1 Community Engagement: A Process of Learning and Change Critical Questions For A Successful Engagement Outcome March, 2009 Prepared for the CENTRAL LOCAL HEALTH INTEGRATION NETWORK
A New Paradigm for Community Engagement 2 From control and power to partnership and learning a new paradigm Assessing the Impacts of Public Participation: Concepts, Evidence and Policy Implications» there is no empirical evidence that the current mechanisms to enhance citizen participation, accountability and responsiveness are likely to be effective. Canada s health care system is undergoing a transformation. Community engagement is a foundational tool in this effort towards sustainability. But there are challenges some of which include: the need for a common and comprehensive language to describe our intentions around engagement, the need to shift the prevailing perception of community engagement from one of power distribution to collaboration, and the need to build capability in health service provider organizations to see engagement as a tool of community and organizational development.
Engagement a strategic conversation 3 From control and power to partnership and learning a new paradigm From To Sharing information Supporting people Commitment Feedback Engagement a strategic conversation with the community to facilitate learning, change and commitment Searching for perspective together Deciding together Arnstein, Sherry R. "A Ladder of Citizen Participation," JAIP, Vol. 35, No. 4, July 1969, pp. 216-224 Acting together
Community Engagement Outcomes 4 Project outcomes were developed from interviews with LHIN management and Task Group members 1. To inform decision-making respecting engagement practices for Health Service Providers; 2. To create a common language that will facilitate strategic dialogue amongst provider communities; 3. To build community capability for collective and individual self-responsibility for healthcare; and 4. To contribute to the future sustainability of the health care system by creating more opportunities for engagement in health system transformation.
The Framework for Community Engagement 5 TABLE OF CONTENTS The engagement framework Definition, principles and expected outcomes. Engagement a strategic conversation with the community to facilitate learning, change and commitment How to use this framework Four steps initiation to tools. Dynamic engagement processes Begin with a readiness assessment. Dynamic engagement practices. Guidelines for choosing a practice. This framework is a decision-making tool that health service providers (hospitals and community organizations) can employ in developing and executing community engagement programmes. The framework positions community engagement as a practice of learning and change. It suggests that difficult decisions can collaboratively be made when the community co-creates with each other and is guided by explicit processes that respect adult learning principles. Tools, tips and techniques The best web sites. Champions of engagement Supporting human systems interveners
6 Community Engagement: definition and principles Definition of Community Throughout this framework community means (a) patients and other individuals in the geographic area of the network, (b) health service providers and any other person or entity that provides services in or for the local health system, and (c) employees involved in the local health system. Engagement Framework Principles Engagement is about learning, change and commitment, not about power and control; Engagement must always be associated with an outcome or commitment Engagement, by its nature, is an interactive process Engagement is a connective process that is focused on building a relationship with the community ; Engagement is an adaptive, emerging process requiring organizational and leadership support
The Framework for Community Engagement 7 Dynamic Engagement is a process that is directed by four psychological realities: that engagement is an opportunity for learning and change by the community, that people, the community, do not fear change, they fear the unknown Dynamic Engagement is an ongoing strategic conversation with the community that has the desired outcome of building capability to contribute to the achievement of a sustainable health care system. that any change or transition evokes a natural, emotional reaction, and that people own what they help to create,
Community Engagement Framework INTRODUCTION 8 A CURVE OF LEARNING AND CHANGE What are the practices and processes involved? To move from the current state to a new state requires a creative mix of practices and processes over time. Practices In shifting to a new paradigm, the framework includes a change in the traditional thinking of engagement as a linear practices to a more systems, connective and holistic view of engagement. These practices might be considered the what of engagement, the end goal. Processes The processes reflect the how of engagement. They define over time a disciplined process that must each be competently and sequentially addressed for the engagement initiative to maintain a precarious balance on the engagement curve. The process is also interactive as additional understanding and awareness is developed. The Practices In addition to the Initiation of the engagement initiative there are six (6) practices. Each practice represents a stance or goal that the sponsoring organization has initially taken with respect to the engagement initiative. Each practice is a legitimate end, however, the practice or stance may change as more information is revealed. The Processes The processes are structured along a curve of engagement. The process reflect three elements:1) change management experience, 2) a process consulting approach and 3) the questions associated with each process are built around the factors that are commonly seen in the development of an effective learning environment. The slope of the curve is important. Too steep a slope and you risk falling off the curve; too much dip and you risk compliance; too flat and complacency sets in. Some definitions: Sponsor Individual/group who legitimizes the engagement initiative and has the power to make it happen Engagement agent Individual/group who is responsible for implementing the engagement initiative.
The Engagement Curve - A Curve of Learning & Change 9 NEW STATE LEVEL OF COMMITMENT FOR THE CHANGE PROCESSES informed by focused questions Awareness of Need Understand the Change Collaborative Contract Testing and Modifying Positive Perception Commit to Action PRACTICES 6 5 4 3 2 Commitment & Feedback Supporting People Acting Together Deciding Together Search for Perspective Building Relationships Readiness Assessment Initiation 1 Sharing Information CURRENT STATE TIME Adapted from ODR Leading at the Edge of Chaos
How to use this framework 10 STEP ONE : INITIATION Sponsoring Organizations must go through an INITIATION process to review of the scope of the engagement initiative. See COMMUNITY ENGAGEMENT INITIATION STEP TWO : DETERMINE ENGAGEMENT PRACTICE Sponsoring Organizations must make a choice on the ENGAGEMENT PRACTICE they wish to initiate. See GUIDELINES FOR CHOOSING AND ENGAGEMENT PRACTICE STEP THREE : EXECUTE ENGAGEMENT PROCESS Sponsoring Organizations must address a series of questions for each ENGAGEMENT PROCESS to the extent of the engagement practice they have determined above. The Engagement Process questions can be supported by a variety of Tools and Techniques. Remind yourself of the definition of community and the practice of Engagement. STEP FOUR : SELECT EFFECTIVE TOOLS In the selection of tools, tips and techniques for community engagement, there are best practices that can be applied to comparable situations. However, all engagement is situational. The level of confidence and capacity in the engaged population is different; the environmental conditions which influence the population are different; the history of the system within which engagement is initiated is different. Examples of tools and techniques are provided
The Engagement Curve - an Overview 11 CURRENT State INITIATION 1. INITIATION is the point at which something triggers the need to engage the community, and you start to think what that involves. This will be largely influenced by the engagement requirement, strategic planning, HAPS, type of integration such as volunteer, facilitated or required and other considerations such as those associated with health equity issues, access, etc. DETERMINE PRACTICES A. SHARING INFORMATION B. SEARCH FOR PERSPECTIVE C. DECIDING TOGETHER D. ACTING TOGETHER E. SUPPORTING PEOPLE F. COMMITMENT AND FEEDBACK EXECUTE PROCESSES 2. READINESS 3. BUILDING RELATIONSHIPS WITH THE COMMUNITY 4. AWARENESS OF THE NEED FOR CHANGE 5. COLLABORATIVE CONTRACT 6. CREATING THE CHANGE REQUIRED 7. POSITIVE PERCEPTION OF THE AGREED TO CHANGE 8. TESTING AND MODIFYING THE CHANGE 9. COMMIT TO ACTION SELECT TOOLS & TECHNIQUES The operating phrase in the selection and application of tools is: it depends. There are literally hundreds of tools, tips and techniques that are relevant to community engagement; and because community is defined inclusively in the Act to include patients, the public, providers and employees, the range of tools increases dramatically. It does so because the scope of engagement, from sharing information to supporting people; and the broad nature of the community being engaged begins to move into the fields of community and organizational development. NEW State
Community Engagement Curve INITIATION 12 1. INITIATION clarify the scope of the Engagement Initiative Initiation is the point at which something triggers the need to engage the community, and the sponsoring organization begins to think what that involves. This will be largely influenced by the engagement requirement, strategic planning, HAPS, type of integration such as volunteer, facilitated or required and other considerations such as those associated with health equity issues, access, etc. NB: A series of implementation questions have been developed for each process the following two slides are examples for the reader PROCESSES Awareness of Need Searching for Perspective What does your organization want to achieve outcomes? What does your organization want to preserve? What does your organization want to avoid? What is most important in this initiative? What is most uncertain in this initiative? the desired Have you undertaken a stakeholder analysis to identify the community, key stakeholders and influencers? Who are the principal stakeholders in the community? Do the stakeholders control, influence or give input to the initiative? What are the perceived barriers to overcome? What is the principle engagement practice or stance the sponsoring organization is taking in managing this engagement initiative? (See Guidelines for Choosing an Engagement Practice) Building Relationships Initiation Readiness Sharing Information CURRENT STATE PRACTICES