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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

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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.

A New Paradigm for Community Engagement

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.

From control and power to partnership and learning a new paradigm

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Engagement a strategic conversationFrom control and power to partnership and learning a new paradigm

Arnstein, Sherry R. "A Ladder of Citizen Participation," JAIP, Vol. 35, No. 4, July 1969, pp. 216-224

Sharing information

Searching for

perspective together

Deci

ding

to

geth

er

Acting together

Supporting

people

Com

mitm

ent

Feed

back Engagement a

strategic conversation

with the community to

facilitate learning,

change and commitment

From To

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Community Engagement Outcomes

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.

Project outcomes were developed from interviews with LHIN management and Task Group members

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The Framework for Community EngagementTABLE OF CONTENTS

The engagement frameworkDefinition, principles and expected outcomes.

How to use this frameworkFour steps initiation to tools.

Dynamic engagement processesBegin with a readiness assessment.

Dynamic engagement practices.Guidelines for choosing a practice.

Tools, tips and techniquesThe best web sites.

Champions of engagementSupporting human systems interveners

Engagement a strategic conversation

with the community to facilitate learning,

change and commitment

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.

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Definition of CommunityThroughout 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 PrinciplesEngagement 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

Community Engagement: definition and principles

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The Framework for Community Engagement

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

that any change or transition evokes a natural, emotional reaction, and

that people own what they help to create ,

Dynamic Engagement is an on-going strategic conversation

with the community that has the desired outcome of building

capability to contribute to the achievement of a sustainable

health care system.

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Community Engagement Framework | INTRODUCTION

To move from the current state to a new state requires a creative mix of practices and processes over time.

PracticesIn 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 thewhat 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.

A CURVE OF LEARNING AND CHANGE

The PracticesIn 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 ProcessesThe 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:

SponsorIndividual/group who legitimizes the engagement initiative and has the power to make it happen

Engagement agentIndividual/group who is responsible for implementing the engagement initiative .

What are the practices and processes involved ?

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The Engagement Curve - A Curve of Learning & Change

Building Relationships

Sharing Information

Search for Perspective

Deciding Together

Acting Together

Supporting People

Commitment & Feedback

NEW STATE

CURRENT STATE

Readiness Assessment

Awareness of Need

Collaborative Contract

Understand the Change

Positive Perception

Testing and Modifying

Commit to Action

PROCESSES informed by focused questions

Initiation1

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3

4

5

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PRACTICES

TIME

LE

VE

L O

F C

OM

MIT

ME

NT

FO

R T

HE

CH

AN

GE

Adapted from ODR

Leading at the Edge of Chaos

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How to use this framework

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

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The Engagement Curve - an Overview

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.

INITIATION

A. SHARING INFORMATION

B. SEARCH FOR PERSPECTIVE

C. DECIDING TOGETHER

D. ACTING TOGETHER

E. SUPPORTING PEOPLE

F. COMMITMENT AND FEEDBACK

DETERMINE PRACTICES

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

EXECUTE PROCESSES

CU

RR

EN

TS

tate

NE

WS

tate

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.

SELECT TOOLS & TECHNIQUES

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Community Engagement Curve | INITIATION

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.

1. INITIATION

What does your organization want to achieve the desired 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?

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)

clarify the scope of the Engagement Initiative

Building Relationships

Sharing Information

Searching for Perspective

Readiness

Awareness of Need

PROCESSES

PRACTICESCURRENT STATE

Initiation

NB: A series of implementation questions have been developed for each process the following two slides are examples for the reader