This post continues a Croakey discussion about the new primary health care organisations to be known as Medicare Locals. It is responding to a request from GP Access, the trading name for the Hunter Urban Division of General Practice, about how they could engage consumers in their planned transformation into a Medicare Local.
Tony McBride, a consultant on consumer and community engagement and the Chair of the Australian Health Care Reform Alliance, has some practical advice for wanna-be PHCOs.
Tony McBride writes:
The actual directions of post election health reform are still wrapped somewhat in the mists of the New World Order that is now Federal politics.
However, GP Access’s bold move to work out how it should actively engage with its community sparks both optimism and anxieties. It should be congratulated both for wanting to actively engage the community, and also immediately putting policy into practice by asking them how to do it. Fantastic.
For the sake of this post, I will put aside my significant anxieties about the diversity of roles expected of PHCOs and offer some humble suggestions that might be useful in enhancing this approach. But first let’s consider some context.
Consumers of health service and community members can be engaged at several levels:
- at individual level about their own care
- at service level (giving feedback or sitting on a quality improvement committee)
- at organisational level (e.g. Consumer Advisory Committee or on Root Cause Analysis Teams or staff selection panel)
- at community/regional/state level (e.g. on the PHCO Board, or statewide advanced care planning policy committee).
Not all consumers will want to be involved at all these levels – in fact most will only be interested in commenting on either services they use or on the broad principles around which services should be organised (eg equity of access). So the roles of PHCOs are probably not keeping many consumers awake at night, yet they are crucial to future reform.
However, this doesn’t mean that consumer and community input is not still worthwhile including – far from it. It does mean being realistic about who might be involved in complex policy debate at this stage of consumer participation in Australia.
So the trick it seems to me is to structure engagement around these factors, including the following (and Hunter might well already be thinking of these). PHCOs need to:
- build own capacity, policy and skills to engage with communities (ie don’t undertake in an amateurish or poorly conceived way – will the PHCOS seriously consider all input and act on at least some of it? – otherwise engagement will just waste consumers’ time)
- ensure there are consumers/community members already involved in current committees
- engage around as concrete as possible issues (given PHCOs probably not easily understood) and provide good easy-to-read information to consumers & communities to consumers to respond to, ensuring it is focussed only on feasible options for change
- engage community or consumer groups strategically, not on everything all the time and where they have capacity to respond
- use results of other processes (eg Conversations with Australians at www.healthreform.org.au or consultations, engagement by local community health service or council) so don’t seek what already known
- communicate and build relationships more broadly so other organisations and communities are aware of PHCOs and will want to get engaged when an issue of relevance to them arises
- engage with existing community structures (eg like local Council’s existing Citizen Panel such as Newcastle Voice and via health services) as well as consumer / community organisations where possible but occasionally (and probably later on and around very focussed issues) go direct to the consumers or citizens (eg via discussion groups, focus groups, surveys etc)
- start small, build on successes and don’t aim for perfect participation (probably impossible), just better involvement than last time.
Previous posts in this discussion: