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10 Top Tips for smart engagement

10 Top Tips for smart engagement

Insight: engagement
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First the bad news: Despite the rhetoric of ‘nothing about me without me’, organisational approaches to involve people seldom move beyond tokenistic consultations, questionnaires, one-off projects or overly-bureaucratic structures with a seat for a tame public representative. The engagement industry gathers data through an endless variety of specialist techniques but often avoids using that intelligence to improve services.

The good news is that the best CCGs are engaging with patients and the public to inform commissioning decisions. And, with CCG authorisation looming, the rest now have to. But some clinical commissioners still wonder why they should do it. They think they know what’s best for ‘their’ patients, or are unconvinced of the benefits of Patient and Public Engagement (PPE). Others want practical ‘how to’ advice. These ten top tips can help CCGs towards, but more importantly beyond authorisation: To ensure engagement is part of everyday business.

1. Get clear on the benefits
When used as part of the authorisation and establishment process, PPE can help
•    Develop responsive governance processes and engagement strategies.
•    Capture solid intelligence and develop trusting dialogue with local people.
•    Align approaches to achieving improvements in quality, innovation, productivity and prevention (QIPP).

It can also create a ‘social return on investment’ (SROI) which is about outcomes that achieve social benefits. Developing reputation is also valuable in tough times when scrutiny from local authorities, the community and media is intense. Trust is paramount. How commissioners learn from and respond to complaints will be an acid test. Evidence shows significant cost savings and enhanced reputation are achieved from engaging with dissatisfied individuals locally and quickly.

Good engagement can make the CCG’s ‘journey’ clearer – the community and stakeholders must want to come with you on the same journey, especially when tough decisions and service changes need to be made.

2. Develop shared understanding of what engagement means
The engagement cycle is a strategic tool that helps commissioners understand who needs to do what, in order to engage communities, patients and the public at each stage of commissioning. It helps develop a shared understanding of what good engagement looks like and its different purposes and benefits. The engagement cycle identifies five stages when patients and the public can and should be engaged in commissioning decisions:
•    Community engagement to identify needs and aspirations.
•    Public engagement to develop priorities, strategies and plans.
•    Patient and carer engagement to improve services.
•    Patient, carer and public engagement to procure services.
•    Patient and carer engagement to monitor services.
At each of these five stages, there may be particular data to capture and use, and activities to undertake. Each stage of the cycle provides useful intelligence for the next (like a baton being passed on from one stage to another).  

3. Develop an engagement strategy
The authorisation process will scrutinise the CCG’s engagement strategy. The engagement cycle is one way of developing such a strategy – chapters might parallel the cycle’s five stages (and include the ten top tips sections). It can be used at board level and with different stakeholders in order to develop senior commitment to engagement and the principles underpinning a vision, strategy and plans.

4. Think through cultures and systems
A strategy is more than a piece of paper or pretty diagram. Hard-wiring engagement means monitoring and performance management - what difference does engagement make? Nothing will happen without investment (money, time, energy). Staff and patients require practical support to be involved. Other strategies and plans have to link with engagement (eg. organisational development, leadership support, QIPP activities, communication plans) and be developed in tandem.

5. Embed PPE into governance arrangements
CCG constitutions and governance arrangements should have reference to, and align with, good PPE principles. The CCG’s business focus is improvement of health, health services and good engagement. The lay member is crucial, but the board has a collective duty for engagement and should not leave it to one person. The CCG lay member is one type of representative. All representatives are ‘outsiders-inside’ - coming from the community with a patient/user perspective (‘outside’) to try to influence the system (‘inside’). It requires them to be:
•    A community channel – externally facing, credible, in touch with local communities and bringing in wider perspectives.
•    A critical friend – internally facing, flying the patient flag, offering strategic advice from a non-institutional perspective.
There should be a standing PPE item on the board agenda. The board requires processes to ensure that outcomes from PPE are used to provide an insight (into current services) and foresight (for strategic planning).

6. Be clear on who needs to do what (and when)
There needs to be central co-ordination of engagement and mechanisms by which data can be fed in from (and fed back to) local stakeholders. It is important that engagement activities developed in each stage of the engagement cycle are developed so that outcomes from each stage are fed into the next one - so that the ‘baton’ is not dropped.Roles and responsibilities at strategic and operational level need to be clear. These include specifying PPE roles for the Chief Operating Officer, clinical lead for PPE, lay members, engagement practitioners and those providing commissioning support.

7. Develop trusting relationships
Commissioners should develop dialogue with local patient and community organisations and patient leaders. They need to ‘walk the talk’ and be able to explain clearly what they are doing. Partnership roles should be thought through, for example, how to coordinate PPE work with the Health and Wellbeing Board, Overview and Scrutiny Boards, LINk and HealthWatch.   

8. Capture the right data
An audit of engagement activities should be undertaken that records:
•    What outcomes do you have access to (eg. from quantitative or qualitative approaches) that provides a picture of what matters to patients and the public.
•    What processes are there that generate useful information?
•    What mechanisms can you tap into to find additional information? For example, partnership boards, project groups, patient and community organisations, etc.
The data obtained can be coded and mapped onto the relevant authorisation domains and provide evidence for the authorisation process.

9. Develop ‘fit for purpose’ structures
It is tempting to automatically set up new patient and public reference groups and formal PPE mechanisms. But existing mechanisms may just need tweaking. The crucial thing is ‘function before form’ – what is the purpose of a group? Should it gather data, co-ordinate activities, or serve as a sounding board for plans? And how will it connect to decision-making?

10. Build capacity for shared leadership
It is important to remember who needs skills in this area:
•    Board members, senior leaders, staff and all health professionals require learning and support to be able to work with patients and the public.
•    Providing learning and support for patients and the public is crucial.

There are many sorts of patient leaders who need opportunities to build capacity to engage in dialogue, be effective and build trusting relationships.
Building leadership capacity underpins the decision-making process. Patient leadership is an undervalued asset in commissioning. Clinical engagement divorced from PPE-led change is not sufficient.

Patient leaders can be critical friends whose constructive challenge and community enablement helps the CCG lead the case for change.

David Gilbert, Director, InHealth Associates, Co-Director, Centre for Patient Leadership

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