The changing relationship between user and provider and its impact on quality

Joined puzzle pieces


This Evidence Review from The Health Foundation and RAND Europe looks at whether the changing relationships between healthcare service users and providers will improve the quality of care delivered. It is important for anyone who is involved in delivering a more patient-centric service, as it reviews how the recent changes in the relationship between service users and providers are impacting on the quality of the service. It is of key interest to health leaders and commissioners, as it provides guidance on improving quality and experience for users.

Doctor holding patient's handPatient-centric services

One of the priorities for The Health Foundation is to have a more person-centred healthcare system; a system that helps people to make informed decisions and manage their own healthcare. This is a change and has implications on both the health professionals and the patients. Where previously patients have been less involved in decisions about their treatment choices, now they are being actively encouraged to participate, as research shows that patients who are involved in the decision-making process are more likely to comply with the treatment regime, and this leads to better outcomes and greater patient experience and satisfaction. For the healthcare organisations, if patients recuperate more effectively, costs will be reduced because there will be less need for prolonged treatment and hospital stays.

Two thumbs pointing upChanging relationships and patient satisfaction

This report looks at the evidence about how this change in relationships affects quality in healthcare delivery, exploring six areas of care quality in particular (effectiveness, safety, person-centredness, timeliness, efficiency, and equity) in relation to a set of specific interventions:

  • Patient self-administration of medication
  • Patient access to online health records
  • Addressing complaints about care received
  • Involving women in decision making in antenatal care
  • Use of peer support workers in healthcare
  • Improving healthcare services for homeless patients
  • Shared decision making in child/adolescent mental healthcare

Wooden bricks spelling quality and toppling overThis document breaks the evidence down by the aforementioned interventions, looking at the six areas of care quality for each one, and referencing throughout. The authors found huge variations in the evidence; most was for effectiveness measures, and then person-centredness, efficiency and equity. Surprisingly, they found fewer studies on the measures of safety and timeliness. Sometimes the evidence that they found was contradictory, and in most cases a direct reference to changing relationships was not made. The majority of research focused on the doctor-patient role, but one paper did highlight the importance of analysing the relationships between nurses and patients separately from the doctor-patient relationship. They felt this was important because doctors are more concerned with dealing with the “diseased body”, while nurses are more focused on the “human responses” to treatment.

However, having reviewed all the research available to them, the authors found that the interventions can have an impact on the service user and providers relationship, an example being with peer support workers who can help reduce isolation and stress, and improve knowledge, so that patients feel more empowered and in control. This is something that a doctor may not have the resources to achieve.


This report has some very useful tables, including one which illustrates how many studies they found for each intervention, what type of studies, and summarising whether or not the areas of care quality the authors are interested in are reported on. It breaks down all the research into the different areas, so it is clear to see how quality can be improved in different areas. It is helpful, because the examples provided are relevant to anyone involved in the improvement of health care quality.


The puzzle of changing relationships: does changing relationships between healthcare service users and providers improve the quality of care? (PDF)
JS Pedersen, L Brereton, J Newbould, E Nolte
The Health Foundation
March 2013

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Caroline De Brún

Caroline De Brún

Caroline has been a medical librarian in a variety of NHS and academic roles since 1999, working in academic, primary and secondary care settings, service improvement, knowledge management, and on several high profile national projects. She has a PhD in Computing and currently develops resources to support evidence-based cost and quality, including QIPP @lert, a blog highlighting key reports from health care and other sectors related to service improvement and QIPP (Quality, Innovation, Productivity, Prevention). She also delivers training and resources to support evidence identification and appraisal for cost, quality, service improvement, and leadership. She is co-author of the Searching Skills Toolkit, which aims to support health professionals' searching for best quality clinical and non-clinical evidence. Her research interests are health management, commissioning, public health, consumer health information literacy, and knowledge management. She currently works as a Knowledge and Evidence Specialist for Public Health England, and works on the Commissioning Elf in her spare time.

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