Table 1 Analysis of the relationships between the words used in the definition of engagement of patients and family members

What is engage?

Participation and involvement are used as synonyms of engagement

"I believe it is the participation of the patient and the family in each stage of patient care and an understanding of the quality process implemented."

"Involvement of the patient and family member in his or her treatment and interrelationship with the teams involved in his or her treatment seeking patient-centered care.”

Just as the answers to the closed question about the synonyms of engagement, the words ‘participation’ and ‘involvement’ were mentioned at the beginning of the definitions

Where can patients be engaged?

P/F participation in care

"We understand that the patient should be the center of care and participate in the development and conduction of his or her therapeutic plan.”

"The participation of the patient and family member in all care tasks during his or her stay in the hospital.”

"Involve the patient in the quality of his or her care and in his or her safety; actively participate in the process of their care.”

"I believe it is the participation of the patient and the family in each stage of patient care and an understanding of the quality process implemented.”

Patient and family participating in all stages of care, to improve quality and safety

P/F participation in continuous quality improvement

"[…]. With this, he (patient) becomes a fundamental agent in both the safety of his or her care and the quality improvement.”

"The patient be engaged in all processes of the institution as part of continuous improvement of the quality provided to his or her treatment.”

"Patient engagement in care is an important strategy for healthcare services quality improvement […] "

It is one of the pillars of patient-centered care. It generates benefits in both levels individual and institutional, bringing improvement of quality and safety; improvement of care outcomes; increased satisfaction and loyalty of employees; improvement of the patient experience; improvement of time management; and communication between teams and patients/family members.”

P/F can contribute to continuously improving the quality of services

Why engages patient?

Patient safety as one of the expected results

"Patient-centered care; multidisciplinary team carry out guidance on patient safety; quality research; family involvement in patient care; and community participation in some institutional committees.”

"In the last years, patient involvement has been recognized as an essential component in the health care process. WHO, through the World Alliance for Patient Safety, emphasizes the need to raise awareness among patients and their families about the importance of their engagement in initiatives to promote their own safety […]"

"In my opinion, it is the education of the patient and family members concerning the patient safety goals, explaining, and demonstrating the reason for the processes involving patient safety, so that all people involved in care can contribute to safety and quality of care.”

The patient's participation in their care is important to ensure his or her safety

Patient-centered care promotes and is strengthened by patient involvement in his or her treatment

"Engaging patients and family members in his or her treatment is very important to promote patient-centered care.”

"It is one of the pillars of patient-centered care […] "

Both relationships always appear associated and could be rewritten as patient-centered care

Engagement is important in seeking centered care and allows the patient participation

How

P/F as a participant in the institution's processes

"It is the patient being engaged in all processes of the institution as part of continuous improvement of the quality assistance during his or her treatment.”

"The active participation of the patient and family not only in his or her own care, but in all processes of quality management of an institution, from the definition of strategic planning to the management of results and improvement projects.”

P/F participates in both care and quality management processes

Active describes a characteristic of patient participation

"Active participation of patients and family members in the delivery of value, based on the experience and clinical outcome.”

"An active participation through opinion, gesture or manifestation when making the decision about the institution, taking into account the care provided, or simply commenting at a time opinion regarding the service received when it is possible.”

Both relationships appear associated in most of the stretches, so it can be considered as active participation of the patient

P/F engagement in processes to improve quality requires an organization (process definition)

"Involvement of the patient and family member in decision-making regarding their therapy in order to seek adherence, support or more appropriate strategies throughout the process in which the patient, caregiver or family member needs care.”

"Have processes that facilitate the inclusion of patients and families in:(a) shared decision in treatment; (b) opportunities for improvement (ombudsman or customer service); (c) redesign of processes through improvement projects; and (d) advisory board.”

The word process appears in two contexts:

1. Process aimed at engaging patients

2. Engagement of patient in the care processes

The expression quality management includes information gathering with P/F, involvement in care and improvement actions

"Patient and family engagement in quality management is the most powerful tool for achieving goals.”

"Currently, our ombudsman focuses on quality management; in this way collecting data and transforming it into management information to improve the service provided. We are connected to a humanization working group and receive all users to collect manifestations (suggestions, compliments, complaints, and requests). The ombudsman is the voice of the user within the management.”

The expression 'quality management' has a comprehensive concept, in that it encompasses the processes of communication with the patient, their involvement in treatment and management actions, at the organizational level to improve quality and safety

Quality and safety in care, at the individual and organizational level

"Involve the patient in the quality and safety of his or her care; actively participate in the process of his or her care.”

"Patient engagement in care is an important strategy to improve the quality of healthcare services. Patients are a source of information for quality of care, corroborate the visibility of inequities and facilitate the design of strategies based and focused on results […]"

"In general, family members are participatory, concerned with well-being of the patient and are cooperative with institutional quality.”

Words appear associated both to refer to the quality of care at the individual level (with emphasis on communication as a source of information), and to cooperate to improve quality and patient safety at the organizational level