“You’re asking ME to Cut Down the Red Tape?” – Part II
Friday, April 20th, 2012
In a previous blog, I wrote about the U.K. Government’s Red Tape Challenge (RTC), a national crowdsourcing initiative aimed at reducing the overall burden of regulations for businesses and individuals. I want to outline a few of the public involvement best practices that the RTC follows.
It’s great to see meaningful public engagement initiatives like this being carried out across the pond!
How patient engagement in healthcare leads to better decisions…
Monday, March 26th, 2012
Health system leaders are right that decisions about care should be “evidence based” – grounded in what we know works to make people healthier and ensure they have a positive experience in their care journey.
But, what counts as “evidence”?
Most people agree that clinical data plays an important role, through population health statistics, academic research on health administration, etc.
Just as important, however, is evidence from people as they work their way through the health system – patients as well as their friends or family caregivers.
Patients and caregivers have unique and important perspectives that help improve services. Their experiences tell us what’s working, what needs to be improved for patients, and how it can be improved. That’s why there’s a growing interest in public involvement or “patient engagement” in healthcare, and a recognition that it leads to better decisions about how to better deliver health services for patients and their families.
I was recently asked to be part of an expert panel discussion on patient engagement, organized by the Canadian Institutes of Health Research (CIHR) and Health Canada. Other panelists were:
Together with participants, we had an interesting discussion about the myths, realities and challenges of involving the public in healthcare decisions. From the conversation, my two biggest take-aways were that:
Ascentum has just finished a large-scale engagement project in Ontario for The Change Foundation about the experiences of seniors with chronic health conditions and their caregivers. This is just one example of how patient engagement is being used to create a more patient-centred healthcare system. The results of this engagement will be released in the upcoming weeks, and when they are we’ll make sure to share them with you here.
– Ellis Westwood –
Validating the Economic Case for Public Involvement
Friday, March 9th, 2012
“No decision about me without me’ in these terms goes far beyond traditional methods of engagement and consultation to include patients and the public as shared decision-makers at all levels of healthcare organization and delivery.”
The UK National Health Service commissioned research to explore the economic case for public and patient involvement (http://healthandcare.dh.gov.uk/economic-case-for-ppi/ ). InHealth Associates undertook 14 UK-based case studies to explore the relationship between meaningful and effective involvement and economic, quality and user benefits for NHS, partners and the populations they serve.
The study drew the following conclusions:
These findings contribute to a growing body of international evidence about the merits and necessity of institutionalizing good public involvement in critical dimensions of healthcare design, delivery and evaluation. Public involvement needs to front and centre in strategic thinking about how to address healthcare system innovation in Canada if we are to effectively address current shortcomings and looming challenges.
-Mary Pat MacKinnon-
Chancellor Merkel crowdsources Germany’s future
Wednesday, February 1st, 2012
German Chancellor Angela Merkel is going online to engage Germans on the future of their country. On February 1 the Chancellor’s office launched a “Dialogue about Germany’s Future”, a project that combines an online crowdsourcing website and a series of in-person, “US-style” town hall meetings. It marks the first time the Chancellor is going directly to citizens using an online tool to engage them in decision making.
Over the next two months, Germans will have a chance to share their views on the Germany they’d like to see in the next 5-10 years, answering three main consultation questions:
In a weekend interview with the Bild am Sonntag, Merkel emphasized that all suggestions would be taken seriously: “They won’t land in the thin air of the internet. Rather, each one will receive an answer, and the best have the chance to be acted upon”. Pushed further, Merkel explained how ideas could be acted upon, while acknowledging the novelty of the initiative:
I can’t promise anyone that we will immediately implement everything, but I also won’t say what won’t work. Reasonable ideas could be turned into a research project or model project. Examples of best practices, on topics such as “better working conditions for the elderly” or “the city of the future” could achieve more than current political discourse. We will also send good ideas to the responsible ministries. What’s clear to me is this: With this online “Dialogue of the Future” we’re entering new territory. We don’t know 100% how exactly this will work, and how many people will actually take part.
Merkel explained that her team of “120 experts” would be pouring over the results after the online tool closes in April, releasing a book in June, and presenting the most useful ideas in September.
When asked why the main thrust of the project was online, Merkel answered simply, “there’s no other way to reach so many people”.
After the crowdsourcing site has been closed, authors of the ten top-voted ideas will have a chance to meet with Merkel in her office.
The online process is also being complemented by 3 in-person “US-style” town hall meetings in the cities of Erfurt, Heidelberg and Bielefeld with 100 participants each, as well as sessions for children and youth.
The project has only been live for a few hours, so I can only make general observations. It’s clear that the project has lots of potential. It has buy-in from Merkel herself, who has committed her government to respond to and act upon all “reasonable” ideas within a strict timeline (the timeline below, which appears on every page, explains the process. Click to view larger image). It shows that the federal government in Germany is interested in using novel ways to engage citizens, including both crowdsourcing and “town hall” meetings.
Potential challenges include how to deal with popular suggestions that are beyond the scope of the federal government. A “Citizen’s Forum” project last year in the country, for example, brought together 3,000 interested citizens who suggested that education systems (a state responsibility) be harmonized across the country. The idea was pretty much dead on arrival, as states have clung to that responsibility vehemently. Critical to the collection of useful ideas will be communicating to participants the scope of ideas being solicited (what is up for discussion, and what is not). Another essential step for the Chancellor’s office will be to ensure enough resources to wade through the ideas (6 hours after launching, a total of 123 have been posted).
Stay tuned for further updates as we track this exciting project.
All translations are my own.
Improving Canadian Health Care through Public Engagement
Friday, January 20th, 2012
With last month’s announcement of the new Canadian health care funding formula, federal transfers to the provinces will continue on an annual increase of 6% until 2017, at which point increases will be tied exclusively to GDP. Without delving into the complex politics here, suffice to say this unilateral federal decision is generating both positive and negative reactions (and the manner in which it was proposed). But what I’m more interested in is how this significant change impacts the ongoing health care debate in this country.
Maclean’s “Best of 2011” featured an article entitled, “Our health care delusion, which brings to light some of the current realities around the functioning of our health care system. According to author Ken MacQueen, a 2010 Commonwealth Fund report found that when compared with the health care systems of a dozen other countries, “Canada scored well on leading ‘long, healthy productive lives,’ but it was mid-pack or worse on every other measure.” In recent years, one major issue that has come to the forefront is wait times, which are “widely regarded as the Achilles heel of the system.” MacQueen explains how these issues have emerged in ERs across the country; yet many Canadians still believe that we have the best public health care system in the world.
So why don’t we address this issue? Some argue that health care reform in Canada carries a lot of patriotic baggage with it, as “intelligent debate about what should be done has basically ground to a halt by incendiary claims that any attempt to update the system amounts to treason- a repudiation of sacred Canadian values.” However, there seems to be a definite need for change as the long-term sustainability of our health system has been questioned more and more in recent years. This presents an opportunity for all of us to reflect on our experiences with the health care system that so many of us take great pride in.
So how does public engagement fit into all of this? Before we can even determine what exactly we need to do, there needs to be opportunities for informing that discussion. In 1964, we had the first “real conversations” about health care in this country with the Royal Commission of Health Services (to get a sense of the conversation back then, check out the full November 2, 1964 broadcast on CBC’s National Farm Forum Radio). When asked about the importance of universal health care (which was only available to Saskatchewanites at the time), the Commission’s chair stated that “there is an obligation on society to be concerned with the health of its individuals.” Even though much has changed since then, the need to engage citizens in the health system will always remain. Why? Consider what citizens represent in the health care context: they “are not only interested representatives of the general public, but are also consumers of health services, patients, caregivers, advocates and representatives of various community and voluntary health organizations.”
So what has been done so far? This past year the Canadian Medical Association (CMA) engaged Canadians in a national dialogue on health care transformation, which consisted of an online consultation process and six in-person town hall meetings, which Maclean’s helped moderate. You can read their final report here.
Let’s just hope that momentum builds and that such efforts continue as we look to 2014…
The Possibilities for Citizen-Led, Community-Level Change… in Canada?
Thursday, December 22nd, 2011
In an effort to follow new and interesting practices in engaement, I’ve spent some time looking into the work of Everyday Democracy – a non-profit organization that works closely with communities across the U.S. to address complex, local level issues through public involvement (PI). Its work seems to reflect a much larger trend around PI, which is the rise of community-based initiatives, particularly in the U.S.
To help demonstrate the type of impact that PI can have on the local level, let’s look at Portsmouth Listens, a collaborative effort between the city of Portsmouth, New Hampshire, and its citizens to impact important local issues through increased PI. According to Matt Leighninger, “Portsmouth Listens shows that public engagement processes do not have to be ‘owned’ by government – that they in fact may be more effective and sustainable when they are jointly owned… it harks back to a time in New England when public life was as much a function of community as politics.”
It all started in 1999 with the issue of bullying in the city’s middle school. In an attempt to address the situation, the school invited students, teachers, parents and neighbours (e.g. homeowners, shop owners and individuals from a nearby senior’s housing complex) to participate in a dialogue.
Some of the most notable ideas came from students themselves, which included moving the school’s bike rack to another area that has more traffic and is less isolated, and increase lighting in certain areas around the school grounds. A year later, the town council used this process as the foundation for gathering public input on school redistricting, which can be a ‘hot’ issue in any community. With a significant enrollment imbalance between Portsmouth’s three elementary schools, rotating dialogues were held in each one. This process helped increase comfort levels, as parents were given the opportunity to get a feel for all the schools, thereby decreasing the antagonism around “moving my kid from their school.”
These types of participative initiatives continue to be used in Portsmouth today. For example, residents can review the city’s Master Plan, which outlines the framework for the community’s planning and land use decisions. In one review, citizens came up with a unique idea that wasn’t in the Plan – to convert an old soap factory to an art colony, which could also attract tourists to the city. For more information, please visit this link for Everyday Democracy’s two-part orientation video (scroll down).
All of this leads me to ask three questions:
Ascentum community engagement project for South East LHIN a “resounding success”
Friday, October 21st, 2011
Earlier this year, Ascentum was hired by the South East Local Health Integration Network (LHIN) to engage community members across southeastern Ontario and gather public input on new health care plans for the region.
We worked closely with staff from the South East LHIN, as well as physicians and other clinical experts, to design a series of deliberative workbooks that local residents could complete online to have their say.
The fact that we heard from 867 participants who took the time to complete a total of 1775 detailed workbooks is a solid indication that this engagement worked very well,” said Huras. “Each of these participants took the time to learn, understand and comment on workplans that were detailed and complex. The process provided a great deal of quantitative and qualitative feedback that has helped our Clinical Leads and their teams to adjust and fine tune these plans,” he added.
We appreciated the opportunity to work with the LHIN and their partners on this project. From our perspective, they were truly committed to gathering input from their communities and using it to help guide their decision-making.
In support of LHINs
Recently, some people have questioned the value of LHINs. These critics say that LHINs are too costly, or take money away from front line care.
From my perspective, the right question about what LHINs do should be framed differently. Who best understands the health care needs of local communities across Ontario? Local residents and health system planners, or those in a head office thousands of kilometers away?
We have done work for several LHINs, including Share Your Story, Shape Your Care for which the North West LHIN won the International Association for Public Participation (IAP2)’s Innovation of the Year award for 2009.
We’ve always found LHIN staff to be dedicated, hard-working local residents driven by a desire to coordinate health services in a way that reflects local priorities, needs and values. We think their work is important and hope they are able to continue building on the progress already made.
To end, a local MPP for the region once told me “When you get the public involved, you get way better results. When you leave it up to a politician, it takes too much money; it takes too long; and they’ll probably get it wrong!”
– Ellis Westwood –
An alternative view of Alberta: Edmonton, energy, climate change and citizen deliberation
Friday, September 30th, 2011
The brouhaha against the Keystone XL pipeline once again shines a harsh light on Alberta and its oil sands industry. And the National Roundtable on the Environment and the Economy’s latest report on the costs of climate change to Canada sharpens the debate.
What flies under the radar in the rest of Canada is the fact that Edmonton City Council recently passed a comprehensive and far reaching environmental strategy called The Way We Green (TWWG). Its goals and policy directions, including on climate change and energy, are nothing if not forward looking and very ambitious. (more…)
Inspiration and Iron Fists
Thursday, September 22nd, 2011
Rob Mariani and I represented Ascentum at the Strategy Institute’s inaugural Innovations in Public Consultation and Engagement Conference in Toronto this week. It was an interesting event for a couple of reasons. One reason was the “new” diversity of interest, but the other was an inspirational address that caught me by surprise. (more…)
Announcement – Mary Pat is becoming a Partner at Ascentum!
Monday, September 19th, 2011
As the warm air subsides and the seasons shift, the Ascentum team is also feeling some major changes in the atmosphere. It has recently been announced that Ascentum’s Director, Mary Pat Mackinnon, will be promoted to Partner at Ascentum! In her position as Director, Mary Pat has led public and stakeholder engagement initiatives and is integral to the strategic planning work Ascentum does for its clients. (more…)
“When you get the public involved … you get way better results”. Strengthening Healthcare in Southeast Ontario
Wednesday, March 30th, 2011
“When you get the public involved … you get way better results. When you leave it up to a politician … it takes too much money; it takes too long; and they’ll probably get it wrong!” (Lou Rinaldi, Ontario MPP for Northumberland-Quinte West)
When Ontario MPP Lou Rinaldi opened a media event with this tongue-in-cheek observation last week, he certainly got a good reception from the audience, ranging from nodding heads to roars of laughter.
He was in Belleville, along with staff from Ascentum, for the official launch of the Community Engagement for the South East Local Health Integration’s “Clinical Services Roadmap” initiative – a project to involve communities across the region in helping design measures for improving the way health care services are organized and delivered locally. (more…)
Recovery in Haiti – Using the Power of Dialogue
Tuesday, February 22nd, 2011
One year ago, Haiti was shattered by one of the most devastating natural disasters in its modern history. The 7.0 magnitude earthquake destroyed an already fragile country, killing 300,000 people (roughly the size of London, Ontario), leveling towns, villages and cities, including the capital Port-au-Prince, and chipping away further at the spirit of the nation. (more…)
A Resolution and a Commitment
Wednesday, January 5th, 2011
It is never too late to make a New Year’s resolution. We at AmericaSpeaks and Ascentum thought it might be helpful if we proposed a resolution focused on Open Government that federal managers can adopt to start the year off right: Resolve to make a specific, concrete commitment to enhance citizen participation in your agency.
(Note: Ascentum and AmericaSpeaks are partners in offering online public engagement services to agencies in the US Government in support of the White House’s Open Government Directive) (more…)
Public Involvement: some parting thoughts from Ascentum’s first co-op student
Thursday, April 29th, 2010
With my current co-op semester coming to an end, it seems appropriate to reflect on my experiences here at Ascentum. As the company’s very first intern, I really didn’t know what to expect when I first began. But now, in considering what I’ve learned over the past four months, it’s challenging to figure out where to begin! (more…)
The New Advocacy: NGOs take note…
Tuesday, March 30th, 2010
Public involvement has changed how advocacy works.
Today, civil society organizations – whether they are local nonprofits or national associations – are fostering social change through collaborative dialogue with their publics instead of “top-down” or expert-oriented campaigns.
By involving the public, who want to be engaged, these advocacy efforts are leading to more sustainable and innovative solutions to shared problems. (more…)