Engaging Patients in Quality Improvement

©️ 2026 Kaiser Foundation Health Plan, Inc.

Overview

PHMI encourages practices to engage patients served by your practice to validate any proposed process improvements and to suggest alternative approaches for enhancing quality in your designated focus area.

Importance

Engaging patients in quality improvement (QI) initiatives is a strategy for addressing health equity gaps, especially among persons that have been historically marginalized—such as persons of color, immigrants, and persons whose preferred language is not English. By actively including, centering, and inviting insight from these patients, health centers gain crucial insights into the barriers and challenges shaped by both social and systemic factors. Additionally, engaging directly with patients who have diverse backgrounds and experiences enables organizations to gain broader insights into the unique needs of their patient population. By involving individuals with varying perspectives, health centers can better identify and address factors such as the need for extended provider hours, training on patient portals, and other specific supports. This approach not only helps community health centers (CHCs) tailor their services to meet patient needs more effectively, but it also strengthens their ability to retain patients and reduce the risk of individuals seeking care elsewhere or foregoing care altogether.

  • Peer Example: Sonoma Valley Community Health Center heard feedback from their patient advisory committee that the FIT test instructions from their vendor were difficult to understand. As a result, Sonoma Valley created its own version of the instructions, including pictures rather than lengthy explanations, to make them more accessible for all patients, including individuals with lower literacy levels.

Centering the voices of patients in quality improvement processes not only enhances the effectiveness of healthcare delivery but also fosters a collaborative environment where their needs and preferences are at the forefront. Clinicians and team members can gain invaluable insights that lead to more personalized care, improved outcomes, and greater patient satisfaction.

 

Levels of Patient Engagement

Patient engagement can occur at varying levels of intensity, from simple feedback collection to full partnership in quality improvement efforts. The table below outlines a practical way to think about these levels, helping health centers plan and implement strategies that deepen engagement over time. As a best practice, health centers should fairly compensate patients for participating in improvement activities.


Level
Description
Key Aspects
Advantages
Disadvantages

Baseline
Asynchronous feedback
Involves patient surveys
Patients can complete surveys at their convenience, making it easy for them to participate
Gathering feedback on a specific process can be difficult with this method, as patients may worry that their responses could be identified and impact their care.

Level 1
An active patient engagement strategy beyond asynchronous feedback
Involves asking standardized questions before, during, or immediately after a visit to get direct feedback on a QI/PHM process you have selected

  • Patients can provide input while they are on-site and engaged with care 
  • Easy to integrate into the workflow by any care team member 
  • Allows for rapid responses to relevant, timely questions 

  • Best suited for straightforward topics or simple concepts 
  • Does not usually facilitate in-depth discussion or detailed feedback 
  • Patients might not fully comprehend the questions being asked  
  • Patients may withhold back honest feedback out of fear it could affect their care or offend staff 

Level 2
A more active form of patient engagement, where feedback is gathered on specific processes over a designated period of time
Involves asking one or more members of the patient council to share their feedback on your chosen processes

  • Patients are engaged and committed to supporting the centers as members of the patient council 
  • Patients are familiar with the operations of the CHC, enabling them to provide constructive feedback that supports ongoing improvements 
  • Patients may be acquainted with QI 
  • Patients have developed the skill of offering feedback to their CHC. 

  • Patients may not represent your Population of Focus, which may limit their ability to answer questions from the firsthand perspective
  • The need for timely feedback might not align with the council's schedule or capacity 

Level 3
An ongoing, advanced level of patient engagement
Involves patient advisors taking on a formal role as members of the QI/Implementation team

  • Allows for co-production with patients and enables continuous, immediate feedback 
  • Allows for true partnership between centers and advisors 

  • Identifying the ideal person takes time and careful consideration to ensure a good fit 
  • Maintaining effective communication and providing ongoing support are essential for successful engagement. 
  • If you have not already begun this process, it may be challenging to achieve the foundational competency by the end of April 

 

Examples of patient engagement across Populations of Focus

Children

Establish youth advisory councils composed of children and adolescents to offer input on pediatric services, share their experiences, and recommend enhancements pertaining to their care.

Pregnant People

Organize focus groups with pregnant people to gather in-depth insights to enhance maternity care services. Health centers should prioritize changes that will positively impact patient outcomes and birth experiences.

Adults with Preventative Care Needs

Facilitate the formation of advocacy groups that focus on preventative health measures, allowing patients to share their insights and collaborate on solutions.

Adults with Chronic Conditions

Involve patients in the design and improvement of chronic care management programs through regular feedback sessions and patient-led discussions on managing their conditions, and recommendations for improving care delivery.

People with Behavioral Health Conditions

Form committees composed of persons with lived experience or families of patients with lived experienced of behavioral health conditions to actively participate in shaping policies and co-developing programs that enhance mental health services.

 

Planning worksheets to generate ideas on aspects of point-of-care feedback:

 

Selected resources on human-centered design and collaborative design: