Consumer participation in health care governance

Health care entities are often governed by boards that are charged with setting the organization’s strategic direction; board decisions help determine organizational policy, shape patient services, and ultimately, affect patient outcomes. Governing boards are generally comprised of a variety of stakeholders, and may include consumer representatives. Consumers may also be integrated into other governance activities, participate in organization-led projects to develop and disseminate consumer-friendly health and comparative quality information, or in health care system redesign efforts (). Consumer roles may be long-term commitments such as reviewing current services or potential change initiatives, or short-term engagements to provide feedback or preferences on discrete questions (Crawford 2003).

Expected Beneficial Outcomes (Rated)

  • Improved quality of care

  • Increased patient engagement

  • Increased organizational accountability

Evidence of Effectiveness

Involving consumers in health care governance is a suggested strategy to improve health care quality (), service effectiveness, and organizational accountability, as well as to empower disadvantaged consumers (Crawford 2003). Available evidence suggests that consumer engagement in priority setting may result in different decisions than those that would have been reached without it ().

A large-scale US-based effort to involve consumers in health care governance indicates that identifying appropriate participants, defining consumer roles, and resistance from some stakeholders can be challenges to successfully engaging and integrating consumers. Requiring consumer involvement, however, appears to help ease barriers to including consumers in governance discussions ().

The experience of the UK’s National Health Service, which has long sought and included some element of consumer involvement, indicates that clearly articulating both what involvement means and what it is intended to achieve is needed in order for consumers to be substantively engaged in decision making ().

Impact on Disparities

No impact on disparities likely

Implementation Examples

Consumer involvement in health care governance is becoming more common among both public and private organizations. Health centers supported by the Health Resources and Services Administration (HRSA) are required to have consumers on their governing boards, as are accountable care organizations (ACOs). The Robert Wood Johnson Foundation’s (RWJF’s) Aligning Forces for Quality (AF4Q) initiative, which ended April 2015, supported efforts to improve quality and value in 16 communities in 14 states, requires local consumer involvement in governance and decision making, program design and implementation, and information dissemination efforts (). 

Implementation Resources

CC-Consumer input - Community Catalyst (CC). Best practices for meaningful consumer input in new health care delivery models. 2012.

AF4Q-Best practices - Aligning Forces for Quality (AF4Q). Best practices for engaging consumers in organization leadership: Lessons learned from Aligning Forces for Quality communities.

Citations - Evidence

* Journal subscription may be required for access.

Mende 2013* - Mende S, Roseman D. The Aligning Forces for Quality experience: Lessons on getting consumers involved in health care improvements. Health Affairs. 2013;32(6):1092-1100.

Crawford 2003 - Crawford M, Rutter D, Thelwall S. User involvement in change management: A review of the literature. National Institute for Health Research, National Health Service (NHS). 2003:1-205.

Mitton 2009* - Mitton C, Smith N, Peacock S, Evoy B, Abelson J. Public participation in health care priority setting: A scoping review. Health Policy. 2009;91:219-28.

Hogg 2007* - Hogg CNL. Patient and public involvement: What next for the NHS. Health Expectations. 2007;10:129-38.

Citations - Implementation Examples

* Journal subscription may be required for access.

Mende 2013* - Mende S, Roseman D. The Aligning Forces for Quality experience: Lessons on getting consumers involved in health care improvements. Health Affairs. 2013;32(6):1092-1100.

Date Last Updated

May 26, 2015