Crossing the Quality and Health Care Chasm for Rehabilitation from Brain Injury: Applying Fair Process to Policy Development

For quality and health care policy improvement efforts for rehabilitation from brain injury to be realistic and fair, they need to involve all stakeholders, including survivors, in analyzing the situation, exploring possibilities, and evaluating and learning from the policy development process. Failure to include the survivor's perspective is a justice issue; it is also an issue of fair process. Yet incorporating the brain injury survivor's perspective into health care improvement efforts is problematic, as they may face challenges in reflecting on their situation, developing their ideas, and communicating them. These challenges require a creative approach to eliciting their perspective on this chronic condition. The author and two survivor co-facilitators led a 10-week photovoice project with eight brain injury survivors. The project was intended to provide an opportunity for participants to reflect on living with brain injury and their progress in dealing with this major life change, raise awareness about brain injury, and help policymakers understand ways to support healing from this injury. Photovoice involves working in a group to represent lives, experience, and point of view using photographs and narratives. This study actualized fair process at both a micro and a macro level—at an interpersonal level within the group and at a societal level in the context of health care quality and policy development. This presentation will provide an overview of fair process and relate experiences and lessons learned from this participatory attempt to cross the quality and health care chasm related to rehabilitation from brain injury.