Illuminating the importance of adding patient knowledge to continual improvement in healthcare.

© Author(s) (or their employer(s)) 2022. Reuse permitted under CC BYNC. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION The importance of involving patients in quality improvement (QI) is becoming increasingly evident in healthcare. 2 To achieve this, various approaches, such as codesign and coproduction, are being introduced alongside different models and frameworks to improve the quality and safety of healthcare systems. Codesign describes a way of involving both patients and professionals in QI, focusing on the improvement of the experiences of healthcare services. Coproduction refers to the interdependent work of patients and professionals to design, create, develop, deliver, assess and improve the relationships and actions contributing to patient and public health. However, patent involvement and QI have, historically, mainly developed independently. The traditional way of working with improvements in healthcare has been for healthcare professionals to develop what they believe is best for the patients according to their professional knowledge only. Yet, to achieve, preserve and improve patient and population health, relationships between the various stakeholders, patients and the public included, some kind of joint action should be involved. There are synergies shown between professional knowledge, improvement knowledge and patient involvement in QI.Thus, an integration of patient and professional knowledge in QI can offer sustainability to the coproduction of value for patients. So, how can this synergy be displayed and understood by patients and professionals alike? Batalden and Stoltz introduced a framework (figure 1) in which the components of professional knowledge and improvement knowledge were linked to enable continual improvement of healthcare. Almost 20 years later, a model of healthcare service coproduction was proposed. In coproduction, patients and professionals work together by sharing their respective knowledge, skills, resources and responsibility. 8 Patients are arguably as much experts in determining healthcare outcomes as are professionals, although with expertise in terms of lived experiences of direct care and of the healthcare system, and knowledge of their symptoms, individual resources and of the context of their lives. In this viewpoint, we argue for the importance of adding patients’ experiential knowledge as an equally significant component of the original Framework for the Continual Improvement of Healthcare. We suggest a model for visualising how patient knowledge in healthcare QI may establish sustainable codesign and coproduction. If linked together, the three knowledge domains can enable continual and sustainable QI to better fit patient purposes and needs. The model may help healthcare organisations as well as patients and professionals to understand the importance of the integration.