learning lab - home - imperial college health partners · 2019-06-06 · source: ipsos mori...
TRANSCRIPT
Population Health
Learning Lab:
Citizen engagement and
co-design
Thursday 16 May
#PopHealthLab
Panel Speaker 1
Samira Ben OmarAssistant Director of Patient Experience and
Equalities North West London Collaboration of
CCGs
#PopHealthLab
Citizen Engagement and Co-design
1. Collaborative: Bringing people together as equal partners to develop a shared vision
2. Evidence-based & Person-Centred: Bringing
together grassroots community / patient insight and intelligence with national and international learning of ‘what works?’
3. Asset-based: Recognising the contribution that citizens, families and communities as part of a wider workforce in promoting and delivering health, care and wellbeing.
4. Continuous and iterative: Constantly reviewing, evaluating and testing out new ideas for improving health and reducing inequalities in health
Insight, Communication, Engagement, Co-design? ….what’s that about….?
Service
Question
Population
Health
Question
A different Type of Question and ConversationMaking Sense of an Integrated Care System
“Integrated care should be seen as a different way of thinking about planning and delivering care based on people – not buildings or organisations; based on outcomes – not procedures or activity”.
Listening to front line staff, communities, providers and partners across North West London
“In an integrated care system, NHS organisations, in partnership with local councils and others, take collective responsibility for managing resources, delivering NHS standards, and improving the health of the population they serve.”
Overview• 15 neighborhood projects in housing estates
• Collaboration between communities, health, housing, and PH
• Asset based community volunteer projects
• Focus on prevention
Approach• Designed by residents
• Local community mapping
• Extensive volunteer training
• Evaluate beneficiary outcomes
• Share successes/failures
• Annual conference
Key Findings• Resilience depends on motivation and action
• Social movement grows through connecting projects
• Communities do more when they decide for themselves
• Community centres and organisations are the lifeblood of community action
• Councils and CCGs listen to engaged residents
The Voices• Housing estate residents
• 75% unemployed
• 90% women
• Equal parts: no qualifications, school leaving, university
• Ethnicity reflects housing estate
The Action• Commissioned through community anchor organisations
• Regular neighborhood Health and Housing Partnership Groups
• Locally designed public health campaigns
• Over 3 years
o 80,000 people engaged
o 5000 weekly activity groups
Results• SROI- £1 : £5-£6
• For residents – reduced isolation, improved health, activity, wellbeing, social cohesion
• For champions – improved belonging, problem solving, wellbeing, employability
• For services – delayed/prevented care needs, sustained tenancies, better use of health services
• For governments – reduced benefits, increase taxes
COMMUNITY CHAMPIONS PROGRAMME: LOCAL VOICE INTO ACTION
www.communitychampionsuk.org.uk
So what have we learnt so far….?
Willing to shift from structured approach to
engagement and communication toward
investment in relationships and networks
Power belongs to the voices we hear and
not to our programmes and services, or
commissioners
Ethical accountability to ensure
interpretation, assumptions and copyright
and other ethical concerns are manage in an
open and transparent way
Ability to be system challengers and to
stimulate wider conversations that lead to
visible and sustainable change and positive
experiences at the front line and with local
communities
Build alliances across systems to share
learning, build capacity, networks and
connections
Wherever the challenges exist in a community / neighbourhood / areas, the solutions
unequivocally lie there too.
If we’re trying ‘to reach out to community’ then we as organisations and systems area already
too far removed.
established methods of engagement tend to play to organisational or service prescribed
agendas and thus fail to connect to the complex lives of communities
Communities do their own organising to survive and our static participation engagement
models could learn from observing how this takes place.
We know that participation and engagement that are not built around equality, coproduction
and collaboration will only serve the narrow interest of silo ways of working and delivering
services. Patients and communities don’t work in that way.
Our citizens and frontline staff demand holistic services and they are prepared to make that
happen by connecting people, resources and organisations in a way that systems are unable
to do; a great illustration of this Community Champions programme where local communities
at ward and neighbourhood level are able to demonstrate what an integrated and connected
care system looks like in practice but can also show evidence of positive impact in addressing
the wider population health challenges.
Approach that delivers ..Because Insight / Evidence so far tell us that…
Films Password: communityvoices
What Next… Opportunities to Collaborate…
@benomsam
KEEP SMILING
Panel Speaker 2
Anna QuigleyResearch Director at Ipsos MORI
#PopHealthLab
15
© 2016 Ipsos. All rights reserved. Contains Ipsos' Confidential and Proprietary information
and may not be disclosed or reproduced without the prior written consent of Ipsos.
15
Anna Quigley, Ipsos MORI
Citizen engagement and co-design
16
75%
9%
16%
1948
Good Neither Bad
87%
9%4%
2018
What is your main feeling about the National Health Service, that it is a good thing or a bad thing?
The context: 70 years on, the public still really value the NHS
Base: c. 1,000 adults 16+ in England 1948; 1,000 adults 16+ in England 2018Source: Gallup 1948 and Ipsos MORI 2018
Please note that data have been re-based to exclude ‘don’t know’ responses
17
5450
55 5660 60
66 6771
66
73 71
7772
7578 78 78
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
They are proud of the NHS and think it is one of the best in the
Base: c.1,000 adults aged 15+ per wave in England 2007-2016
Please tell me whether on the whole you agree or disagree with each of the following statements…
Britain’s National Health Service is one of the best in the world
world
Survey source: Ipsos MORI / DH Perceptions of the NHS Tracker
18
GET MUCH
BETTER
GET A LITTLE
BETTER
STAY THE
SAME
0
10
20
30
40
50
60
70
Mar-…
Sep…
Mar-…
Sep…
Mar-…
Sep…
Mar-…
Sep…
Mar-…
Sep…
Mar-…
Sep…
Mar-…
Sep…
Mar-…
Sep…
Mar-…
Sep…
Mar-…
Sep…
Mar-…
Sep…
Mar-…
Sep…
Mar-…
Sep…
Mar-…
Sep…
Mar-…
Sep…
Mar-…
Sep…
Mar-…
3%
19%
21%42%
12%
2%
Source: Ipsos MORI Political Monitor 2018
June 2018%
22%Better
Worse
54%
March 2002 - June 2018
Base: 1,026 British adults 18+ 22 – 27 June 2018.
GET A LITTLE
WORSE
GET MUCH
WORSE
DON’T
KNOW
But over half think it will get worse over the next few years
– although expectations are better than in 2017
Thinking about the NHS over the next few years do you expect it to..?
19
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
88% Agree
7% Disagree
Most people think the NHS will face a severe funding problem in
Base: Adults aged 16+ in England (c. 1000 per wave)
Source: Ipsos MORI / DH Perceptions of the NHS Tracker
Please tell me whether on the whole you agree or disagree with each of the following statements…
The NHS will face a severe funding problem in the future
the future
20
23%
77%
The NHS was a
great project but
we probably can’t
maintain it in its
current form
The NHS is crucial to British society
and we must do everything to
maintain it
Which of the following statements best reflects your thinking about
the NHS?
protect it
And they are still bought into the ideal of the NHS and are keen to
Survey source: The King’s Fund / Ipsos MORI 2017
Qualitative source: The King’s Fund / Ipsos MORI
It’s highly important to have it
there for generations to come;
it’s up there with the most
important things for the
government – it needs to be
sustained for the future.”
It’s a fundamental right to be
able to feel that peace of
mind… It should be a
fundamental right in any
modern society.”
Base: 1151 English adults aged 15+, 4-10 August 2017
21
% Yes % No
14
86
%
Few have heard of their area’s STP
Source: Ipsos MORI
Q2. The NHS is looking at different ways of working to improve health and the quality of care, while also saving money to meet financial budgets. Each local area has written a five-year
plan called a Sustainability and Transformation Plan (STP). Have you heard of a Sustainability and Transformation Plan (STP) for your area?
86%of the public have not heard of their area’s Sustainability and Transformation Plan
Base: All (943 English adults aged 16-75, online).
22
29%
56%
14%
1%
Decisions about which NHS treatments and services are available should be made solely by qualified health professionals and not the general public
The public should be consulted on decisions shaping which NHS treatments and services should be available but the final decisions should be made by qualified
health professionals
The general public should be much more actively involved in shaping which NHS treatments and services are available, e.g. deciding local priorities and allocating
budgets
20%
54%
20%
5%
And thinking of how decisions about treatments and services should be made, which of these statements most closely matches your opinion?
Base 2017 1151 English adults ages 15+, 4-10 August 2017
Base 2008: 988 English adults aged 18+ November 2008
Source Ipsos MORI / King’s Fund
Source: Ipsos MORI / Social Market Foundation
2017 2008
but are more open to HCPs making decisions than previously
They think they should be consulted on decisions about the NHS
23
When asked about how, nearly 9 million people want more of a say
Base: 1,896 GB adults, 18+. Sept 2008.
Q Levels of involvement/interest in involvement in local services
Just want information47%
24%
16%
Already involved (4%)
Want active involvement (5%)
Want more of a say
Don’t care
1.5m people
And 7.2m people
Source: Ipsos MORI
24
Different models of listening and involving
Research Consultation Engagement
• Less formal ‘rules’
• Open access
• ‘Local vocals’
• Often biased
• Often one-off
• Formal ‘rules’
• A sample – by
invitation only
• People you don’t
hear from
• Representative
• Often one-off
• Less formal ‘rules’
• Open access
• Local activists but
also wider
community
• Depends
• Ongoing
25
Dimension 1: how many are you involving?
Individual Population
26
Dimension 2: how representative are they?
Open access
Have an interestInvited
Representative
27
A map of engagement techniques
Population
Open access
Have an interest
Invited
Representative
Focus
Groups
Deliberative
workshops
Surveys
Census
Individual
Panels
Peer
research
Online
consultation
Patient Groups
Public
meetings
Patient interviews
Members
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Key points to consider
▪ The public care deeply about the NHS and worry about it – goodwill
to be harnessed
▪ They have limited knowledge of reforms and structures (and don’t
care about them)
▪ But they do want to be involved (to varying extents)
▪ Be clear about the purpose of engagement
▪ Who do you need to hear from and how many?
▪ Surveys have their place within a suite of tools – understanding
population priorities/concerns
Panel Speaker 3
Rich StockleyHead of Research and Engagement at Surrey
Heartlands Health and Care Partnership
#PopHealthLab
The Engagement Spectrum
People understand usWe understand peopleSocial research Communications
Co
nsu
ltation
“I’m involved in delivering a service and I need to know how to get people to use it”
“I’m planning a new service and I need to know how to people might use it so I can make it effective”
1. “I want to set up a new service or change an existing one which I want to co-produce with users”
2. “I undertake robust research and co-design so I can build in users’ experience to my design”
4. “I make changes to the service based on the experiential that I have gathered”
3. “I analyse the data thoroughly to ensure that my findings reflect users’ experience”
5. “I consult with stakeholders on the new service / changes to the service”
6. “I make changes based on the consultation results or I respond explaining why I have decided not to make changes ”
7. “I use evidence from my research an co-design to design a effective communications campaign that I know will resonate with the audience”
8. “I officially launch the service and communicate with the population about it”
4
6
5
3
How Surrey Heartlands used citizen and workforce engagement to co-design services : Planned Care PrinciplesDesk research was conducted over 6 weeks and focussed on international health serviceredesigns in the United States and New Zealand, as well as the work of some of SurreyHeartland’s neighbours – namely South East London, South West London, and NorthCentral London HCPs. National initiatives, such as as NHS RightCare, Map of Medicine, andthe ‘House of Care’ care model, were also examined. The desk research identified thatconsistent pathways are needed so that all patients receive the same quality of care,patients’ health and social care needed should be managed within the community enablingthem to stay at home, and patients should be involved in decision making around theirconditions and educated to make the best choices for their health.
Co-DesignIn October 2018, the Planned Care World Café co-design event was attended by approximately 70delegates, including citizens, carers, clinicians,commissioners, local authority colleagues andcommunity & hospital staff. Participants were dividedinto groups and asked to move between five-facilitated tables representing a different stage of aPlanned Care pathway. The groups discussed thebuilding blocks for the relevant stage of the pathwaybefore prioritising the related planned care principlesinto order of importance. Groups were also asked tothink of any additional principles. From the discussionsat the five-facilitated tables at the world café eventand the results of votes on the highest priorityprinciples, a set of overarching themes were identified.
Knowledge MobilisationThe intelligence gathered from the desk research andprimary qualitative research was fed back to thePlanned Care Programme Board. Phase One of theresearch established five different stages of a basicplanned care pathway model and the building blocksthat contribute to each stage. From the building blocksan initial set of planned care principles were created.The research findings were transformed into aframework for the next phase of the project, to co-design what the ‘building blocks’ to a best practiceplanned care pathway should be and what principleseveryone should work to.
The Planned Care Citizen Ambassadorfed into the discussion guide for thequalitative interviews and alsoattended the World Café session. Theyprovided us with a citizen’s perspectivebefore we went into field.
1
2
Knowledge MobilisationUsing the desktop and qualitative research, and the findings from the world café session, a set of nine keyPrinciples were endorsed in April 2019 to be used across any Planned Care service in Surrey HeartlandsHCP. A best practice pathway was also developed, representing an ideal high level Planned Care journeyfor citizens. The pathway includes a set of building blocks to guide the services to bring about the bestpossible outcomes across the local population.
The Principles will be communicated across Surrey Heartlands until the end of June 2019. To date,references to the Principles have already started at system-wide meetings and events including at a recentAcademy-led outpatients event and at the Planned Care Clinical Forum. Discussions are also taking placewith change and improvement leads in acute hospitals and further communication is taking place toembed the Principles at the heart of the work we are carrying out.
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7
The Citizen Panel was used to recruitcitizens for the World Café Session. Byrecruiting from the panel we wereaiming for representative engagement.
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Primary research
In parallel with the desk research, the SHHCP researchteam commissioned 27 qualitative interviews withclinicians, managers, commissioners, citizens andcarers to get an understanding of what a good plannedcare pathway looked like from their perspective and tostart designing principles which would benefit thepatient.
Foundation ResearchA system refresh of Surrey Heartlands HCP prioritiesshowed that there were multiple opportunities toimprove Planned (elective) Care pathways across thepartnership to reduce unwarranted variation inhealthcare and achieve consistent clinical pathways.Desktop research with KSSAHSN and King’s Fund libraryhad revealed that nationally there is no agreement onwhat a ‘good’ Planned Care pathway looks like. Thoughthere was evidence and research to show specificelements of pathways, such as links with social care andreferral management, nothing covered the wholePlanned Care pathway across an integrated system.Agreeing a generic good practice Planned Care pathwaywas therefore the primary aim of this project in order toinform the redesign of care pathways.
In July 2018, the Planned Care workstream expressed aninterest in gathering information on whether a genericplanned care pathway had been mapped out by anyoneinternationally and whether other healthcare providerswere using best practice guidelines for Planned Carepathways. In addition, it was unknown whether therehad been any studies into what are the key componentsto a Planned Care pathway which have a positive impacton the patient journey.
It doesn’t appear he knew what I meant
by ‘just a tidy up please’
Just a little off the top
I knew I should have gone to Tony and Guy
linkedin.com/in/richstockley
@TheNakedCitizen
Questions?
