Från passiv mottagare till aktiv deltagare: : Ett förbättringsarbete och en kvalitativ studie om patienters och professionellas perspektiv på patientdelaktighet i Samordnad Individuell Plan (SIP)

Sammanfattning

Patient participation in the Swedish coordinated individual plan (SIP) is a central component of person-centred home healthcare. Previous baseline analyses have identified insufficient documentation of patients’ own goals as well as limited influence in care planning. The aim of this master’s thesis was to strengthen patient participation in SIP within home healthcare in the municipality of Lomma and to explore how patients and healthcare professionals experience participation and which organisational and practical factors influence it. The improvement work was conducted using an improvement science framework and PDSA cycles, in which a structured preparatory tool and preparatory conversations prior to SIP meetings were developed, implemented, and tested. The study had a qualitative design including observations of SIP meetings, semi-structured interviews with healthcare professionals, and brief patient follow-ups. The data were analysed using qualitative content analysis. The results of the improvement work demonstrated an increase in the proportion of SIPs in which patients’ goals and preferences were documented; however, the target level of 75 percent was not achieved. Patient participation emerged as a variable phenomenon in which the degree of influence was strongly affected by preparation prior to the meeting, communication quality, and the structure of the meeting. Structured preparatory support increased patients’ understanding of the SIP process and their ability to express needs, whereas time pressure, multiple meeting participants, and complex communication limited participation. Healthcare professionals highlighted organisational conditions, unclear allocation of responsibilities, and communicative structures as central factors influencing the outcome. Taken together, patient participation in SIP emerged as a complex and context-dependent phenomenon shaped through the interaction between organisational structures, professional practices, and individual conditions. Enabling more equitable and meaningful participation requires long-term and systematic improvement efforts in which preparation, structure, and communication are integrated into everyday practice, and where the patient’s role as an active participant in the care process is clearly defined and strengthened.