Community Engagement

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Community Engagement

• Supporting Improvement and Innovation Learning
  Series

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Community Engagement

• Presenters
• Sue Davis Vancouver Coastal Health
• Valerie Nicol Impact BC Quality Improvement
  Advisor
• Lisa Dwyer Fraser Health Authority

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What are we trying to accomplish?

• The aim of this web conference is to
• Learn a framework for community engagement
• Use what you know about your population to help
  drive community engagement process
• Real life examples from Health Authorities for
  learning

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Interactivity

• This session is to be interactive a real
  opportunity to share and learn from each other
  please feel free to raise your hand at any time
  to ask a question or make a comment..
• You can also use the chat pod if you have any
  questions, comments, contributions we will pick
  up on these as we go along

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Shifting the system to achieve the desired
outcomes, through an evidence based care model
and change management model
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Community EngagementSue DavisVancouver
Coastal Health
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What is community engagement?

• The goal of Community Engagement is to develop
  and enhance public participation in health
  service planning and decision-making, and raise
  awareness within the health system about
  community issues and concerns that may otherwise
  not be apparent. When we engage the community,
  we create a process for mutual communication
  between the public and the health system,
  ensuring community values and needs are reflected
  in healthcare provision.

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How does Community Engagement line up with
patient -centered care?

• Providing care that is respectful and responsive
  to individual patient preferences, needs and
  values and ensuring that patient values guide all
  clinical decisions
• Crossing the Quality Chasm, 2001

• Through the CE lens, patient-centered extends
  beyond treatment of individual patients to whole
  communities
• Extends beyond the bedside to involvement in
  planning, policy, operations

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Context for Expansion of CE in Health Care

• Growing body of research links lack of patient,
  provider communication with ineffective,
  inappropriate care, errors
• Dramatic change in activation of, and advocacy
  by, patients and family caregivers
• Importation of private sector consciousness re
  the customer
• Recognition of the value of engagement to
  decision-making and communications
• Financial imperative, client preference and
  improved outcomes driving self-management,
  supported self-responsibility

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Engagement is guided by the Spectrum of
Participation
VCH Community Engagement Framework Adapted from
World Health Organization ladder of participation
and IAP2s spectrum of participation
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A different way of looking at the Spectrum
EMPOWER
COLLABORATE
INVOLVE
CONSULT
INFORM
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Engagement methods include

• Online/ in person/ mail-in questionnaires
• Focus groups
• Interviews
• Education forums
• Reference committees
• Advisory committees
• Community meetings (dialogue based)
• Open houses
• Dialogue circles
• Open space discussions
• And many, many others

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where might you find CE?
F/S
Provider and family/support
HCP
Provider and patient/ client/ consumer
VCH staff and staff of external providers
VCH staff and patient/ consumer advocates
C/P
A
EP
COMMUNITY/ PUBLIC
Management and community agencies
VCH and public at large
CA
VCH and neighbourhoods
NEIGHBOURHOODS
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What do we want to Accomplish?
Outcome Measures Demonstrate Impact
ECCM Process Measures Demonstrate Implementation
of ECCM
Improving patient access to PHC
access/continuity
Build healthy public policy
Create supportive environment
Improving patient health outcomes through quality
improvement
Strengthen community action
Self management / Develop personal skills
Improving patient confidence and experience with
the health system
Delivery system design / Reorient health services
Decision support
Improving provider confidence and experience with
the health system
Information systems
Decreasing the average annual cost per patient
Health System / Organization
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How do you choose the strategy?

• Context analysis
• History with the stakeholders
• Understanding of all the players and the
  relationship they currently have
• What can you commit to resources, time,
  relationship, transparency, supporting the
  process
• Where is your organization at? Change management
  needs?
• Then match it to the tool/ method

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Principles of Community Engagement VCH

• Everyone is a stakeholder
• Diverse voices contribute to better decisions
• Communication is a two-way street
• While seeking input on particular program areas,
  we target engagement directly to affected clients
  and their families/loved ones
• We help VCH consider the patients journey in its
  entirety
• We bring diverse and marginalized voices into the
  planning process and allow for consideration of
  perspectives that would not otherwise be
  understood

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• Engagement stimulates the growth of healthy
  communities
• We help dissenting voices within communities work
  through differences towards collective solutions
• We are open and transparent in how we share
  information about VCH decision-making with
  community stakeholders
• Our ultimate goal is to engage community leaders
  as partners
• We engage the community with integrity, in a way
  that builds trust and credibility
• We complete the circle of engagement

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Making CE Meaningful and Useful

• Clearly define purpose of engagement what are
  you going to do with the information you gather?
• Match the level of engagement from the spectrum
  to your desired outcome
• Determine the right method to reach your goal and
  your stakeholders
• Clearly define the benefit of engagement to the
  participants (e.g. improved services for your
  community)
• Identify what is negotiable and what is a given
• Inform participants of the other inputs into
  decision-making (e.g., best practices, financial
  inputs, labour constraints)

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• Act as if what you do makes a difference. It
  does.
• Tom Brokaw    

Any other questions or for a copy of this
presentation Sue Davis
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VIHA Community Engagement Process

• 2007-2009
• Presented by Valerie Nicol
• Impact BC

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2007 2008

• Integrated Health Network formation begins
• Community Advisory Committees established in each
  of the 6 Primary Health Care (PHC) Integrated
  Health Network (IHN) communities
• 3 PHC developers take on 2 IHNs each and function
  as chair of the CACs
• - Membership includes Chair, IHN staff
  representative, representation from related VIHA
  services (DEK, KCC, MHAS, Heart Health,
  Aboriginal Health, etc), local government,
  municipalities/recreation facilities, Social
  Planning Committees, interested service providers

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2007 2008

• Sooke IHN had a pre-existing Community Health
  Initiative committee (CHI) with comprehensive
  membership and a wealth of community data
• The CHI committee merged with the additional
  membership of the IHN CAC in late 2007
• Communication and functionality greatly improved

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2007 2008

• In order to meet HIF funding deadlines, one or
  two NGO contracts was written in each IHN based
  on anticipated needs of future pt population and
  the recommendations of the CACs
• No formal RFP process was undertaken due to time
  constraints and lack of pt pop info
• All contracts were less than 25k

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2008 2009

• April 2008 In anticipation of large numbers of
  enrolled patients, we decided to embark on the
  development and implementation of a formal
  Request For Proposal (RFP) process to enable
  contracts larger than 25k
• Handshake agreements with NGOs to continue
  service per under-utilized contracts from 07/08
• July 2008 RFPs issued on BCBid for all 6 IHN
  communities. Ads run in local community papers
• RFP selection process developed and Selection
  Committees formed as sub-committee of CAC
  (conflict of interest issues considered)

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2008 2009

• Proponent meetings held in each IHN community
• Selection Committee forwarded recommendations to
  VIHA IHN Steering Committee for approval
• Contracts written
• RFP process completed in November 2008
• Results
• Over 30 contracts written
• Dollar range from lt 1,000 to gt 60,000

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2008 2009

• Contracts with BC Lung and Pacific Institute for
  Sport Excellence were also written to provide
  service across all 6 IHNs
• Learnings
• Ideally, the patient population would be
  well-defined and the needs established prior to
  embarking on a large-scale RFP process. (Still
  working on this)
• RFP process takes several months to complete
  (April Nov 2008)

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2008 2009

• Little or no uptake for services in IHNs where
  patient population thought to be ideal (eg.
  Victoria age of patient population much higher
  than estimated not willing to attend classes
  regularly)
• Across all 6 IHNs, contracts with best
  utilization were less than 25k in value
• RFP process not required
• Consider Expression Of Interest process as in
  Sooke

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2009 2010

• Moved to an Expression of Interest Process (EOI)
• Ads in local IHN community papers to notify all
  service providers of the opportunity and the date
  of the proponents meeting
• Contact recommended service providers directly to
  notify
• Selection committee reviews submissions, forwards
  recommendations to VIHA IHN Steering Committee
  for approval
• Contracts written to include a template for
  Quarterly Evaluation (see attachment)

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Learnings

• Partner/Merge with existing committees where
  possible
• Provide info on your process (EOI or RFP)
  directly to service providers recommended by
  local committee to enhance engagement
• In smaller communities (ie. Sooke) where many
  stakeholders and providers are already engaged,
  RFP process creates a competitive rift. EOI
  allows more flexibility regarding choice and
  selection process

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Community Wellness Funding Opportunities2009 -
2010

• Lisa Dwyer
• Fraser Health Authority

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Fraser Health Community Wellness 2009 - 2010

• Approach to Community Wellness Funding
  Opportunities is influenced (primarily) by the
  Enhanced Chronic Care Model (ECCM)
• In particular, Community Wellness funding is
  driven by the Expanded part of the Expanded
  Chronic Care Model. That is, population health
  promotion and enhancing community capacity
  underlies Community Wellness funding.
• The overall purpose of this funding is to help FH
  citizens to (1) stay healthy, (2) get better, or
  (3) manage chronic conditions with greater ease.
• Because Community Wellness funding is intended to
  support the expansion of Integrated Health
  Networks (IHN), the iConnect Health Centres have
  played an important role in choosing which
  organizations to fund (to date)

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Structure for Application Submission and Approval

• RFP circulated to all Community-based Agencies in
  IHN communities via websites, community
  newspapers, and FH communications.
• RFP requested agencies to submit 2 page LOI prior
  to proceeding to full RFP
• Standardized RFP template was developed for all
  agencies to ensure that information was complete
  and to ensure equity in the application process
• RFPs are assessed by a committee of volunteers,
  including a volunteer representative from a NGO
  funded in the 2008-09 competition
• Maximum funding award is 100K per proposal.

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Status of Community Wellness Funding

• 5 Community Agencies were funded in 2008-09 for a
  total of 157,135
• Punjabi Chronic Disease Self-Management Program
• The Disabled Womens Program
• Healthy Eating/Cooking for South Asians DVD
• Punjabi Educational Learning Series Presentations
  and Ask the Expert Sessions
• Stroke Community Linkage Project
• 22 agencies were approved to proceed to the
  2009-2010 RFP process
• Deadline for RFPs is July 10th

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Lessons Learned

• Focus of funding
• Connection with iConnect Health Centres
• Levels of Engagement
• Networking
• Program Outcomes

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Focus of funding

• Obvious by the second call for letters of intent
  that there is a wide array of community needs all
  deserving of consideration based on the ECCM
  focus on population health, prevention and
  promotion, and enhancing community capacity
• Given this wide array of needs, FH is currently
  debating the identification of particular funding
  themes based on where the needs are the greatest
  and on the greatest benefit to the system in
  future funding calls

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Connection with iConnect Health Care Centres

• At this juncture in the IHN development, the
  iCHCs are operating at the limits of their
  capacities, and therefore, do not have the
  resources to work in direct collaboration with
  funded community projects.
• The new approach is to emphasize that successful
  community agencies, including the five funded
  projects, should endeavour to establish other
  connections within the community and among their
  constituents. At the same time they should make
  sure that iConnect Health Centres are among their
  referral sources (rather than their main linkage)
  for the enhancements they have created

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Program Outcomes

• Conducting rigorous outcome evaluation is a
  challenge faced by most healthcare agencies
• Primary Care staff have established working
  relationships with funded project staff to
  provide technical assistance regarding evaluation
  
• The opportunity of working more directly with
  funded project staff may result in the collection
  of more meaningful and useful outcome data

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Networking

• Establish an informal network of community
  agencies funded by FH in the 3 IHN communities
• Such a network might lead to collaboration among
  network members. Through the various meetings
  that have been hosted by Primary Care, networking
  between community agencies appears to be a
  distinct possibility. Indeed, informal
  collaborative partnerships have already been
  struck between a few of the funded agencies
• FH currently investigating ways to enhance or
  support the informal networking opportunities
  further
• E.g., Primary Cares Community Wellness Funding
  Opportunity is one component of a broader
  community engagement initiative currently
  operating within Fraser Health

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Levels of Engagement

• The initial Community Engagement funding cycle
  essentially involved a one way process. Primary
  Care identified and set the terms of reference
  for the funding opportunity and a committee made
  up of personnel from Fraser Health made the
  decision regarding which projects to fund.
• In the second round of funding, community
  agencies have been invited to participate in the
  proposal rating process.
• Intent is to expand FHs engagement with the
  community to more deliberately follow the
  spectrum of engagement (1) Inform, (2) Consult,
  (3) Involve, (4) Collaborate and (5) Empower.

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Acknowledgements

• George Tien
• Katayoon (Kathy) Riyazi
• Community Wellness Proposal Committee
• 5 Community Agencies funded last year

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Questions for Discussion

• Roundtable discussion
• What are you doing in your Health Authority to
  engage the community?

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Thank you for participating!

• Please take the time to fill out our survey we
  need your feedback!
• Next web conference Tuesday July 21st, 2009
  Health Authority Leadership
• Please note that web conferences will be on
  vacation for the month of August and will get
  started again in September!