implications of patients' collective action are discussed to identify new directions for future research and interventions.

Individual, Institutional, and Environmental Factors Promoting Patient Retention and Dropout

The primary purpose of this chapter is to determine factors that shape client dropout and adherence to Cardiac Disease Prevention and Rehabilitation Programs. The sample consists of 68 individuals, including those currently in the program (adherents) and those who have dropped out (dropouts). Findings show that clients undergoing rehabilitation are much likely to drop out when they are in the critical zone. This is a point where institutional factors, individual factors and environmentally-related factors are not favorable to clients. The risk of clients dropping out can be drastically reduced through the provision of an enabling environment comprising a set of factors that foster adherence such as financial sponsorship, institutional support, high intrinsic motivation, improved illness perception. In that context, there is the need for program administrators to closely monitor at-risk clients, especially those whose social, economic and psychological profiles predict non-adherence.

Barriers to and Facilitators of Older Adult's Adherence to Health Recommendations

Non-adherence to health recommendations (e.g. medical prescriptions) presents potential costs for healthcare, which could be prevented or mitigated. This is often attributed to a person's rational choice, to not adhere. However, this may also be determined by individual and contextual factors implied in the recommendations communication process. In accordance, this chapter focuses specifically on barriers to and facilitators of adherence to recommendations and engagement with the healthcare process, particularly concerning the communication between health professionals and patients. For this, the authors present examples of engagement increment through different degrees of participation, from a one-way/directive towards a two-way/engaging communication process. This focuses specifically on a vulnerable population group with increasing healthcare needs: older adults. Future possibilities for two-way engaging communications are discussed, aimed at promoting increased adherence to health recommendations and people's self-regulation of their own health.