Reconciling patient and provider priorities for improving the care of critically ill patients: A consensus method and qualitative analysis of decision making

• Published in: Health expectations : an international journal of public participation in health care and health policy Vol. 20; no. 6; pp. 1367 - 1374
• Main Authors: McKenzie, Emily, Potestio, Melissa L., Boyd, Jamie M., Niven, Daniel J., Brundin‐Mather, Rebecca, Bagshaw, Sean M., Stelfox, Henry T., Groot, Jackie, Hatcher, Caroline, Petersen, Carmen, Reed, Marian, Sassa, Kathy, Scholefield, Devina, Whalen, Karrie, Zuege, Dan J, Zygun, David
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.12.2017; John Wiley and Sons Inc
• Subjects: Analysis; Bargaining; Clinical decision making; Communication; Consensus; Consensus building; Consensus methods; Content analysis; Critical care; Critical Illness - therapy; Decision analysis; Decision makers; Decision Making; Delirium; Delphi method; Delphi Technique; Design modifications; Exercise; Feasibility; Feasibility studies; Female; Health Priorities; Humans; Intensive care; intensive care unit; Intensive Care Units; Male; Medical research; Medical screening; Mental disorders; Methods; Mobilization; Original Research Paper; Original Research Papers; patient participation; Patient-Centered Care - methods; Patients; Personal experiences; Priorities; Qualitative analysis; Qualitative Research; Quality; Quality control; Quality Improvement; Quality management; Quality of care; Ratings & rankings; Relatives; Stakeholders; Storytelling; surveys and questionnaires; Canada; consensus; intensive care; health priorities; patient participation; quality improvement; critical care; intensive care unit; qualitative research; surveys and questionnaires
• ISSN: 1369-6513; 1369-7625
• DOI: 10.1111/hex.12576

Background Providers have traditionally established priorities for quality improvement; however, patients and their family members have recently become involved in priority setting. Little is known about how to reconcile priorities of different stakeholder groups into a single prioritized list that is actionable for organizations. Objective To describe the decision‐making process for establishing consensus used by a diverse panel of stakeholders to reconcile two sets of quality improvement priorities (provider/decision maker priorities n=9; patient/family priorities n=19) into a single prioritized list. Design We employed a modified Delphi process with a diverse group of panellists to reconcile priorities for improving care of critically ill patients in the intensive care unit (ICU). Proceedings were audio‐recorded, transcribed and analysed using qualitative content analysis to explore the decision‐making process for establishing consensus. Setting and participants Nine panellists including three providers, three decision makers and three family members of previously critically ill patients. Results Panellists rated and revised 28 priorities over three rounds of review and reached consensus on the “Top 5” priorities for quality improvement: transition of patient care from ICU to hospital ward; family presence and effective communication; delirium screening and management; early mobilization; and transition of patient care between ICU providers. Four themes were identified as important for establishing consensus: storytelling (sharing personal experiences), amalgamating priorities (negotiating priority scope), considering evaluation criteria and having a priority champion. Conclusions Our study demonstrates the feasibility of incorporating families of patients into a multistakeholder prioritization exercise. The approach described can be used to guide consensus building and reconcile priorities of diverse stakeholder groups.