This is the sixth in an ongoing series of posts explaining the approach which our team at NHS North West has taken to drive up equality outcomes in one NHS region... and the spinoffs of national best practice which that work has generated.
The story so far
In part four of this series I explained how our research pointed to the need to develop certain tools for improving equality outcomes in the NHS. Earlier parts also described how we measure those outcomes objectively.
In this post I want to go on and describe another of the innovations we realised we needed: the Health Equality Stakeholder Engagement Approach.
You can read more about what I'm about to describe in our publication about this, An Equal Partnership. However, I'll summarise it here.
Consultation and Involvement that lasts
Consultation and involvement with stakeholders is just as important to successful planning as having good research. Indeed the two overlap, as stakeholders are often the best source of the information needed to make good decisions.
The problem with engagement of this kind is that it's often not very well done. Our research told us that there was a need to establish some best practice and point the way.
We also needed effective and sustainable strategic consultation partners of our own. The project to establish those relationships was a way of proving the theory in practice.
And the word 'sustainable' isn't an idle throwaway. We wanted to develop long term relationships that would last -- by being good for all sides.
The bear traps
Firstly, we were aware of what can go wrong with consultation and involvement
The first mistake, often made, is to assume that organising a big public consultation event with hundreds of people is all that you need to do. There are several problems with this:
- It is pure luck whether an event of this type attracts people from all of the diverse communities in society. I.e. Both men and women, of all ages; representatives of all the local black and minority communities; disabled people; lesbian, gay bisexual and trans people; people with different religious beliefs (or none) and people with caring responsibilities, gypsies, travellers, homeless people and so forth. The list will depend on the makeup of your local population.
- Not everyone in these categories wants to be recognised as such. For instance, there may be many lesbian and gay people in the audience, but they won't necessarily wish to 'out' themselves publicly to express their experiences
- Even if you DO identify people from all these groups in a public consultation (the obvious example is a person in a wheelchair), there is no guarantee that that person knows about the wider needs and experiences of other people like themselves or, for example, people with other forms of impairments. The answers you get may not be representative.
- Lastly, of course, the needs of small communities can easily be drowned out by bigger and more insistent voices.
All this points to the need to seek out more specialist organisations who should have the depth and breadth of experience to give authoritative input.
Again, however, it is very easy to get this wrong too.
- Firstly, how do you know that the group you've chosen is properly representative? Is consulting with them going to upset other parts of that community?
- Lack of forethought can also mean that managers seeking input don't get the full picture. How do you plan for the people you are engaging with to give of their best? How much time do they need to prepare or follow-up? How much time can they actually afford to give, without you supporting them in practical ways to do that?
- Lack of insight into the stakeholder's view of the process can also mean that organisations fail to appreciate the burden they're imposing on people with limited resources. The result can be 'consultation fatigue' and disengagement. We've spoken to organisations who've said they just couldn't respond to every 100 page consultation document which plops through the door. In the North West alone there are well over 100 organisations who might be wanting to consult the same small charity. Yet, if they don't reply, are the people at the other end simply assuming that everything is fine?
The Health Equality Stakeholder Approach
The methodology we created addresses all of this and more. It's a complete philosophy for how to engage with third sector equality stakeholder organisations in a way that recognises the needs of both sides.
At the heart of the approach is the almost radical commitment to commission this work on a financially viable basis from the best organisations in class, and to embody everything required for a full year's committed engagement in a formal Service Level Agreement with each one.
The approach embodies seven easy steps for public sector organisations like NHS Trusts to follow:
- Decide on which kinds of expertise you need to cover all the diverse groups in your area (including the ones sometimes referred to mistakenly as 'hard to reach')
- Decide on some sensible selection criteria. (We supply a complete set to adapt)
- Decide how much work is involved ... how many days of time you want to buy over the life of the agreement
- Work out a fair going rate for that time
- Conduct a fair and objective procurement exercise to locate possible partners, shortlist and select one of each type
- Set up an SLA with each partner
- Design the engagement activities in a way that develops the expertise of the partners. That way, over time, they give even better advice. The methodology contains advice on how to structure engagements to do this.
A complete success
We developed our approach in the autumn of 2008 and issued the first set of agreements in time to begin consultation exercises in January 2009. Now, in 2011, we are about to embark on a third year of operation.
In the first year we consulted with our partners on a wide range of topics - a dozen in all - kicking off with the SHA's ten year workforce and education strategy.
The methodology paid off straight away, through allowing the preparation time, in-depth face to face discussions, and written follow-up and evidence submission that our 3 day 'set piece' format allowed.
Over the course of time we also noticed how stakeholders who were essentially activists with very specific issues on their minds began to provide ideas in a more strategic way. As they began to understand how the health economy works, they tended to present thought through practical solutions, rather than simply lists of problems.
The SLA doesn't just provide for big 'set-piece' consultations. It also has time built in to fund ad-hoc telephone support. This means nobody feels guilty or imposed upon unfairly by contacting our expert stakeholders for quick advice on a policy matter. Time was also built in for each stakeholder partner to carry out a specific piece of research for us in their own specialist area. We also used everyone's resources to provide the research to stock our 'HELP' library.
Success is judged from two perspectives: whether we felt it worked for us, and whether the stakeholders felt it worked for them. At the end of the first year we carried out a thorough audit on the value for money and effectiveness of the approach. The returns were excellent. And both our own managers and (just as importantly) the stakeholders gave glowing feedback.
How to set up your own HESE
As I explained at the outset, the goal in setting up our own Health Equality Stakeholder Engagement arrangements wasn't just to meet our own needs. The project (designed by me) included detailed documentation on every step. The publication "An Equal Partnership" is therefore a complete 'How to' manual for anyone who wishes to repeat our success.