Managing integration and disintegration: performance conditions of patient and public involvement to hospitals quality improvement

Purpose Patient and public involvement (PPI) has been a major issue for health systems for the last decade. PPI generated great expectations such as more patient-centred health systems and improved quality. However, evidence remains patchy. Most of the literature depicts a lack of evidence on the effectiveness of PPI initiatives. This paper aims to go beyond the performance measurement to analyse the performance conditions of PPI initiatives at the organisational level. Design/methodology/approach Building on Luhmann’s systems theory, we approach the performance conditions of PPI initiatives at an organisational level through the notion of integration, itself composed of the dimensions of connectivity and freedom degree reduction. We conducted a comparative case study to compare the performance conditions of three patient committees (PFAC) in Belgium. Data were collected through observations, individual interviews and document analysis from 2018 to 2024. Findings The cases presented three integration configurations that underlay the performance of each PFAC: strong integration, middle and weak integration. The combination of diverse forms of connectivity and reduced degrees of freedom significantly modified the PFAC’s capacity to perform. Originality/value The systems theory approach provides tools for thinking about PPI in a way that complements analyses in terms of individual or organisational culture. The study helps to explore how to improve PPI initiatives deployed at the organisational level.