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Front. Sociol. | doi: 10.3389/fsoc.2019.00038

A Hierarchy of Power: The Place of Patient and Public Involvement in Healthcare Service Development

  • 1Kingston University, United Kingdom

Amidst statutory and non-statutory calls for effective patient and public involvement (PPI), questions continue to be raised about the impact of PPI in healthcare services. Stakeholders, policy makers, researchers and members of the public ask in what ways and at what level does PPI make a difference? Patient experience is widely seen as an important and valuable resource to the development of healthcare services, yet there remain legitimacy issues concerning different forms of knowledge that members of the public and professionals bring to the table, and related power struggles.

This paper draws on data from a qualitative study of PPI in a clinical commissioning group (CCG) in the UK. The study looked at some of the activities in which there was PPI; this involved researchers conducting observations of meetings, and interviews with staff and lay members who engaged in CCG PPI activities. This paper explores power imbalances when it comes to influencing the work of the CCG mainly between professionals and lay members, but also between different CCG staff members and between different groups of public and lay members.

The authors conclude that a hierarchy of power exists, with some professionals and public and lay members afforded more scope for influencing healthcare service development than others - an approach which is reflected in the ways and extent to which different forms and holders of knowledge are viewed, managed and utilised.

Keywords: Patient and public involvement, healthcare, power, hierarchy, influence, lay members, Public members, professionals

Received: 16 Oct 2018; Accepted: 11 Apr 2019.

Edited by:

Tiago Correia, Instituto Universitario de Lisboa (ISCTE), Portugal

Reviewed by:

Doreen Tembo, University of Southampton, United Kingdom
Ewen Speed, University of Essex, United Kingdom
Andy J. Gibson, University of the West of England, United Kingdom  

Copyright: © 2019 O'Shea, Boaz and Chambers. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Mrs. Alison O'Shea, Kingston University, Kingston upon Thames, United Kingdom, a.oshea@sgul.kingston.ac.uk