How

Guiding Principles for Effective Engagement

Let's consider some guiding principles that, if followed, will make engagements with patients more effective (Pushparajah, 2018).

Firstly, inclusivity and diversity will ensure that the entire patient population is represented. Being inclusive and embracing diversity allows the health system to appreciate the perspectives of everyone they serve.

The health system and the public must have a shared vision for what they are looking to accomplish. Without this, they will be at odds and unproductive, which may lead to dissatisfaction. This vision must be mutually shared and understood by everyone involved.

Everyone needs to be transparent about roles, responsibilities, and any other issues that may affect the work being done. The person being engaged needs to understand their level of influence and what is expected of them. Role clarity is crucial.

The teams and patients need support. This can be training, mentoring, or tools. There are a plethora of resources available to help support the process. Most health systems would have this available, as patient engagement is an integral part of accreditation. Some examples may include engagement algorithms and patient and family support groups. Everyone shares accountability, and everyone needs to know what they are accountable for.

Mutual respect is essential. Engaging a patient to help navigate a change is not a check box for Accreditation. As mentioned earlier, the benefits are tremendous.

Effective Implementation of Patient Engagement

Four Stages of Effective Implementation of Effective Patient Engagement (Nova Scotia Health, 2022):

To facilitate effective engagement, teams must move through four stages: background work, which enables the organization to be prepared to invite patients into their world; planning and getting the details right; implementation; and evaluation and subsequent follow-up.

The background work ensures that your organization is prepared for the engagement. Good preparation will pay dividends as the change progresses. First of all, the organization needs to understand "why" engaging patients is important. This can be supported by an effective communication strategy. There will need to be an engagement policy for the organization to follow. Training needs to be developed for staff, patients, and families. There needs to be a clear understanding of roles and responsibilities for everyone. The health system needs an effective recruitment strategy to bring patients and families into the organization. This needs to be supplemented with an effective orientation and onboarding process.

Planning – During the planning stage, the level of engagement required needs to be determined. This will frame the subsequent plans. The organization must ensure that resources and support are available for the teams and the patients. All the details need to be considered. This includes technology, parking, and refreshments. These things are important for success. Take nothing for granted. There may be a need for a communication plan. All this work helps to form the overall implementation plan.

Implementing – Now we are ready, and we actively engage the patients following the actions of the above implementation and communication plans.

Evaluation and follow-up – In order to see if the engagement has been effective, it is important to perform a formal evaluation of the experience. It is then essential to report back to everyone involved. Then, the team must make improvements as necessary.

Pearls:

Build relationships
Use effective communication with approachable language (no acronyms)
Offer support from other patients
Develop tools and resources to support engagement (checklist, etc.)

Levels of Engagement - the IAP2 Spectrum

The International Association of Public Participation (IAP2) developed the spectrum seen below. It is ubiquitous in the public engagement world. As per Porter (2022), the IAP2 spectrum "...was designed to assist with the selection of the level of participation that defines the public's role in any public participation process". It is used all over the world.

As you move across the spectrum, you will see that there is an increasing impact on the level of participation from the public decisions (inform – consult – involve – collaborate – empower).

It outlines the goals and the associated promises that are made to the public. Once the level of engagement is decided upon, this spectrum can help to inform roles and responsibilities and subsequent planning.

International Association of Public Participation, 2018.

When to Engage

Consider engaging patients when :

patients understand the issue and possess (or have access to) relevant information that allows them to understand their role and participate in the decision-making process.

When should you engage patients and families in the change you are making? Different health systems have policies and processes to help teams answer this question. A simple way to determine your answer is to ask yourself:

"Do patients / the public understand the issue and have (or have access to) relevant information that allows them to understand their role and to participate in the decision-making process?"

If not, engagement may not be appropriate (Nova Scotia Health, 2022).

Opportunities to Enable Patient Engagement

Let's consider some instances when engaging patients may be of great benefit to the health system (and hence the public):

Infrastructure planning – When planning new builds, the patient's perspective lends a patient-focused lens that may be lacking. A simple but impactful example is the type of chairs to be used on a renal dialysis unit. Patients could be part of the procurement process.

Quality teams/committees/councils- Patients and families can give excellent guidance on the priorities and actions that these teams are trying to achieve. An example could be related to patient and family feedback. The health system provides phone numbers and email addresses where they can contact the patient feedback line to share a compliment or a concern. The patient advisor on the committee may suggest other ways to get the info to patients like posting the info in the waiting room where they have a captive audience

Rapid response – During the acute stages of COVID-19 policies and guidelines were getting updated very rapidly. To get a patient's perspective, a rapid response team of patient and family advisors was set up with the mandate to review urgent items within a tight time frame. This model has been employed in various health systems in Canada (University Health Network, 2020).

Service planning- When a health system is considering a change to a service or introducing a new service, having the patient and family's perspective is essential (Baker et al., 2016). Patients are "experts by experience" (Baker et al., 2016) and their insights and priorities must be considered during service delivery changes.

Quality Improvement Initiatives- When considering quality improvement initiatives, think about how having a patient voice could shape your change ideas.

Accreditation activities (surveyor, mock tracers) - Many health systems engage with patients as part of the accreditation process. Examples include having a patient surveyor and having patients do "mock" tracers to help health systems prepare for an onsite survey.

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