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Consumer Engagement Part 1 Print E-mail
The Quarterly 2012

This article was written by Dr Susan Keam, derived from material presented by Ms Deborah Smith and Dr Lee Gruner on Thursday the 22nd of March 2012 for the RACMA Interact Webinar series.

This article considers the reasons for and benefits of consumer engagement in health care delivery. In part 1, Deborah Smith of the Consumers Health Forum of Australia identifies the significant benefits that consumer engagement contributes to clinical quality and health outcomes, the experience of care, and the business and operations of delivering care. She also discusses the way in which frameworks are used to assess how well engagement is happening across an organisation. In part 2, Dr Lee Gruner discusses the five enduring service factors that consumers look for in health services, and then considers the beneficial effects of consumer partnerships on the efficiency, effectiveness, quality and reputation of health services, as well as the role of consumer partnerships as a driver for implementing the new accreditation standards (National Standards Partnering with Consumers - Std 2).


Part 1: Unlocking potential - getting things done

The Consumers Health Forum (CHF) of Australia is a national body representing the interests of Australian healthcare consumers. They are advocates for appropriate and equitable healthcare and their mission is to ensure safe, quality healthcare for all Australians, supported by accessible health information systems. With a vision of "consumers in control of their healthcare", CHF undertakes consumer-based research, works to raise health literacy and provides a strong national voice for health consumers and supports consumer participation in health policy and program decision making. Membership comprises a large number of organisations, including Breast Cancer Care Australia and State Health Consumer Organisations and local consumer groups. The CHF aspires to develop an integrated healthcare system that values consumer experience, prevention and early intervention and working in partnership.

Why partner with consumers?
Healthcare works better when consumers are partners, because after receiving the service, consumers can tell you what works and what doesn’t, as well as identifying gaps in the service, and where there are opportunities to do things better. They can also help to design services and improve communication, and can be powerful allies and advocates for driving change. Considering consumers and the consumer’s lived experience of health care keeps providers focused on the target for healthcare, which leads to better health outcomes for people and helps providers to find innovative ways of reaching the target. The National Health Reform Commission (NHRC) has emphasised the role for consumer engagement and consumer empowerment in healthcare and has identified that one of the key levers for achieving system change and better health care for all Australians is a strengthened consumer engagement and voice.

In 2010, CHF received government funding to help strengthen the consumer voice. This is being achieved through "Our health, our community", a project providing resources to support consumer participation in health reform. It has two key elements:
  1. Training and support for consumer and community members contributing at the governance level of Medicare Locals and Local Hospital Networks. This is delivered through professional leadership workshops and discussion about practical matters such as the reasons for involving consumers, and what effective consumer and community engagement looks like, and skill development around communication and governance;
  2. A web resource to involve consumers and support consumer advocacy - www.ourhealth.org.au. This is an interactive web and telephone based resource for health consumers with three main foci:
    • 'Find your way' around the health system - a helping hand for consumers to find their way around the health system
    • 'Have a say' - a safe place to involve consumers in a conversation about ways in which the health system can be improved and create a knowledge base to improve consumer advocacy conversation at national, state and local levels

Consumer engagement
In our experience, there are three main reasons why stakeholders in healthcare look to engage with consumers:
  1. Tick a box (there's a box on a funding agreement that needs a tick)
  2. It is the 'right' thing to do (the moral imperative)
  3. Because it helps to get things done.
Helping to get things done is the most important reason and one we should focus on. We also need to look at how to move from tokenism to using consumer engagement as a powerful resource in getting the work of a health organisation done. Consumer engagement is all about learning from and working with people to use resources effectively and deliver better healthcare.

Is there evidence that consumer engagement works?

According to the Australian Commission on Safety and Quality (in the Partnering with Consumers Standard), studies have shown that consumer engagement has significant benefits for clinical quality and health outcomes, the experience of care, and the business and operations of delivering care.

A lot of the information about consumer engagement in healthcare is qualitative rather than quantitative, so it is difficult to draw firm conclusions about the effectiveness of consumer engagement. Nevertheless, there are parallels in the commercial world we can learn from. Businesses succeed or fail on their ability to understand and engage with consumers and to influence consumer needs and behaviour. For instance, Apple, with a market value of US$400 billion, it's 200 million users worldwide and 97% increase in market share is a great example of how user experience and consumer engagement can drive success.

Likewise, in our sector, if we want to succeed in changing the health of a community we need to change the health of individuals. To do that we need a shift in thinking at all levels around the role of consumers. We need to ask whether the consumer is the problem or part of the solution, and we need to understand, engage with and change the health of the individuals that make up that community. Healthcare works better when consumers are partners with healthcare professionals at all levels (individual, Service/Program and Policy/Governance levels).

Example: an initiative in a rural community in New South Wales where there were 6-8 teenage deaths/year and a high number of teenagers ending up in the Emergency department at weekends with injuries from road traffic accidents who then needed to be referred to local hospitals. Investigation of the unsafe driving practices (drunken teenagers on the road at night) showed that the teenagers were driving quite long distances to go to parties and were then involved in accidents on the way home. With the support of the local police, a local bus company and the community, a party bus was set up to take the teenagers to and from the parties at the weekends. After enthusiastic buy-in from the teenagers to this alternative form of transport, the number of road accidents, deaths and ED admissions dropped significantly. This was a positive outcome for the community.

To be serious about effective consumer engagement, the organisations we lead need to have a culture that says we get things done by working with people. To see if such a culture is prevalent, there are three questions that need to be asked of senior leadership:
  1. Do you believe that patient-centred care works? Does working with people get things done?
  2. Are you process driven, or purpose driven? Are you focused on ticking boxes (process) or achieving goals (purpose)?
  3. What do your 'levers' say? We know that what gets measured gets done, so what do you measure, what do you reward?
Consumer and community engagement should happen in many different ways and at all levels of operation. Within the mechanics of consumer engagement, there are many frameworks to work with, including the Consumer Engagement Framework, the IAP2 Public Participation Network (the basis for many other frameworks), the Medicare local - Primary Healthcare Organisations: Community Engagement Toolkit and the Doing it with us not for us - Strategic Direction 2010-2013.

Within these frameworks there are five important labels - INFORM, LISTEN, CONSULT, PARTNER, GOVERN, that must be examined if we are to get a feel for how well engagement is happening across the organisation.

INFORM
  • Are you providing the right information, in the right form, at the right time to those that need it?
  • How do you know it is achieving the purpose it was designed for?
LISTEN
  • Are you gathering the right information, in the right form, at the right time (sources can include informal and formal feedback)?
  • Are there performance indicators and measure in place?
  • Are you using the information gathered to make a difference?
  • How do you know?
CONSULT
  • Where consultation happens, is it with the right people, meaningful to all parties, respectful, achieving a purpose?
  • Consultation implies an opportunity to influence, so those consulted should be advised of the final decision.
PARTNER
  • Are relationships being leveraged to form working partnerships?
  • Are there opportunities for consumer participation to add value to our work?
  • Have we got the right people involved?
  • Is it working?
  • What is being achieved?
  • How do we know?
GOVERN
  • Are mechanisms in place to bring the consumer perspective into decision-making?
  • Is consumer-experience (health outcomes for people) driving our decision-making?
  • Do consumers have a say in setting our direction?

Problems with engagement (not an engagement problem but a planning problem)
Consumers and community members receiving training for contributing at the governance level of Medicare Locals and Local Hospital Networks have identified a number of challenges in community engagement. These include:
  • Getting beyond the squeaky wheel
  • Reaching hard to reach communities
  • Getting constructive input – not just a talkfest
  • Same old faces
  • Getting 'suitable' consumers
  • Resourcing
Often these challenges are the result of involving the wrong people, or having no clear outcomes. One way of overcoming this is to apply standard strategic principles to the problem. The key is to engage for a purpose. Ask "What are you trying to achieve?" "What is the bigger goal?" "How will you know when you have achieved it?"

For example:
  • Reduce the re-admission rates for asthma patients by x%
  • Reduce waiting times in the ED to meet the four hour target
  • Obtain funding for a chronic conditions self-management program for our growing over 50s population
  • Raise health literacy rates from 33%

We need to ask and answer the what, why, who and how questions and we need to assess the results

What is our goal?

Why engage? What is the purpose of the engagement?
Is it any or all of the following?
  • Better decision-making
  • Change behaviour – whose?
  • Support empowerment
  • Influence perception – whose?
  • Obtain buy-in – take people on the journey (this will achieve smoother implementation)
  • Achieve transparency in community accountability
  • Build relationships and understanding
  • Align goals - marshal allies behind the change you want
Who could help and how? Who needs to be 'engaged' and why?
You need to know your community, and this can be achieved through mapping it, analysing stakeholders and auditing relationships. You also need to answer the question why would the community and stakeholders want to engage; what's in it for them?

How? What resources do we have; what resources do the community have? What methods of engagement will achieve our purpose, and work, given the opportunities and constraints? What will success look like?

Assess/Measure - Did engagement fulfil its purpose and did we achieve whatwe set out to (rather than just achieve engagement)? We need to measure what really counts. Factors critical for successful engagement include:
  • Leadership commitment
  • Knowledge of your community
  • Recognition that culture is not a side-dish but a central tenet
  • Strategic planning
  • Building on strengths / leveraging partnerships and relationships
  • Recognition that there are many different ways in which consumers wish to engage, and no one way is the “right” or “best” way
  • To get the right mix of consumers when recruiting, go to where the consumers are, and work around the way in which they can get involved
Engagement that works relies on a culture that says two things:
  • Health care is about what happens to people
  • We get things done by working with people.

Deborah Smith
Consumer Relationships Manager, Consumers Health Forum of Australia
www.chf.org.au



The Royal Australasian College of Medical Administrators
Ms Deborah Smith , , p530
racma.edu.au /index.php?option=com_content&view=article&id=530:consumer-engagement-part-1&catid=122:the-quarterly-june-2012-&Itemid=277