2. Patient Engagement as Competitive Advantage
The Utilization of patient and family engagement is a largely untapped
resource, offering opportunities to enhance patient-centered care and
confer organizational advantages and sustainability upon hospitals
(Burton & Rycroft-Malone, 2015; Kuhn et al., 2016). In addition to
internal resources, certain RBV studies have broadened their focus to
encompass how to complement resources that organizations may lack.
Drawing from the resource-dependence theory, some highlight the
significance of inter-organizational relationships and networks,
enabling organizations to secure unique resources through collaboration
(Yarbrough & Powers, 2006; Gloede et al., 2013). However, the
relationship between hospitals and patient engagement has remained
unexplored.
Patient and family engagement, facilitated through PFACs, can contribute
to providing values, knowledge, expertise, experience, creativity, and
community needs to all levels of hospital management (Peikes et al.,
2016; Sharma et al., 2017; Mahdavi et al., 2021). Co-production theory
explains that participation can occur in multiple stages, including
co-commissioning, co-designing, co-delivery, and co-assessment (Nabatchi
et al., 2017). PFACs can provide various resources to hospitals through
planning, designing, implementing, and evaluation as one form of
collective co-production. For instance, PFACs can be pivotal in
strategic planning and decision-making, quality improvement, staff
hiring and education, developing a patient-centered culture, facility
design, or improving health service design, delivery, and evaluation
(Dukhanin et al., 2019). PFACs function to establish collaborative
partnerships between patients and healthcare professionals, providing
valuable insights into care processes and enabling the development of
tailored programs and services aligned with community needs (Kuhn et
al., 2016; Snow, 2022).
In this regard, PFACs can be considered a noteworthy asset for improving
organizational performance. As resources are valuable, rare, and
difficult to imitate (Barney, 1991), PFACs are a useful tool for
healthcare practices in improving the quality of care and addressing the
patient care experience, offering invaluable insights and resources
regarding various processes within the system, and providing real-time
feedback (Johnson et al., 2008; Peikes et al., 2016). Moreover, as
patient feedback and participation in decision-making allow
organizations to have critical information on patient demands, it can
develop a priority setting aligned with patient-centered care and
improved organizational performance (Sharma et al., 2017). Thus, by
leveraging patients’ broad engagement, hospitals can often cultivate
innovative practices, processes, systems, and organizational cultures,
meeting the health services demands and distinguishing them from
competitors.
Prior studies have acknowledged this positive role of PFACs on
organizational performance (Johnson et al., 2008; Johnson et al., 2016;
Peikes et al., 2016; Sharma et al., 2017; Taff et al., 2018; Jarrar et
al., 2019; Oldfield et al., 2019; Fredrickson & Modigh, 2021). Seminal
systematic reviews examining the impact of patient engagement and its
outcomes have outlined its influence on various organizational outcomes.
These encompass clinical quality outcomes – clinical care outcomes,
patient safety, and satisfaction – and extend to organizational
innovation, including design and policymaking (Sharma et al., 2017;
Oldfield et al., 2019). For instance, in the case of the Hospital of the
University of Pennsylvania (HUP), implementing a PFAC creates innovative
avenues for hospitals to bring in new expertise to improve the quality
of care and create a better patient experience (Cunningham, 2016). PFACs
have yielded information on patient falls, nurse communication, facility
design, and patient billing inputs. Regarding the quality of care, PFACs
embraced quality improvement efforts, such as convening small-group
discussions with nurses, evaluating educational materials, offering the
patient perspective, and providing guidance on practical approaches to
disseminating information to patients. Professionals recognized that
interactions with PFAC members and their interventions significantly
reduced the fall rate per 1,000 patient days from 3.03 in 2011 to 2.18
in 2016.
Furthermore, regarding patient satisfaction, PFACs worked to develop and
implement patient-centered nurse reports. They contributed to their
HCAHPS “communication with Nurses” domain scores, rising from 76.9 in
2011 to 84.4 in 2016 (Cunningham, 2016). Therefore, this study sheds
light on the positive role of PFACs in hospital performance, offering
various strategic resources that empower hospitals to gain a competitive
advantage. Focusing on the quality of care and patient satisfaction,
which are core dimensions for patient-centered care, this study
hypothesizes that hospitals with a Patient and Family Advisory Council
are positively associated with their quality of care and patient
satisfaction.
H4-1: Hospitals with a patient and family advisory council are more
likely to provide better quality of care.
H4-2: Hospitals with a patient and family advisory council are more
likely to lead to higher patient satisfaction.