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.