Theoretical directions for an emancipatory concept of patient and public involvement
Theoretical directions for an emancipatory concept of patient and public involvement
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DOI：
10.1177/1363459312438563
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发表时间：
2012-09-01
期刊：
影响因子：
2.1
通讯作者：
Lynch, James
中科院分区：
文献类型：
--
作者：
Gibson, Andy;Britten, Nicky;Lynch, James
病人和公众参与（PPI）现在已经牢牢地嵌入到英国卫生部的政策中。本文首先回顾了PPI在英国的健康和社会保健的结构变化，主要是在自己明确的理由，使用作为一个跳板的发展一般的理论框架。认为所有民主国家面临着重大的困境，在寻求满足相互冲突的需求和参与的期望，我们确定了不同的，有时是相互冲突的文化和政治特征嵌入在当前模式的参与在英格兰，在更广泛的政治体系的快速合法化的背景下。我们确定了一些主要的固有弱点的一个单一的，单轨模式的病人和公众参与的管理和运行的卫生和社会保健系统。尽管实现这一目标的机制和方法可能有所不同，但我们认为该模式基本上是相同的。我们还建议，为什么目前的结构是不可能提供一个有效的回应，无论是价值观，意识形态和社会团体参与该部门或重视外行知识，可能会维持社交网络的有效参与和服务的改善至关重要。本文提出了一个四维框架来分析PPI的性质。这些方面，有人认为，提供了沿着新的“知识空间”的PPI可以构建的坐标。这些知识空间可以促进和支持知识渊博的行为者的社交网络的出现，这些行为者能够与专业人员在平等的条件下接触，并影响服务的提供。
Patient and public involvement (PPI) is now firmly embedded in the policies of the Department of Health in England. This article commences with a review of the changing structures of PPI in English health and social care, largely in terms of their own explicit rationales, using that as a spring board for the development of a general theoretical framework. Arguing that all democratic states face major dilemmas in seeking to meet conflicting demands and expectations for involvement, we identify the diverse and sometimes conflicting cultural and political features embedded in current models of involvement in England, in a context of rapid delegitimation of the wider political system. We identify some of the major inherent weaknesses of a monolithic, single-track model of patient and public involvement in the management and running of health and social care systems. Although the mechanisms and methods for delivering this may vary we suggest the model remains fundamentally the same. We also suggest why the current structures are unlikely to provide an effective response either to the pluralism of values, ideologies and social groups engaged in the sector or to the valuing of lay knowledge which could potentially sustain the social networks essential for effective participation and service improvement. The article proposes a four dimensional framework for analysing the nature of PPI. These dimensions, it is argued, provide the co-ordinates along which new 'knowledge spaces' for PPI could be constructed. These knowledge spaces could facilitate and support the emergence of social networks of knowledgeable actors capable of engaging with professionals on equal terms and influencing service provision.