Quality in Health Care

The involvement of patients in the decisions about their treatment or care seems an unquestionable advance. There are philosophical and ethical justifications for this. Evidence is also accruing about its benefits—namely, increased satisfaction with care and communication, increased certainty about making the best decision, reduced anxiety levels, and greater adherence to chosen management plans. Some of the practical barriers that limit the greater involvement of patients in clinical practice are also being recognised and addressed, including the wider availability of information to patients, often outside the consultation. Yet patient involvement and informed choices are still not a reality in routine health care. There still appear to be barriers that directly relate to healthcare professionals which must be addressed if patient involvement is indeed to become a wider reality. Healthcare professionals need to assimilate a number of principles and practices if they are to facilitate patient involvement. Some of these apply more to global changes in attitudes and approaches to healthcare provision (“macro” level), and are the fundamental competences which professionals acquire as the platform for their practice. Others relate to their skills in providing care to the hundreds, or perhaps thousands, of patients with whom they interact— that is, the “competences” of practice—and apply to the process within the consultation (“micro” level), the way professionals deal with individuals, their needs, concerns, desires, and expectations.