Health 2.0: how community engagement can transform healthcare
The health sector is at the very beginning of experimenting with community engagement. In many respects, it’s at the start of a journey that local government has been on for many years.
In September 2012, the Australian Commission on Safety and Quality in Health Care (ACSQHC) published the National Safety and Quality Health Service (NSQHS) Standards. This might not sound like big news but, believe me, for reasons I will detail below, it opens up a world of new opportunities for how community engagement can transform healthcare services and patient support.
What are the Australian NSQHS Standards?
The NSQHS Standards were developed by the NSQHS in consultation and collaboration with the Australian state-based health agencies, technical experts and a wide range of stakeholders, including health professionals and patients. The Standards have been designed for use by all health services and can be used as part of their internal quality assurance mechanisms or as part of an external accreditation process.
In the introduction to the Standard, it states:
The primary aims of the NSQHS Standards are to protect the public from harm and to improve the quality of health service provision. They provide a quality assurance mechanism that tests whether relevant systems are in place to ensure minimum standards of safety and quality are met, and a quality improvement mechanism that allows health services to realise aspirational or developmental goals.
What do the NSQHS Standards have to do with community engagement?
It’s all about Standard 2: Partnering with Consumers.
The Standard states:
Leaders of a health service organisation implement systems to support partnering with patients, carers and other consumers to improve the safety and quality of care.
Patients, carers, consumers, clinicians and other members of the workforce use the systems for partnering with consumers.
While the focus on “co-design” of places and services has been around for many years outside of the health sector, its explicit recognition here is relatively new and has the potential to drive massive cultural and behavior change.
Critically, the authors note that Standards #1 (Governance) and #2 (Partnering with Consumers) “set the overarching requirements for effective implementation of the remaining eight Standards, which address specific clinical areas of patient care.”
It’s worth saying that again. Consumer “partnering” is judged by the authors to be one of two fundamental preconditions for the effective delivery of health services.
And yet, most (although not all) health professionals have barely thought about partnering and engagement in the past.
What are the benefits of engaging health consumers?
According to the authors, there’s a growing body of evidence about the importance of partnerships between health service organisations and health professionals, and patients, families, carers and consumers.
Studies have demonstrated significant benefits from such partnerships in clinical quality and outcomes, the experience of care, and the business and operations of delivering care. The clinical benefits that have been identified as being associated with better patient experience and patient-centred care include:
- decreased mortality
- decreased readmission rates
- decreased rates of healthcare acquired infections
- reduced length of stay
- improved adherence to treatment regimens
- improved functional status.
Operational benefits that have been identified include lower costs per case, improved liability claims experiences, and increased workforce satisfaction and retention rates.
How is consumer partnering defined and measured?
The authors have defined three key criteria that service providers must achieve in order to meet the “consumer partnering” standard.
1. Consumer partnership in service planning
Governance structures are in place to form partnerships with consumers and/or carers.
2. Consumer partnership in designing care
Consumers and/or carers are supported by the health service organisation to actively participate in the improvement of the patient experience and patient health outcomes.
3. Consumer partnership in service measurement and evaluation
Consumers and/or carers receive information on the health service organisation’s performance and contribute to the ongoing monitoring, measurement and evaluation of performance for continuous quality improvement.
What does ‘partnering with consumers’ mean in practical terms?
Of course, the rubber hits the road at the point of implementation. The Standard’s authors have identified a number of strategies and actions that are required to meet each of the Standards. To be honest, this is where the Standards are weakest (in this iteration) in terms of their comprehension of the concepts, spirit and practicalities of leading practice partnership and engagement.
Consumer partnership in health service planning
Within consumer partnership in the health services planning process, there are four areas of focus and seven action items.
There is a strong focus on diverse consumer involvement in “governance structures”.
There a three area of particular opportunity for engagement practitioners:
- Strategic Planning: Pleasingly there is an explicit note of the need for mechanisms for engaging consumers and/or carers in… strategic and/or operation planning.
- Safety & Quality Standards: There is also a call for the same stakeholders to by involved in decision-making about safety and quality.
- Information Resources: There is a lower standard of engagement here, with the requirement for a mechanism for feedback (only) on health publications. This could be strengthened significantly.
There is no guidance on what these mechanisms might look like. The opportunity, therefore, is for the implementation of some really interesting engagement practice in this space. The risk, of course, is a lowest common denominator approach.
The Royal Women’s Hospital in Melbourne took a codesign approach to developing Post-Natal Care information packages and is currently using EngagementHQ as part of its strategic planning process. It is also worth reading our case study on this project here.
Consumer partnership in designing health care
Within the consumer partnership in designing care outcome area there are two key success criteria focusing on; (1) partnering in the design and redesign of health services, and (2) training staff to appreciate the value of this co-design process.
This is good. There is no doubt that the “control and command” mentality, that is unfortunately all too common in the local government space, is well and truly embedded in the health sector. As a “patient” in the health system, the current model has a built in expectation that we will hand over any decision-making control to the system. There is no sense of partnership between the patient and the service providers.
Again, there is no “practice” advice about what bringing health consumers into service design process might look like. There is an opportunity for very deep engagement with BOTH consumers and health professionals here to drive more patient-centered outcomes.
Crohn’s and Colitis have taken this a step further in Canada by using EngagementHQ to provide an online space for peer to peer support for people living with Crohn’s disease or ulcerative colitis.
Consumer partnership in health service measurement and evaluation
Within the consumer partnership in service measurement and evaluation outcome area there are three success criteria focusing on; (1) accessible information, (2) participation in data analysis, and (3) participation in evaluating patient feedback.
There is significant opportunity here for transparency with patient stories about their personal experience with the health services provider. Many years ago, Bang the Table provided an online space for mothers to talk about their birthing experience in the hospital system. It revealed an incredible array of stories that would bring enormous value to the health care system as a whole and individual health service providers in particular.
The United Kingdom based not-for-profit, PATIENT STORIES, uses digital, broadcast and social media approaches to provoke debate about quality issues in healthcare. Imagine a world where individual health services providers provide a dedicated online space for patient feedback.
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