Patient and Public Participation in the English NHS: An assessment of experimental implementation processes

This article analyses the impact of the implementation of a set of policies introduced after 1997 in the English National Health Service aimed at increasing patient and public involvement in organizational decision-making processes. Adopting the ambiguity/conflict policy implementation model and based on a year-long research project, it shows that patient and public engagement can be more effectively achieved when there is room for interpretation and discretion in selecting the means for involvement. Local initiatives, based on effective leadership governance mechanisms and organizational learning processes, are more likely to generate inclusiveness, shared ownership, and user-centredness than a top-down framework for involvement.