Community Driven Planning, Priority Setting and Governance

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Speaking Notes: Community Driven Planning, Priority Setting

and Governance

Ontario Hospital Association ConferenceCommunity Engagement in a LHINs EnvironmentJune 26, 2006

Bob Gardner, PhDDirector, Public Policy


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Starting Points

• Community engagement is here to stay– it is mandated for the LHINs– the current Minister and government is very serious about it– community engagement is going to be a critical success factor in all

facets of health care reform• What community engagement really means and how to ensure it

really works are going to be crucial challenges of the coming years


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Building on a Good Start

• The LHINs have made a good start in community engagement• The challenge is how to build on this start:

– how to sustain community involvement and enthusiasm– how to ensure that the full diversity of community needs and

perspectives is included– how to permanently embed community involvement in LHINs planning

processes and work culture• The focus of this talk is on how this challenge can be met


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Community Ownership

• Which community? Who owns what?

• Need to differentiate different organizations and components of ‘the community’ – who can have very different perspectives, priorities and needs

• 1. the dense web of agencies and groups that deliver services outside of institutional settings in neighborhoods and communities:

– each with specific organizational needs for funding and sustainability– many of these agencies are self-organized into networks and

partnerships– these networks are a tremendous building block for the LHINs– one element of the good start has been working with these existing

networks and partnerships


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Diverse and Complex Communities

• 2. community-based can mean more than simply where services are delivered – some service providers have particularly solid roots in specific communities:

– their origins may be in a particular ethno-cultural community or a community neglected by mainstream institutions

– they may have elected boards, local advisory committee and otherways of staying accountable to particular communities

– staying connected to their particular communities is a crucial part of their ethos

– they may use community-based research and other techniques to understand their communities better

• 3. advocacy groups – for particular conditions or communities; and

• 4. residents and consumers of health care services who live in particular neighborhoods and communities


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Principles of Community Engagement

• The LHINs will be able to develop a responsive and effective community engagement strategy by:

– building on, and working closely with, the large number of service networks and coordinating bodies that have been created over theyears;

– developing local and neighbourhood planning committees that can understand local needs and feed these priorities up into LHIN planning in a systematic way;

– using a wide range of flexible and innovative forums and processes to tap into the full diversity of community needs, views and perspectives;


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Principles of Community Engagement II

– paying particular attention to engaging the most vulnerable and marginalized populations whose voice is seldom heard

– providing the information and tools for communities and individuals to meaningfully participate in planning and priority setting;

• and recognizing that there is a cost to under-funded community agencies in participating

– developing clear indicators for how successful community engagement will work in practice

• which also means consulting with the community on what the goals and indicators should be in the first place


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Two Examples

• I will illustrate these principles of community engagement by discussing two crucial challenges:

1. how to ensure that the voices and interests of the most marginalized and vulnerable communities are included

2. how to ensure that the planning and priorities reflect the full diversity of communities

• then I will come back to challenges in sustaining community engagement


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Involving the Marginalized and Excluded

• The usual kinds of forums, surveys and meetings simply do not work for homeless, poor or many marginalized communities

• One of the most effective ways to ensure their voices are heard will be working with front-line service providers who have built up trust and long-standing relationships with these populations:

– Street Health – working with and for homeless people for 20 years– St Christopher's House and other multi-service neighbourhood agencies

• Another is to use solidly grounded community-based research – one of them most innovative methods to enable marginalized communities to

define their own needs has been inclusion research – Count Us In from the Ontario Women's Health Network, Ontario Prevention

Clearing house and other partners involved homeless and under-housed women researching the health, service and other needs and barriers facing marginalized women http://www.owhn.on.ca/home.htm

http://www.owhn.on.ca/home.htm


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Lead on Diversity

• One of the crucial challenges in Toronto especially, but all across the province, is the incredible diversity of the population

• This diversity must be reflected in all aspects of LHINs governance, planning and resource allocation:– not just as a simple matter of social justice and equity– but because planning will inevitably fail that does not reflect and include

this diversity


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Diversity Into Practice

• This means developing particular forms of engagement for particular communities

• It also means thinking carefully about representativeness:– on LHIN boards, management and staff– and where these are not reflective of the diversity of their communities, then

setting up advisory committees or other means to ensure involvement by all sectors of the community

– representatives and accountability should be among the standards LHINs expect from all hospitals and agencies they fund

• And it means ensuring that culturally competent care is one of the driving principles of health care delivery in every agency funded by the LHINs:

– this means far more than having translation available wherever needed– communities have to define what competent and appropriate care means for

them


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Diversity Into Practice II

• Here again, the LHINs and all providers can build on existing resources and foundations– many hospitals have diversity coordinators or programmes, often

under-funded and under-used – the Diversity Health Practitioners Network includes members

who work in many hospitals, – a working group is currently developing diversity tools and

resources that can be used throughout the system


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Building Community Engagement

• I will finish by focusing on the next six months in the development of the LHINs’ working relationships with their communities

• Action is needed on three key challenges:

1. learning from the first round of engagement2. sharing and building on the lessons learned3. sustaining community engagement for the long-term


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Assessing Early Community Engagement

• The first action needed is to involve community partners in evaluating the initial round of consultation and communication

– in the Toronto Central LHIN, this would be the networks who took a lead in coordinating the action planning days, participants in those days and other stakeholders who were involved

– the goal would be to look forward – what lessons can be learned for ongoing consultations and collaborations?

• The means could be community conferences in each LHIN to:

– report on the findings from the consultations and planning days – as a check-back mechanism

– reflect on how the process worked and can be made better for the future


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Sharing Lessons Learned

• The second challenge is sharing these lessons learned:

– I expect the 14 CEOs and Directors of Planning, Integration and Community Engagement will be meeting to share their experiences

– take that further -- choose several community representatives from the post-consultation evaluation conferences I just recommended for each LHIN

– convene a province-wide working conference of these community representatives

• This model of community representatives from all the LHINs could be used not just for this immediate evaluation of the early engagement, but for sharing lessons learned on an ongoing basis:

– just as senior management regularly meet, so too could effective forums for province-wide sharing among community partners be institutionalized

– one such forum could be annual conferences of community representatives from every LHIN


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Institutionalizing Community Involvement in LHIN Planning

• The third key challenge is sustaining community engagement• Not just the LHINs, but all institutions must build long-term

collaborative relationships – not just scrambling around for community partners at accreditation time

or to fill out a research LOI– working relationships and trust needs to built up over the years

• Most importantly, community involvement in planning has to be both systematic and significant


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Institutionalizing Community Impact in LHIN Planning

• Systematic means:– building community involvement in at all stages of the planning and budget

processes:• identifying needs and gaps• developing plans and priorities that reflect and balance those needs• allocating resources to put those priorities into action• monitoring and evaluating outcomes and how well plans and services worked out

– then starting the planning cycle all over again and re-adjusting for the next year– there are always going to be trade-offs

• consultation and involvement can’t be endless or it will not be effective• but significant community involvement will make the inevitable compromises between

competing local interests and priorities easier, not harder


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Institutionalizing Community Impact in LHIN Planning II

• Significant means:– community input and involvement have to be seen to have an impact -- otherwise

people won’t bother to participate– most immediately, the LHINs need a transparent process:

• where community partners are involved in analyzing the initial consultations and planning days, and helping to turn this input into plans and priorities

• obviously this can’t take away from the key role of LHIN staff – but neither can it merely be a report back after all the priorities are set

– and then they need a permanent process where community partners are involved in monitoring the planning process to ensure that community input is taken seriously and acted on

• which, of course, doesn't mean that every community recommendation is accepted –rather that the full range of input is seriously analyzed and responded to


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Summary: Action Recommendations

• Each LHINs should convene a community conference or meeting soon to:– check back on the results of the first rounds of consultations– assess these processes from a community standpoint and learn

lessons for the future• A province-wide conference should be held where

community representatives from each LHIN share their experiences and conclusions on initial community engagement and map out the way forward

• Community partners should be involved in analyzing the initial consultations and recommending priorities to feed into development of the first integration report


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Conclusions: Benefits of Effective and Responsive Community Collaboration

• Involving the widest range of community partners will result in far more nuanced and detailed understanding of community health needs

• There will be far more significant and insightful input into planning →planning and priority setting will be far more effective

• Community providers are the essential building blocks of a seamless continuum of care – involving them in planning is essential to making the continuum a reality

• Widespread community involvement can yield the new ways of thinking and new ideas and innovations that are vital for reforming the system

• Engaged communities can be a positive force for overall reform – not least as a way to counterbalance the weight of other interests reluctant to change

Community Driven Planning, Priority Setting and Governance

Government & Nonprofit

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