Conceptualizing lay participation in professional health care organizations Benjamin Marent*, Rudolf Forster and Peter Nowak *School of Applied Social Science, University of Brighton b.marent@brighton.ac.uk Published in: Administration & Society 2015, Vol. 47(7) 827– 850 DOI: 10.1177/0095399713489829 http://aas.sagepub.com/content/47/7/827 Abstract The participation of lay people in health care decision-making lacks an adequate analysis from an organizational perspective. This article aims to develop conceptual devices to analyze policies and practices and to discuss ways in which these policies and practices could be further developed. By recapping established frameworks and drawing on theories of professional organizations, four roles for the participation of lay people and their potential to adapt organizational decision processes to internal requirements and external challenges are elaborated. While individual patient participation is widely acknowledged, there is still a lack of systematic approaches to the roles of significant others, patient groups and the broader community and their implementation within health care organizations. Keywords: Lay participation, health care organization, patient participation, public participation, decision making Introduction Lay participation in health care policy, planning and management has been a prominent theme since the emancipatory social movements of the 1960s (White, 2000). A cultural change is noted in which the authority of experts has gradually been challenged by citizens and users of services who lay claim to more possibilities for participation (Gerhards, 2001). Drivers for this change are seen mostly in the higher levels of education of lay people, in new communication technologies and in the emergence of post-materialist values (ibid.). The World Health Organization formally took up these demands in 1978 by acknowledging that the “people have the right and duty to participate individually and collectively in the planning and implementation of their health care” (WHO, 1978, p. 1). Subsequent WHO policy documents have confirmed this perspective. The issue of participation is now high on the agendas of governments and health policy makers all over the world, especially in the UK, the USA, Canada and Australia (Forbat, Hubbard, & Kearney, 2009). Yet this trend is put into practice rather differently (Tambuyzer, Pieters, & Van Audenhove, 2011). Participation often does not work as intended (Rise et al., in press) and the impact of participation is, as yet, largely undetermined (Tritter, 2009). 1