Strengthening Community Engagement in Ontario LHINs

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Strengthening Community Engagement in Ontario
LHINs

• Julia Abelson, PhD
• Centre for Health Economics and Policy Analysis
• McMaster University
• Presentation to the Change Foundation Symposium
• Community Engagement and the LHINs Truth
  Consequences
• Toronto, ON, March 11, 2009

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From Consultation to Engagement

• Public consultation
• One-way, top-down, one-way information flow
• Past experiences have produced cynicism and
  distrust
• Citizen/public/community engagement
• Two-way obligations, information sharing,
  trusting relationships
• Linked to deliberation and reason-based decisions
  
• Effort to correct past failures, re-establish
  trust between citizens and government officials

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(No Transcript)
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Role of LHINs (Part II, sec.5)

• To plan, fund and integrate the local health
  system to achieve the following
• Promote integration
• Plan and recommend allocation of resources in
  response to health services needs
• Engage community in planning and priority setting
  through formal channels of community input and
  consultation
• Establish processes for responding to concerns
  raised about health services
• Evaluate, monitor, report on and be accountable
  to Minister for local health system performance

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Community Engagement and LHINs (Part III, sec. 16)

• LHINs shall engage the community of diverse
  persons and entities involved with the health
  system on an ongoing basis, including about the
  integrated service plan and while setting
  priorities (Part III, 16.1)
• Community definition (Part III, 16.2a-c)
• Patients and other individuals
• Health service providers
• Employees involved in the local health system

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Methods of Engagement (Part III, 16.3.)

• The methods for carrying out community
  engagement may include holding community meetings
  or focus group meetings or establishing advisory
  committees
• Specific requirements for engaging with
• Aboriginal and First Nations
• French Language health planning groups in each
  LHIN
• Health professionals advisory committee

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Public/ Stakeholders
Government
LHINS
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LHINS
Government
Public/Stakeholders
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Supports for Community Engagement

• Choose carefully among CE goals and audiences for
  CE outputs
• Develop concepts of effective CE and measure it
  as rigorously as you can
• Determine your evaluation priorities
• Build and sustain CE capacity

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The Goals of Community Engagement

• Instrumental to inform (and potentially improve)
  decisions that are more reflective of
  patients/public needs and preferences
• instrumental objective of regionalization
• Developmental to inform, educate and build
  citizen capacity
• Procedural/democratic to legitimize decision
  making and to fulfill democratic accountability
  requirements

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Define effective CE and measure its achievement

• Convergence among academics, decision makers and
  the public about effective or successful CE
• Contextualize generic definitions
• Standardized approaches to evaluation across and
  within LHINs

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Example LHIN Common Assessment Tool Project

• Common LHIN-tailored evaluation framework and
  questionnaire developed using concept mapping
  methodology
• Determine how effective CE is understood across
  the LHINs
• Steps
• Brainstorming statements about effective CE
• Sorting and rating to determine relationships and
  importance
• Mapping to visually represent statements about
  effective CE and their relationships

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Point Map Generated from Sort Data of LHIN Staff
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Sample Cluster Solution
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Sample Cluster Solution
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Determine Evaluation Priorities (and link these
to CE goals)

• Process
• Clear communication of objectives, format and how
  input will be used
• Outcomes (How) does effective CE
• Health system knowledge
• Capacity for future public involvement
• Improved trust of fellow citizens, LHINs and
  health system
• Shape policy, decision making and political
  process
• Contribute to improved integration?
• Context also matters
• exerts fostering and inhibiting influences that
  contribute to more (and less) effective CE

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The Context of Public Participation (Abelson et
al. 2007)
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Building and Sustaining Capacity for Effective CE

• How do we facilitate effective CE in our
  organizations, communities and health systems?
• What capacity is required to carry this out?
• How is the practice of effective CE diffused
  within health systems?
• Can organizations learn it?
• What type of leadership required?
• Stay tuned
• Evaluating the Impacts of Public Engagement A
  Research-Practice Collaboration (Abelson et al.,
  CIHR, 2008)

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LHINS
Government
Public/Stakeholders
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Public/ Stakeholders
Government
LHINS