Patient participation in quality improvement: managers' opinions of patients as resources.

Quality improvement has lately become a ‘hot’ topic within the Swedish healthcare sector. In the Kalmar county council in south-east Sweden, a large-scale improvement programme was initiated in 2007. The aim is to become the safest county council in Sweden by 2014. Quality in health care is often measured in terms of patient safety. Health care has traditionally seen the patient as an ‘outcome’, but changing this view to begin using the patient as a ‘co-producer’ of healthcare quality improvement may be gaining ground (Lengnick-Hall 1996). Therefore, it is essential to find different ways to derive advantage from patient participation (Groll et al. 2005). The Swedish Association of Local Authorities and Regions (SALAR) has developed a programme to strengthen the role of patients by increasing their participation and influence (SALAR website, http://www.skl.se; accessed 28 September 2011). The programme is developed from the perspective of practice-based business development and has its focus on the patient and includes the following four steps: (1) capture experiences from both patients and personnel; (2) understand the benefits of those experiences; (3) identify possible improvements; and (4) implement the improvements. Different tools are suggested, such as Breakthrough and the PlanDo-Study-Act wheel, flow charts and collecting patient stories. The importance of measuring and following up results as well as active, secured management is also emphasised as important to success (SALAR website, http://www.skl.se; accessed 28 September 2011). Studies on Swedish health care have shown that patients as a factor for improvements appeared far down on a ranking list, in ninth place, far below organisational factors such as optimal daily work and working environment issues (Olsson et al. 2003).