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Background: Despite increasing calls for patient and public involvement in health‐care quality improvement, the question of how patient evaluations can contribute to physician learning and performance assessment has received scant attention.
Objective: The objective of this study was to explore, amid calls for patient involvement in quality assurance, patients' perspectives on their role in the evaluation of physician performance and to support physicians’ learning and decision making on professional competence.
Design: A qualitative study based on semi‐structured interviews.
Setting and Participants: The study took place in a secondary care setting in the Netherlands. The authors selected 25 patients from two Dutch hospitals and through the Dutch Lung Foundation, using purposive sampling.
Methods: Data were analysed according to the principles of template analysis, based on an a priori coding framework developed from the literature about patient empowerment, feedback and performance assessment.
Results: The analysis unearthed three predominant patient perspectives: the proactive perspective, the restrained perspective and the outsider perspective. These perspectives differed in terms of perceived power dynamics within the doctor‐patient relationship, patients' perceived ability, and willingness to provide feedback and evaluate their physician's performance. Patients' perspectives thus affected the role patients envisaged for themselves in evaluating physician performance.
Discussion and conclusion: Although not all patients are equally suitable or willing to be involved, patients can play a role in evaluating physician performance and continuing training through formative approaches. To involve patients successfully, it is imperative to distinguish between different patient perspectives and empower patients by ensuring a safe environment for feedback.
What does it mean to design democratic innovation from a deliberative systems perspective? The demand of the deliberative systems approach that we turn from the single forum towards the broader system has largely been embraced by those interested in designing institutions for citizen participation. Nevertheless, there has been no analysis of the practical implications for democratic innovation. Is it possible to design differentiated but interconnected participatory and deliberative settings? Does this better connect democratic innovations to mass politics? Does it promote greater legitimacy? This article analyses one such attempt to design a systems-oriented democratic innovation: the ambitious NHS Citizen initiative. Our analysis demonstrates, while NHS Citizen pioneered some cutting-edge participatory design, it ultimately failed to resolve (and in some cases exacerbated) well-known obstacles to institutionalisation as well as generating new challenges. To effectively realise democratic renewal and reform, systems-oriented democratic innovation must evolve strategies to meet these challenges.