Acute hospital service reviews are being undertaken throughout the country with the aim of delivering significant improvements to quality of care, patient safety and efficiency. This, along with more sustainable workforce and infrastructure, should be seen as positive by patients and service users. However, it is clear from some high-profile recent examples that there can be a mistrust of motives or methods both from the public and from some wider staff groups.
Attain have led a number of clinical service reviews and public consultations on major service change. In this article, we explore some key factors for a successful public engagement/consultation process, based on our experience.
Four critical success factors for engaging patients and the public
We have identified four key factors that are vital to effective public engagement and consultation for acute service change. These are:
- It’s not just about the decision
- The case for change must be compelling and comprehensive
- Feedback is critical
- It requires specialist skills and knowledge
It’s not just about the decision
We often focus our communication and engagement efforts around the outcome of a review, or the big changes that we want to make. However, as public sector organisations we have a statutory obligation to involve stakeholders, patients and the public in the development of options for major service reconfiguration as well as to consult on the final decision. Failure to do this could result in a Judicial Review application which even if not successful would add significant delay to the process. A judicial review can be applied for on the basis of failure to follow due process – not a dislike of the decision made.
It isn’t possible to prevent a judicial review application; however it is possible to minimise the likelihood of the application being upheld.
This brings a different dimension to our public engagement exercises and means we must involve the public much earlier in the process. It also supports a very clear divide between “current state” activities and the “future state / decision making process” so we can demonstrate that we have listened to patient and public views and ideas all the way through.
A number of hospital reviews have had negative national media coverage with perceptions of decisions being a “done deal,” with lists of options or ideas being shared too early in the process. It’s important to give people the chance to understand and buy-in to the case for change and then contribute to the ideas and options being developed and considered, or the result is suspicion and mistrust which is hard to undo.
Do not share future state ideas or discuss options until you have engaged with patients and the public in the case for change. Separate out the current state review work from future state options development so you can ensure genuine engagement on the case for change and idea generation before moving to consider solutions.
The case for change must be compelling and comprehensive
It sounds obvious, but before you can “sell” a new idea or service model to the public there must be a clear rationale for why change is necessary. The public can be suspicious of NHS reconfiguration and several pressure groups / campaigns have been formed to challenge rationalisation of services. Often the key concern is about prioritisation of cost savings over quality of care and geographical access.
The case for change can mean different things to different people, so it is helpful to include a range of drivers such as safety, quality, workforce sustainability, changing health and care needs and use of resources. A balanced case for change can be more compelling as it shows that “do nothing” is not an option. If you allow patients and the public to be part of the development of the case for change you can include issues raised by them, which can add weight to the need to do things differently.
Many people are relatively pragmatic about financial drivers for change and recognise that there is a finite resource. However, the overriding emphasis from the many focus groups we have run is that people want to be assured that due regard for safety and quality will be front and central to any proposed changes.
There are two key tips we would recommend for developing and sharing a compelling case for change:
1 Include patient stories
Stories can highlight problems with the current service using real experiences that people can relate to. This could show an entire treatment pathway with delays, multiple appointments/visits and other issues which can provide an excellent introduction to conversations with service users about what they would like to change about the service.
We have used case studies of real patient stories with quotes and pictures where consent is given.
Consider asking a real patient to come and tell their story in person!
2 Invite clinicians to present
The rationale for change from the perspective of a clinician can be very powerful either as part of a focus group or engagement process. Having a Doctor explain that there is a national shortage of Doctors can demonstrate that even with more money the problem might not be fixed! This drives a different conversation about working differently to deliver a sustainable service.
Clinicians can present live in person or develop a video to share on a website or show at meetings.
We would not recommend hosting an engagement event without a clinician present – often patients and the public can associate managers with financial focus.
Always involve clinicians in presenting the case for change. Use a range of different drivers to show that “doing nothing” isn’t an option. Use patient stories to highlight the problems with the current service.
Feedback is critical
It’s tempting to think that we know what patients and the public want from services, however time and time again when we undertake meaningful and sincere engagement we find the key issues are not quite what we expected them to be. Often we focus on quality and safety, but numerous studies have shown that many patients take that for granted and focus on other areas such as experience of care, location of services and car parking!
We must be open to positive and negative feedback on services and use that to build our compelling case for change. A number of change management theories state that if no negative feedback is received then you will miss some critical piece of information or idea.
Sometimes patients will surprise us by highlighting unexpected issues that help to frame our transformation and redesign focus – in areas that we would never have recognised without that input. One example we often refer to is the need for more toilets in an endoscopy unit instead of additional beds or scoping equipment as expected by the clinical team.
There are a number of excellent frameworks and methodologies that help us to get “under the skin” of patient experience, and these can be helpful. The simplest and easiest is a focus group allowing people to talk about their experiences.
Local patient involvement groups, Healthwatch and clinical support groups can offer significant expertise in hosting engagement meetings, undertaking interviews and supporting a public engagement exercise. Sometimes patients feel more comfortable talking to independent and external people about any negative experiences.
Don’t try to predict what matters to patients and the public. Work with local Healthwatch and support groups to undertake a meaningful engagement exercise and allow patients and the public to help form a compelling case for change.
It requires specialist skills and knowledge
Whilst effective communication and engagement is definitely “everybody’s business” there is a very specialist level of expertise and skill offered by communication and engagement specialists. Most organisations have dedicated communications or engagement expertise, and many systems or STPs have networks of communication and engagement teams. Developing public facing documentation, writing -in “plain English” supporting the development of “easy read” documentation and working with local voluntary engagement groups can be invaluable, not to mention offering specialist advice around the statutory obligations around engagement and public consultation.
The temptation can be to contact communications teams when we feel there is “something to communicate” however we would recommend involving them early in the process to advise on engagement methods from the outset. This can help to ensure all the statutory obligations are met, and that you maximise the benefits of involving patients and public in the development of the case for change and future options.
Involve local communications and engagement specialists at the outset to advise on the best methods for engaging with patients and the public. They will advise on the statutory obligations as well as support you in communicating sensitive issues in the most effective and understandable way.