Engaging People in Sustainable Healthcare

Engaging people in sustainable healthcare

Engaging people in sustainable healthcare

Here is a practical tool to help NHS organisations think through how they build staff, public and patient engagementintotheir work on sustainability.
This Guide provides practical advice, suggestions for action, examples of good practice and evidence of what works.
It brings together the learning and evidence of good engagement and experience from a variety of healthcare organisations, including emerging clinical commissioning groups across the country.
You can download the Guide here.
Please f you have any comments or suggestions to improve this tool.

Section 1 - How to use this guide

Who is this guide for?
The guide is intended for sustainability managers and leads across the NHS.
It may also be usefulforNHS engagement specialists who wish to extend their work into areas connected with sustainable healthcare and climate change. We haveincluded material which willinterestcommissionersas well asproviders of primary and secondary care.
What does the guide aim to do?
It provides a set of signposts to the huge amount of material which now exists on-line on the subject of patient engagement and service user involvement in health and social care.(See this toolas a printable pdf).
It is aquick and easy to understand tool. It focuses onpatient as well as public engagement in whathealthcare sustainability means in practice and how healthcare organisations can become more sustainable.
It is essential thatsustainable development leads linkwith engagement specialists within the NHS. Significant divides also need to be bridged between commissioners and providers,between health and social care and across neighbouring geographical localities. Please view this guide'scase studies to see this in action.
What can you do next?

·  Please give usfeedback on this guide andtell us how it has helped you. We also welcome constructive criticism

·  Please send us information about what you are doing. Tell us about your own engagement story by filling in this short form.

Section 2: What do we mean bysustainability?

Different approaches to this question are offered below.
Developing a short and meaningful “pitch” will be an important part of engaging with each audience or target group.
Sustainable development is a way of thinking about how to organise our lives and work – including our health services and system – so that all people throughout the world can satisfy their basic needs and enjoy a better quality of life, without compromising the quality of life of future generations.
The UK Sustainable Development Strategy, Securing the Future, has five key principles:

Sustainability can be defined as meeting the needs of today without compromising the needs of tomorrow.
Commissioning for Sustainable Development is the process by which commissioners improve both the sustainability of an organisation and the way it provides services and interacts with people in the community. It incorporates all aspects of World Class Commissioning including environmental considerations into commissioning processes and decisions.
Take a look at theNHS Sustainable Development Unit's guidanceCommissioning for Sustainable Development.

Why is it important?

The NHShas contact with millions of peopleand employs more than1.3 million staff. It therefore has the potential to reach tens of thousands of people every day with positive health and environmental messages.
Thegood news is thatwhat is good for the environment is also good for people’s health.

What do we mean by engagement?

Engagement and involvement – these two terms are often used interchangeably.

·  Involvement can be passivee.g. receiving information, understanding what is required of me or

·  Involvement can be active e.g. requiring anactive response, a level of commitment to action.

Engagement and involvement activity can be aimed at individuals or groups.
Different kinds of Engagement

1.  Information provision and exchange. Letting people know what is going on in the NHS and listening to their views.

2.  Consultation. Involving people in making decisions about the services we provide.

3.  Working together. Partnership working with anybody in the community to challenge health issues. This is sometimes called “co-production”.

4.  Community control or ownership. Helping people find ways to develop and influence services for their community.

5.  Patient experience. Understanding what really happens on a patient’s journey through care. NHS Central Lancashire,Public Engagement Toolkit for Health Commissioners and Partner Organisations, 2011

Whodo you want to engage?

Target Audiences / Guide / Examples
Board Members (e.g Executive and non-executive Directors, governors and lay members) / Section 6 - part 1 / Section 8
Staff and senior managers / Section 6 - part 2 / Section 8
Patients, carers and service users / Section 6 - part 3/4 / Section 8
Wider Public / Section 6 - part 3
Other audiences (please specify) / Section 6 - part 4

Section 3: Why sustainability and engagement matter

Engagement is not an end in itself – it’s an important lever to improve patient experiences and health outcomes.
Engagement is particularlyimportant for sustainable development in the NHS.
Without engagement the NHS will not achieve its long term goals for reducing carbon emissions and the public will not understand whyaction isneeded.
Engagement and sustainability share some similarities. Engagement andsustainability both need to be owned by boards and staff. Engagement and sustainable development programmes must also draw in service users, communities and the wider public, local councils, third sector and Health and Well Being Boards.
Sustainability mattersbecause it provides a way of addressing wider NHS commitments and goals: quality and productivity improvement, resource efficiency, preventative health strategies (QIPP). Environmental, social, political and economic sustainability are closely woven together. What is good for individual patients and service users, can be good for organisations and for the planet as a whole. This is the“triple bottom line” for measuring success in the future.
Clinical commissioners who work every day with patients may assume they know what it is like to live with a health condition. Yet as most people will tell you, you don’t really know what it is like until you experience it for yourself. By using people’s experiences within commissioning, you can start to walk in the shoes of those you commission for and see the world through their eyes.
Engagement pays - it makes good business sense to involve patients and public and take account of their individual experiences:

·  Involving patients in decisions about their own health and care has the potential to boost outcomes, reduce unnecessary consultations,

·  reduce unwarranted variations, improve patient experience, improve concordance with treatment and makes the best use of limited

·  resources

·  Understanding patient experience of services can help you identify areas of waste and inefficiency and how to make services better

·  Patients and public can you help redesign care pathways so that they are more patient friendly and efficient

·  Engagement pays (literally) – the new Patient Participation DES supports engagement at practice level but also encourages engagement at CCG level.

Engagement helps to manage risk and deliver difficult changes successfully:

·  Bringing patients and public with you from the outset about proposed service change can increase your ability to manage risk and deliver difficult change successfully

The law requires you to engage patients and public and take account of patient experience. Check the following:

·  Health and Social Care Acts 2006, 2012

·  Equalities Act of 2011 and the Equality Delivery System

·  Authorisation criteria for Clinical Commissioning Groups

For more information:
Better Health, Better Experience, Better Engagement -why good commissioning needs patients and public at its heart, DH, 2011
Making the Case for Public EngagementEdward Andersson, Emily Fennell and Thea Shahrokh, Involve and Consumer Focus, 2011
Guide to Sustainable development for Clinical Commissioning Groups, NHS Sustainable Development Unit.

Building a local case for engagement

Stage 1
Scope the Business / Stage 2
Define the focus and purpose
Stage 3
Decide what to do / Stage 4
Complete the checklist and chart
Stage 5
Analyse results / Stage 6
Present the business case

For more information: Making the Case for Public Engagement Edward Andersson, Emily Fennell and Thea Shahrokh, Involve and Consumer Focus, 2011 (Download)

Section 4: Taking stock

This section provides a number of tools to enable you to make an assessment of the capacity of your organisation for engagement and communication.
These could support your analysis of the strengths and limitations of existing approaches within your organisation. They could also help to identify the opportunities and threats which you face.

Focus of Stocktake / Resource
Commissioning / World Class Commissioning Competencies- patient and public engagement
The Engagement Cycle
Provision and commissioning / Good Engagement Practice for the NHS
On-line self assessment tool for universities
Sustainable development / Good Corporate Citizen Assessment
Communication / The Communicating Organisation

Four attributes of a communicating organisation

The scale and complexity of the NHS, coupled with the diverse needs of the local communities that it serves, means that each NHS organisation has different priorities and goals. As a result, they will organise their communications functions and communication processes in different ways. However, all organisations that are good at communicating will share four core attributes, as stated above:

·  An excellent understanding of the brand

·  Excellence in planning, managing and evaluating communication

·  Leadership support for communication

·  Communication as a core competency

For more information: The Communicating Organisation - using information to support the development of high-performing organisations, Dept of Health. Nov 2009 (Download)

Section 5: Planning your approach

·  Planning needs to happen at a number of different levels.

·  Effective engagement needs to be sustained over time and specific activities need to be incorporated in a consistent overall programme of work.

·  A good plan will act as a map for the journey and provide a reference point for reflection and review.

·  As such it will need to allow for change and improvement, as implementation progresses.

Develop a programme for engagement

Subjects for engagement can come up at any time, but if you look ahead you can anticipate most of them and develop a forward programme for engagement. This will help you prepare in good time, coordinate effort and focus resources on the most important issues.
When planning ahead, look out for things that will trigger an opportunity for engagement, for example:

·  Key issues in your commissioning plan

·  Contracts coming due for review or renewal

·  Emerging health priorities

·  New standards and practices at the national level

·  Compliments, complaints and issues in the local media

·  Continuing relationships with patient groups and other stakeholders

·  Deepening understanding of patient experience

For more information: Public Engagement Toolkit, NHS Central Lancashire,, 2011

Checklist: Assessing each opportunity for engagement - More information can be found here

Ask / Consider
Who would we engage with? /
Patients, carers, potential service users, local communities, pressure groups. Don’t forget groups that are easy to overlook. Partner organisations, other commissioners and service providers (current or potential; public, private and voluntary sectors).
Anyone who will be affected, or stands to gain or lose if things change. Don’t forget opinion formers such as MPs and the media; they can influence the success and outcome of the engagement.
Consider doing an outline stakeholder analysis (you can get a handy template for this - see Appendix F
for download information).
Is there a legal
requirement to
consult here? /
See table in Section 2.2
See also Appendix A
What would we
want to get out of
the engagement? / Who would be the decision making body? What info would they need?
What approach
might we use? /
If consultation, see table in Section 2.2.
For a wider range of options see Appendix B
What might it cost? /
Cash cost: printing, advertising, hire of venues and equipment,
specialist external support (survey design and analysis,
facilitation), participant expenses?
Other: time and capacity within your organisation.
Timescale? /
Is there a deadline for decision making?
How long will be required to engage with people to the
necessary level of detail?
How long will it take to plan the engagement?
How much notice will participants need?
Should we commit
to this engagement
and include it in our
programme? /
Is there a legal or business obligation to do so?
Do the potential benefits justify the cost?
If it looks disproportionate, can we refine the approach and still
get the benefits?

Section 6: Where to start and how to move on

This section provides some signposts to a range of activities. It is not an exhaustive list. It provides a starting point. There are likely to be many factors involved in making a choice of activities.
However, clear objectives, awareness of timing, and a good knowledge of who are the target audiences – these are all likely to be important.

Part 1 - Engaging with the Board

The following practical guidance is offered by the NHS Sustainable Development Unit at its website and in a recent publication for commissioners:

ACTIONS:

1.  Have a Board approved Sustainable Development Management PlanGuidance.Available here

2.  Sign up to theGood Corporate Citizenship Assessment Modelwhich is aa self assessment tool to help organisations improve their sustainability

3.  A checklist for provider and commissioner boards. Access the checklist here.

CRITERIA FOR GOOD ENGAGEMENT:

1.  Effective leadership and a robust strategy

2.  A clear commitment to engagement

3.  Information and information sharing

4.  Willingness to share power

5.  Equal relationships and mutual respect

6.  Providing appropriate support, training and development

7.  Effective approaches and methods of engagement

8.  Transparent decision making

9.  Monitoring, evaluation and feedback

10.  Evidence of improved outcomes

More information here: Good Engagement Practice for the NHS

Part 2 - Engaging with Staff

The NHS Constitution lays out the value of staff engagement:
‘Engage staff in decisions that affect them and the services they provide … all staff will be empowered to put forward ways to deliver better and safer services.’
Recent research studies show how good staff engagement positively impacts on the quality of service provision. It is associated with patient satisfaction as staff gain valuable insights into ways in which the services can be more responsive. It also leads to longer term beneficial impacts on patient mortality, infection rates, Annual Health Check scores as well as staff absenteeism and turnover.
The more engaged staff members are, the better the workplace environment enabling staff to thrive and the better the outcomes for patients and the organisation generally. (NHS Midlands and East, Good Engagement Practice for the NHS).
Considerations
1. There should be several ways for staff, patients and communities to get involved in the activity, planning, decision making, review of NHS commissioner and provider organisations, depending on their availability, ability and willingness to do so.This could be through
surveys, involvement in governance/decision-making structures, secondments, job swaps, group workshops or social media.
2. Informal methods of engagement can often work best. Large meetings, especially where there a variety of languages are used, can lead to frustration. Smaller discussion groups or events that are relaxed and more sociable have proven popular and effective, e.g. involving food, dance or cultural activity.
3.Barriers to participation amongst staff, patients and communities with protected characteristics should be systematically identified, documented and addressed by NHS commissioner and provider organisations with ‘reasonable adjustments’ being made – and this should be embedded in how the organisation works.
4. Opportunities for staff, patients and communities to get involved in activity, planning, decision making, review of NHS commissioner and provider organisations should be promoted in a variety of ways for example through the local press, radio, online, social networks, outreach and community activity.
5. Engaging with staff is a good pathway to effective engagement with patients and the public.