Community Driven Planning, Priority Setting and Governance

Speaking Notes: Community
Driven Planning, Priority Setting
and Governance

Ontario Hospital Association Conference
Community Engagement in a LHINs Environment
June 26, 2006

Bob Gardner, PhD
Director, Public Policy

© The Wellesley Institute 1
www.wellesleyinstitute.com

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


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


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


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 other
ways 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

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 the
years;
– 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;


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


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


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


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


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


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


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 engagement
2. sharing and building on the lessons learned
3. sustaining community engagement for the long-term


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


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


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


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


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


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


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

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