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Original research
Changing relationships: how does patient involvement transform professional identity? An ethnographic study
  1. Marie-Pierre Codsi1,
  2. Philippe Karazivan1,2,
  3. Ghislaine Rouly2,
  4. Marie Leclaire1,
  5. Antoine Boivin1,2
  1. 1Department of Family Medicine, University of Montreal Faculty of Medicine, Montreal, Quebec, Canada
  2. 2Center of Excellence for Partnership with Patients and the Public, CHUM, Montreal, Quebec, Canada
  1. Correspondence to Dr Marie-Pierre Codsi; marie-pierre.codsi{at}umontreal.ca

Abstract

Objectives To understand identity tensions experienced by health professionals when patient partners join a quality improvement committee.

Design Qualitative ethnographic study based on participatory observation.

Setting An interdisciplinary quality improvement committee of a Canadian urban academic family medicine clinic with little previous experience in patient partnership.

Participants Two patient partners, seven health professionals (two family physicians, two residents, one pharmacist, one nurse clinician and one nurse practitioner) and three members of the administrative team.

Data collection Data collection included compiled participatory observations, logbook notes and semi-structured interviews, collected between the summer of 2017 to the summer of 2019.

Data analysis Ghadiri’s identity threats theoretical framework was used to analyse qualitative material and to develop conceptualising categories, using QDA Miner software (V.5.0).

Results All professionals with a clinical care role and patient partners (n=9) accepted to participate in the ethnographic study and semi-structured interviews (RR=100%). Transforming the ‘caregiver–patient’ relationship into a ‘colleague–colleague’ relationship generated identity upheavals among professionals. Identity tensions included competing ideals of the ‘good professional’, challenges to the impermeability of the patient and professional categories, the interweaving of symbols associated with one or the other of these identities, and the inner balance between the roles of caregiver and colleague.

Conclusion This research provides a new perspective on understanding how working in partnership with patients transform health professionals’ identity. When they are called to work with patients outside of a simple therapeutic relationship, health professionals may feel tensions between their identity as caregivers and their identity as colleague. This allows us to better understand some underlying tensions elicited by the arrival of different patient engagement initiatives (eg, professionals’ resistance to working with patients, patients’ status and remuneration, professionals’ concerns toward patient ‘representativeness’). Partnership with patients imply the construction of a new relational framework, flexible and dynamic, that takes into account this coexistence of identities.

  • change management
  • health policy
  • quality in health care
  • medical ethics
  • qualitative research

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request (Individual participant data that underlie the results reported in this article, after de-identification, study protocol, informed Consent Form, Analytic Code).

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Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request (Individual participant data that underlie the results reported in this article, after de-identification, study protocol, informed Consent Form, Analytic Code).

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Footnotes

  • Contributors This study was conducted in the context of primary author’s Master degree (M-PC). M-PC, PK, GR and AB designed and conducted the study. The data collection was done by M-PC. The coding was done by M-PC and ML. The data analysis was done by all coauthors (M-PC, PK, GR, AB and ML). M-PC prepared the manuscript draft with important intellectual input from all the other coauthors. All authors approved the final manuscript and the revised version.

  • Funding This project received the Patient’s Medical Home 60/20 Caring and Compassion grant (4000$) and the University of Montreal Interfaculty Operational Committee grant (7500$).

  • Competing interests All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: M-PC, GR, PK and AB are part of the CEPPP team (Centre of Excellence for Partnership with Patients and the Public). AB and PK are both co-directors of the Centre of Excellence for Partnership with Patients and the Public in Montreal; AB is the chairholder of the Canada Research Chair in Patient and Public Partnership. M-PC affirms that the researchers work was totally independent from funders.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Author note ***This article follows the guidelines by the European Medical Writers' Association on the role of professional medical writers. ***