Understanding and Enhancing Patient Engagement in Remote Consultations

: (Alternative Format Thesis)

Abstract

This thesis investigates patient engagement in healthcare remote consultation through a detailed exploration of conceptual foundations, operational integration, and key service actor interactions across diverse healthcare contexts. As healthcare systems worldwide increasingly adopt telehealth technologies, understanding how engagement functions within technology-mediated environments is critical for ensuring effective care delivery and improving patient outcomes.

The research employed methodologies including systematic literature review, embedded case study design, and in-depth single case analysis to address research questions that progress from theoretical conceptualisation to empirical investigation and contextual application, creating a coherent investigation of patient engagement across diverse remote healthcare settings.

The work is presented as a set of three interconnected papers. The first paper develops a comprehensive conceptual framework for patient engagement in remote consultation through systematic analysis of 63 articles (2003-2022). This study addresses how patient engagement can be conceptualised and defined in remote healthcare contexts, what factors influence such engagement, and what metrics can effectively assess it. The framework deconstructs patient engagement across behavioural, emotional, and cognitive dimensions throughout the consultation process, revealing nine contextual categories influencing engagement and identifying potential metrics for measuring engagement across different service stages.

Building on these foundations, the second paper examines the operational integration of remote consultation services within routine care processes through an embedded case study of four clinical departments (Cardiology, Dermatology, Gerontology, and Rheumatology). This study investigates how remote consultation services integrate within existing care processes, identifies barriers encountered during integration, and examines how this integration affects patient engagement across different actors within the service and clinical departments. The analysis identified a consistent four-phase structure across remote consultation pathways while documenting significant departmental variations in clinical assessment adaptations, integration patterns for different actors, and technology utilisation. Our analysis uncovered 26 distinct challenge categories that create barriers to effective integration, with their manifestation varying significantly across clinical contexts.

The third paper investigates service triad interactions in mental health settings, exploring how patients, healthcare professionals, and technology providers can effectively collaborate to build and maintain patient engagement while contributing to achieving the triple aim of clinical quality, patient experience, and technical efficiency. The research found that effective engagement emerges from synchronised yet asymmetric contributions from service triad members that shift strategically across different service stages. The research identified five interconnected value dimensions generated through engagement and revealed how responsibility ambiguities create persistent barriers despite well-intentioned interventions from all members of the service triad.

The thesis makes several significant theoretical contributions to Healthcare Operations Management (HOM) by reframing patient engagement as a strategic operational priority rather than solely a clinical concern, advancing process-oriented understanding of remote healthcare delivery beyond technological implementation, extending service triad research toward dynamic operational interactions, and questioning traditional assumptions about inevitable performance trade-offs in healthcare service design. For practitioners, the thesis offers actionable insights for enhancing patient engagement across various clinical settings, streamlining integration processes, and managing collaboration between key service actors throughout the care pathway.

By bringing together insights from conceptual development, empirical investigation, and analysis of service triad interactions, this research not only establishes a foundation for understanding patient engagement in remote healthcare environments but also opens avenues for future research and service innovation. Despite methodological limitations, including the context specificity of NHS England and the challenges of data collection during the pandemic, alongside conceptual constraints in specialties coverage and the diversity of technology platforms, the conceptual frameworks and process insights developed offer valuable theoretical and practical guidance for enhancing patient engagement across diverse remote healthcare settings.

Date of Award	25 Jun 2025
Original language	English
Awarding Institution	University of Bath
Supervisor	Christos Vasilakis (Supervisor) & Alistair Brandon-Jones (Supervisor)