Improving the Health of Communities Through Participation

1. Improving the Health of Communities Through Participation Jane Farmer La Trobe University

2. National Standards • Standard 2: Partnering with Consumers • Partnership in service planning • Partnership in designing care • Partnership in service measurement & evaluation • Governance structures • Mechanisms • Actively involved in decisions making • Training for managers on how to create and sustain partnerships….

3. HWA Leadership Competencies • Leads self, engages others, achieves outcomes, drives innovation • SHAPES SYSTEMS – APPLIES SYSTEMS THINKING • Engages and enables consumers and communities (involves consumers and communities in decision-making, health policy, education and training and healthcare redesign) • Builds coalitions across silos, organisations and sectors

4. Arnstein’s ladder

5. Remote Service Futures: Involving citizens in service design

6. In a situation of protest & suspicion about changing service delivery models

7. Remote Service Futures Project 2 year project: 4 remote communities: 2 islands, 2 peninsulas (partnership with NHS Highland & Regional Development Agency) Ways of providing services Priorities & Planning Needs Skills People & Enablers Budget Self-care/volunteering Aspirations, Assets & Wants Budget Telehealth Remote, rural community Nursing models First responders Help-lines etc

8. Similar health & wants • Key Local Health Issues • Conditions associated with smoking • Associated with obesity • High blood pressure • Mental health • Key wants • Locally resident practitioners • How to deal with types of emergencies • Older people – anticipatory care • Improve local health (through volunteering/leadership)

9. Design Outcomes D A B C 1 GP 2 pt nurses 1 GP 1 pt nurse pt carers -GP in next village (50mins) -Peripatetic nursing team GP in next village (50mins) -2 local ft nurses before 1 GP pt nurse 3 pt carers -1 nurse practitioner -healthcare assistant -pt Intensive home carer -community volunteers -volunteer first responders New local practitioner with these skills: -health emergencies -social caring -leading community health -volunteering Low attendance at final workshop after Telehealth Volunteering Information Mobile phones

10. Process outcomes • Community health system literacy • What there is, when to use it • Who to approach • What to expect • How much it costs • “…it made me feel like I was managing the health service…it made me realise how complex it is…” • Satisfaction • Health culture competence

11. Issues with the Scottish Study • Inclusion • Sustainability • Scalability • When/how is a community decision made? • The role of the mediator • Changing structures • Democracy too far? • Communities are not homogeneous unities – • Heterogeneous disunities!

12. Warracknabeal Rural NorthWest Rochester Heathcote

13. What the managers seek to achieve • A governance process • Ongoing and sustainable • Or a project? • Community health • Better navigation of health services • To make friends with our community • To engage the community in itself and its health

14. The communities so far - characterisation Mapping health Don’t want to interact Highly supportive manager Many groups (150) Groups & ‘alternative groups’ History with the facilitator What represents risky behavour History of protest Doors & thresholds Excluded or disadvantaged groups One dominant group Many events Dichotomous/divided?

15. Inclusion • Groups and “alternative groups” • I feel like they are judging me • Affordable childcare • Activities for children that are affordable & with breastfeeding • Debt consolidation for smaller debts • Centrelink & Legalaid in small towns • Gym membership too expensive • Risky behaviour vs. risky behaviour “the counsellor told me to stop buying Take 5 magazine. I said its my little bit of time out. He said it was unnecessary. I didn’t go back.” “I’m worried about my husband and his mates and their risky behaviour” I said “what – drinking…?” She then told me about spotlighting!

16. Likely challenges • Management involvement, perceptions & wants • Scope creep • Tangential working • Personal distrusts • Tick the box syndrome • What to do with plans that have been built by different groups • What to do with the information? • What if it isn’t what managers want to hear? • Or isn’t in realms health services can deal with? • What structure is best capable here • Consultation isn’t enough; citizen power or even partnership isn’t possible without formal structure?

17. Positive Outcomes • Potential for rich, value-adding partnerships • Understanding community diversity • Understanding inclusion/exclusion • Community perceptions and constructions of data vs what seen in data • Data as a way to raise questions • Difficulties of system navigation • ‘I’ve learnt more about health in the past 3 months than I knew in 30 years as a health professional’ • Affecting health culture – but how, who…?

18. Comm. participation->Leadership • Have a clear process • Keep reminding participants of the type of process they are in • Consider how you will be able to use the information you get • Work with service & other partners from the start • Understand how difficult it will be • An ultimate goal would be to give disadvantaged people more knowledge about health and the health system & connections that helps raise their cultural health capital Shubin S (2010) Cultural exclusion and rural poverty in Ireland and Russia. Transactions of the Institute of British Geographers

19. Jane Farmer La Trobe Rural Health School j.farmer@latrobe.edu.au