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Consumer participation and organizational development in health care: a systematic review

Partizipation und Organisationsentwicklung im Gesundheitswesen: eine systematische Literaturübersicht

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Zusammenfassung

ZIELSETZUNG: Ziel der systematischen Literaturübersicht war die Erfassung der Typen methodischer Zugänge sowie der Häufigkeit von Projekten der partizipativen Organisationsentwicklung in verschiedenen Bereichen der Humanmedizin und eine qualitative Beurteilung der publizierten Daten. METHODIK: Systematische Literaturübersicht über Arbeiten zum Thema partizipative Organisationsentwicklung im Gesundheitswesen anhand von öffentlich zugänglichen Datenbanken. ERGEBNISSE: Wir identifizierten 467 Studien und 5 systematische Übersichtsarbeiten mit unterschiedlichen Partizipationsprojekten, darunter Workshops, Bürgerforen, Focusgruppen, Citizens' Juries und Konsultationen. Ein genereller Trend zu einer besonderen Methode der Partizipation war nicht festzustellen. Eine Kategorisierung der identifizierten Studien hinsichtlich der untersuchten Gesundheitsbereiche ergab folgendes RESULTAT: Allgemeinmedizin/Präventionsmedizin (n = 5), Innere Medizin/Onkologie (n = 132), Geburtshilfe und Frauenheilkunde (n = 2), Chirurgie (n = 1), Neurologie/Psychiatrie (n = 2), Arbeitsmedizin (n = 16), Ausbildung zu Gesundheitsberufen (n = 38), Definition von wissenschaftlichen Zielsetzungen (n = 135) und andere (n = 136). Eine qualitative Analyse von 67/467 (15 %) der Studien anhand von vordefinierten Kriterien ergab ein retrospektives Studiendesign ohne Kontrollgruppen und ohne vordefinierte Bewertung der Ergebnisses in 61/69 Studien (88 %). 6/69 (9 %) Studien beinhalteten eine vordefinierte Bewertung der Ergebnisse, wobei drei Studien ein erfolgreiches Ergebnis und zwei Studien ein nicht erfolgreiches Ergebnis berichteten. Eine Multiprojekt-Studie identifizierte 'sehr erfolgreiche' Projekte in 24 % der Fälle. In 18 Studien wurde das Ausmass der Partizipation angegeben und als 'informiert' in 2/18 Studien, als 'beratend' in 14/18 Studien und als 'beteiligt an Entscheidungen' in 2/18 Studien beurteilt. Die folgenden Faktoren waren in den untersuchten Studien mti einem Projekterfolg assoziiert: adäquate Finanzierung, Kooperationen mit institutionalisierten Organisationen, ausgefeilte Projektlogistik, kleindimensionale Projekte und strukturierte interne und externe Kommunikation. SCHLUSSFOLGERUNGEN: Projekte der partizipativen Organisationsentwicklung wurden im Gesundheitswesen vor allem in den Bereichen Innere Medizin/Onkologie, Ausbildung zu Gesundheitsberufen und Definition von wissenschaftlichen Zielsetzungen durchgeführt. Unterschiedliche Methoden der Partizipation wurden untersucht, das Ausmass der Partizipation war gering und die Erfolgsrate der Projekte moderat. Potenzielle Erfolgsfaktoren von Partizipationsprojekten im Gesundheitswesen werden anhand der Literatur diskutiert.

Summary

OBJECTIVE: To provide an overview of published data on user participation in Health Care. BACKGROUND: Active and passive involvement of consumers into agendas associated with Health Care is still an exception. Data on the success of user participation projects in various areas of Health Care are lacking. DESIGN: Systematic literature review using public databases. RESULTS: We identified 467 studies including five systematic reviews describing various participation projects, among them workshops, citizens' panels, focus groups, citizens' juries, and consultation meetings. A general trend favoring a specific method was not observed. The categorization of evaluable studies according to Health Care area (n = 331) yielded the following results: general medicine/preventive medicine (n = 5), internal medicine/oncology (n = 132), obstetrics and gynecology (n = 2), surgery (n = 1), neurology/psychiatry (n = 2), social medicine (n = 16), health worker training (n = 38), and research agenda setting (n = 135). Predefined qualitative parameters were extracted from 69/467 (15%) studies. Sixty one of 69 studies (88%) were retrospective analyses without control groups and without outcome assessment. Six studies had outcome assessment, three judged the outcome as successful, two as negative, and one multi-project study reported 'very successful' project assessments in 24% of the projects. In 18 studies, the level of consumer participation was described as 'informed' in 2/18, 'advisory' in 14/18, and 'decision-making' in 2/18. The following factors associated with project success were identified: adequate financing, partnerships with well institutionalized consumer organizations, advanced project logistics, small-scale projects, and adequate internal and external communication. CONCLUSIONS: Most consumer participation projects were performed in research agenda setting, internal medicine/oncology, and health worker training. Various methods have been used in the projects, the level of consumer participation was low, and the success rate of the investigated projects was moderate. Potential factors associated with project success and future areas of research are discussed.

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Correspondence to Clemens B. Tempfer.

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Tempfer, C., Nowak, P. Consumer participation and organizational development in health care: a systematic review. Wien Klin Wochenschr 123, 408–414 (2011). https://doi.org/10.1007/s00508-011-0008-x

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