Understanding how organisational culture supports patient involvement in a national research agency

Abstract Background The Belgian Health Care Knowledge Centre (KCE) formally involves stakeholders in its researches since 2012. Patients are treated as one stakeholder amongst others, but it is recognized that patient involvement (PI) requires a different approach. The success of implementing PI depends, however, on the organizational culture towards PI. Objectives The objective of this study was to map the PI culture at KCE in the context of the development of organization-wide supported position statements about PI. Methods A nominal group technique was used to measure the PI culture at KCE. Arguments for and against PI and conditions for PI in different phases of the research process were collected. A literature review and interviews fed the draft position statements, for which support was assessed by means of a two-round Delphi process. Results Arguments in favour of PI in research related to the relevance of the scope, expertise with data collection, bringing in fresh ideas for study design, access to survey participants, validation of data analyses, adherence to recommendations. Disadvantages and risks included the lack of scientific knowledge of involved patients, resources requirements, conflicts of interest, and heterogeneity within patient populations. Conditions for meaningful PI referred to measures mitigating the identified disadvantages. Eighteen position statements supported by KCE could be formulated. Conclusions The KCE culture seems predominantly positive towards PI, although attitudes vary between researchers. KCE recognizes the potential value of PI in research, but considers the level of involvement to be contingent on the topic and phase in the research process. Key messages • Organizational culture towards patient involvement is a driver of successful researches. • 18 position statements supported implementation of patient involvement in a national health agency.


Problem:
The effective communication between a doctor and a patient is considered to be essential, for providing high-quality medical care.A new model of cooperation and partnership which focuses on the patient is being established in the modern healthcare.

Description of the problem:
Data collected by empirical study on the doctor-patient communication has been presented and analyzed based on an overview analysis of the phenomenon communication.An anonymous survey among respondents was taken in the period September 1st-30th 2018 in the region of Pleven, Bulgaria.The respondents were patients who visited their GPs during that period.The results were processed with Microsoft Office Excel 2007.The quantitative analysis was done with statistical software programs -SPSS 17.0.

Results:
The respondents in the region of Pleven were 1053.It was found that the patients' satisfaction was poor in the matter of two crucial issues: 481 (46 %) of the respondents were dissatisfied with the time that was spent for a conversation with each patient and 470 (45 %) -with the information given by the GP regarding their health condition.According to 345 of the respondents (32,8 %) GPs do not practice informed consent and it is rarely required from patients according to 317 of the respondents (30,3 %).

Lessons:
The analysis shows that there are a number of flaws and unsolved problems in the doctor-patient communication.The verbal communication of the doctor is a serious problem: the ability to ask and to listen.The need of communication training for the doctors in their gradiate study and postgraduate education is evident.It is recommended that a specific training programs for communication in the primary health care should be developed and evaluated.

Key messages:
At the present time the communication skills of the general practitioner should be acknowledged and regulated as priority criteria for their overall assessment.
It is necessary that a profound study on the barriers for effective communication between a doctor and a patient is conducted.
Abstract citation ID: ckac131.538Understanding how organisational culture supports patient involvement in a national research agency Marie Dauvrin Belgian Health Care Knowledge Centre, Brussels, Belgium Contact: marie.dauvrin@kce.fgov.be

Background:
The Belgian Health Care Knowledge Centre (KCE) formally involves stakeholders in its researches since 2012.Patients are treated as one stakeholder amongst others, but it is recognized that patient involvement (PI) requires a different approach.
The success of implementing PI depends, however, on the organizational culture towards PI.

Objectives:
The objective of this study was to map the PI culture at KCE in the context of the development of organization-wide supported position statements about PI.

Background:
Involving citizens in health policymaking leads to the development of policies that are tailored to their needs and enables them to exercise their right as citizens.Citizen engagement in health policymaking in low and middleincome countries (LMICs) is rarely practiced and so understanding barriers and facilitators to engagement and the factors that impede effective participation is crucial.This study aims to understand views from policy stakeholders and citizens on citizen participation in health policy making and solicit recommendations on how to improve this process in the context of Lebanon.

Methods:
We conducted 29 individual in-depth interviews with stakeholders who work in fields relevant to health policy and/or have had experience in engaging citizens and four focus groups (average 8 to 10 participants each) with citizens from four municipalities in different governorates across Lebanon.Participants were purposively sampled through local Primary Healthcare Centers and municipality networks.

Results:
Barriers to engagement were seen as a manifestation of a dysfunctional and top-down political system, weak culture of participation, and lack of formal processes and platforms for engagement.Citizens' attributed lack of participation to mistrust with the political system while on the other hand, stakeholders thought that citizens lacked the needed skills for active engagement.Recommendations for improvement focused on the importance of implementing system level changes, developing contextualized citizen engagement processes, and ensuring its adoption and implementation.

Conclusions:
Although participants identified many challenges to engagement, they acknowledged its value and were able to propose concrete solutions and recommendations for change.Those recommendations are useful for other LMICs of similar contexts whose mandates require participation.

Key messages:
By identifying and understanding barriers to citizen participation in health policymaking, public health professionals can work towards improving engagement.
Strategies and methods such as implementing system level changes and developing contextualized citizen engagement processes can be applied to improve citizen participation were needed.
Abstract citation ID: ckac131.540A matter of freedom?Right-wing populist frames of Austria's smoke-free policy

Background:
Even though right-wing populist parties (RWPP) are increasingly influential in Europe, their position on public health has hardly been researched.I aimed to fill this research gap by focusing on the case of the FPO ¨(Freiheitliche Partei O ¨sterreichs) and its opposition to Austria ´s smoke-free policy.
Understanding RWWP positions on health policy can help to prevent detrimental influences on health policy making.Therefore, this project aimed to investigate how the FPO framed Austria's smoke-free policy and whether newspaper articles reflect these frames.Methods: Online archives of the three most-read Austrian newspapers (Standard, Kurier, Kronenzeitung) were searched for articles on the policy published in November 2019, when the policy was implemented.Furthermore, speeches by FPO ¨politicians in the parliamentary debate on the policy in June 2019 were identified via the parliamentary archive.Drawing on 4 speeches by FPO ¨politicians and 29 newspaper articles, I used frame analysis to answer the research question.

Results:
The analysis yielded that FPO ¨politicians used authoritarian, populist, and libertarian frames to argue against the implementation of the smoke-free policy.Thus, the policy was portrayed as not being in the interest of the people, restricting personal and economic freedom, and as elitist.These frames were not reflected in newspaper reports that mainly focused on the practical aspects of the policy implementation.However, in contrast to politicians supporting the policy, FPO ¨politicians were overrepresented in newspaper reports representing 47% of political actors cited in newspaper articles.Conclusions: Authoritarian, populist, and libertarian frames were used by the FPO ¨in opposition to the smoke-free policy.While these frames were not replicated by Austrian newspapers, RWP politicians were overrepresented in articles on the policy.These findings illustrate the importance of effective counter-framing by health advocates.

Key messages:
RWPP used authoritarian, populist, and libertarian frames to oppose Austria's smoke-free policy.
Even though RWPP frames were not replicated in newspaper articles, RWPP politicians were overrepresented in reports on the policy.