Leading Management and Organisation Development for the Health Services Whose Health Service is it Anyway?

Public and Patient Partnership in Healthcare: Outline of Discussion Paper Professor Hannah McGee Health Services Research Centre Department of Psychology Royal College of Surgeons in Ireland

Partnership: what is it? Promoting patient participation in own care Enabling patients to become informed about treatment & to make informed choices Involving patients & carers in improving service quality Involving the public as citizens in health service decision-making processes

Partnership: why? Crisis intervention Reforms/restructuring Safety & complaints systems Quality in healthcare movement Increased voice of patients & advocates

Partnership in Ireland NATIONAL HEALTH STRATEGY (2001) Goal No. 3: responsive & appropriate care delivery Objective 1: The patient is at the centre in the delivery of care Participation: one-to-one / care management / community involvement

Principles of Partnership I Rights-based approach Commitment to building trust Flexible & accessible communication process Motivation & commitment to partnership Flexibility & willingness to adapt Ethos of fairness & accountability

Principles of Partnership II Mutual co-operation & support Concern for process as well as outcome Commitment to delegate power equally Commitment to embedding partnership within & across health system structures Commitment to financial support

Evaluation framework for participation LEVELConsumerist Model Democratic Model Individual Dissemination of information Complaints procedures Consumer surveys Involving patients in own care Consumer- purchaser schemes Group Focus groups Active ‘work’ groups Patient particip- ation groups Board memb’ship Citizen’s juries Supporting advocacy groups Stakeholder meetings

Factors enabling/mitigating against participation ENABLERS Intrinsic respect Increased adherence Increased health responsibility Increased staff satisfaction Health Strategy (2002) BARRIERS Paternalism Fear of loss of control Inequity Time/other pressures Lack of staff support

Evaluation of partnership: key questions WHY?………aims, clarity of purpose HOW? …….right approach, clear roles, involvement in planning, use of feedback, timescales WHAT?……techniques, expectations met, appropriate information & views sought WHO?……..representatives, support given to participation

Participation: the three ‘Ps’ Purpose (what to achieve?)Purpose (what to achieve?) Process (how to do it?)Process (how to do it?) Personal integrity (‘keeping your word’)

Information needs for partnership Strategies for participation How to be effective as participant Making links with participants Integrating feedback into QI Role of consumer councils Why public input is important Patient satisfaction surveys Working with particularly excluded groups

Partnership Paper: key points Emphasis on process as much as outcome Role of quality in healthcare movements Dedicated structures (legislative, administrative & educational) & coordinating centres Explicitly identified partners Staff as partners

Partnership? Change is inevitable…… Change is inevitable……

Partnership? Change is inevitable…… Change is inevitable…… …..….except from slot machines……