From Experience and Outcome Measurement to the Health Professionals’ Engagement

Relationship and stakeholder marketing suggest that the environment in which an organization is embedded is very complex and that the value created through its activity is affected by several internal and external stakeholders. This is particularly true in the public healthcare sector, where behaviors and decisions of healthcare professionals and patients, who are key stakeholders, significantly determine the value created to each patient and to the entire population. Engaging healthcare professionals and patients represents a keystone of improvement processes and value co-creation. However, the service-orientation has been not substituted by a client-orientation, for improving value to patients, organizations and the whole system. Stakeholder marketing has considerable potential in public healthcare contexts. The paper addresses the question of how to successfully engage key stakeholders in healthcare in a systematic and continuous initiative of patient feedback collection, reporting and use for co-producing value in healthcare. The paper describes an empirical ongoing initiative (PREMs and PROMs Observatory) of patients’ engagement into a retrospective healthcare services’ co-assessment, and healthcare professionals’ engagement in the prospective use of realtime patient-reported measures. The paper reports preliminary results of stakeholders’ participation. A case study design was used, with on-field observations, and professionals and managers’ feedback collected during workshops and meetings. The experience was launched in 2018 and is ongoing in Tuscany (Italy). It consists in collecting patients’ feedback on their outcomes and experience with care and in real-time sharing aggregated patient-reported data with professionals and managers, by encompassing methodological innovations. During the first year, managers of all the Tuscan healthcare organizations decided to join the initiative. In 2018, 13,000 patients provided their consent to participate (more than 3,000 for PROMs, nearly 10,000 for PREMs, 45% and 20% of eligible patients respectively). More than 40% of them filled-in the web questionnaire, providing their contribution not for a personal benefit but for a social one. Professionals recognized this initiative as a useful ongoing evaluation of care and services, key for informing their decisions and activities of quality-improvement in the point of view of patients. Professionals and managers described several potential uses of patient-reported data, from the ward level to the whole regional healthcare system. This co-assessment initiative allowed for a multi-way «value exchange», potential affecting healthcare professionals and managers’ culture in Tuscany. A co-production initiative was established in Tuscany. The preliminary results demonstrate interest and willingness of top managers in engaging different stakeholders in a continuous process of value co-creation. The large participation of patients demonstrates that healthcare services’ users want to solidarily contribute in the creation of collective public value. Professionals informed and invited a very large part of their patients, recognising patient feedback as an important source of information. Despite the co-assessment is retrospective, the results of this initiative can be used prospectively. Based on results, the authors depict future research directions, thus proposing a research agenda for leading challenges and questions in this field.