Consumer and community self-assessment project acute services 2002-03 - April 2004

Page contents: Contents | Background | Objectives | Methods | Findings | Reporting on consumer participation activities and outcomes | Download summary | Download document

Contents

Background

From 2001 all metropolitan health services were required to establish community advisory committees and develop community participation plans. The Department of Human Services recommended that audits of consumer participation be undertaken to inform their development. This project took place from March 2002 to November 2003, and sought to:

• dentify current levels of consumer and community participation (primarily in acute
  services)
• provide baseline data
• identify organisational capacity for change
• identify factors preventing further development of consumer and community
  participation in public health services.

Objectives

The objectives of this project were to:

• assist the conduct of consumer and community participation self-assessments in acute settings (other, non-acute services were also included, where resources permitted)
• evaluate the draft audit tool for hospitals (available from the National Resource Centre for Consumer Participation in Health)
• provide information about consumer participation to the Department of Human
  Services, all health services and their community advisory committees
• recommend refinements to the tool and self-assessment process, and identify action
  required for further development of consumer and community participation in public
  health services.

Methods

Participating health services
Five health services participated in this project (in alphabetical order): Austin Health, Bayside Health, Peninsula Health, Southern Health and Western Health. These are deidentified in this document, and referred to as H1, H2, H3, H4 and H5 — not necessarily in
order of site visit or the above list.

Respondents included middle managers of units, wards and departments, from a range of
clinical and professional disciplines.

Data collection and analysis
The project collected these data:

• semi-structured interviews — on the organisational context, staff attitudes, perceptions and beliefs (314 responses)
• self-assessment tool data — twelve questions on current and planned consumer
  participation activities (309 responses, which was a 97 per cent response rate)
• evaluation data on the self-assessment process and tool (307 responses).

Qualitative analysis was conducted on all data — individual, aggregated and comparative,
across the five health services.

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Findings

Attitudes to consumer and community participation
Most respondents (94 per cent) at all five health services indicated that they had an understanding of what was meant by consumer and community participation; that there was a range of processes by which staff could engage with consumers and the community to bring about beneficial outcomes for all stakeholders. These responses indicated very positive support for the philosophical underpinnings of consumer participation, that is, that the public health system should be responsive to and shaped by input from those who use it or might use it. The terminology however, was open to a range of interpretations, in particular, the term ‘consumer’.

The acute services context
The nature of the work and the type of patient in an acute setting was perceived by more
than half of the respondents (54 per cent) to influence the type and amount of consumer
participation that could take place. A small number reported that consumer participation
was a concept with limited application in their clinical area. Comparisons between acute,
sub-acute and chronic settings were made, with the general consensus that there was less
time in an acute setting to engage with patients and their carers than in non-acute areas.

Current consumer participation activities
Collaborative decision making for individual consumers (patients, their families and carers)
in acute and sub-acute settings was most likely to occur in family and patient meetings, where care, treatment and discharge options were discussed, needs stated and plans developed.

The most common consumer participation activities in all health services were provision of
information to, and seeking information from, consumers. Few respondents evaluated the
effectiveness of consumer participation.

Evaluation of the self-assessment tool and process
The process involved staff from a range of disciplines and raised awareness of consumer participation across all health services. Most respondents (93 per cent) perceived the results to be of benefit to their unit or department, and identified ways to improve their current activities.

Further development of consumer participation
Most respondents indicated that further development of consumer participation activities would be resourced through existing staff roles in the organisation, with some indication that additional time would be required. Only respondents from one health service explicitly stated that substantial additional resources were required to undertake further activities at the organisational level. These included resources for:

• planning and implementation of consumer participation activities
• policy development
• training and education for all stakeholders
• evaluation of current consumer participation activities
• payment for consumers to cover costs of participating
• funding for translations, printing and document production costs.

Respondents clearly stated they required additional resources to enable further development of consumer participation, including:

• commitment from Department of Human Services and senior health services
  management
• staff education and training in consumer participation theory and practice
• dedicated time
• skilled staff
• consumer availability and willingness to participate
• funds.

The full range of resources identified as required for the development of consumer participation are listed in the tables in the Recommendations section below.

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Reporting on consumer participation activities and outcomes

The five health services were at various stages in the development of a systematic organisational approach to consumer and community participation when the survey was undertaken. In their own ways, all were developing strategies to meet the needs of their local communities. All focused mainly on community participation via consultation with their community advisory committees (CACs). Consumer participation was addressed by some through strategies detailed in their community participation plans (CPPs), or through involvement in individual consumers or consumer groups in special projects or programs.

Organisational culture
All health services incorporate aspects of consumer and community participation into their mission, vision and values statements in order to promote this as an integral part of the organisational culture.

Policies
Consumer and community participation policies had yet to be developed in all of the health services — except for one health service, which had included a policy statement in its CPP. It is not known whether the intention was to communicate this policy to all relevant staff across the organisation, or if it was intended only for those who received a copy of the plan.

Skill levels
Designated staff in all health services had the skills necessary to further develop consumer and participation activities, including the CAC support staff, community integration manager, quality personnel and other senior management. Training for other (general clinical) staff across the organisations was not routinely offered, except for areas such as complaints and clinical risk management, multicultural awareness, privacy requirements and using patient satisfaction monitors. Further staff education could be developed and offered on consumer participation theory and practice.

Program/clinical division level (ward, unit and department level)
Two health services implemented their CPPs as an organisation-wide approach. This was achieved by involving program and clinical service unit directors in developing consumer participation strategies for their respective areas.

Structures and processes
All health services were well underway in the development of organisational structures for
community participation, including:

• full-time and part-time staff positions to support the CACs
• routine reporting to the community and consumers (for example, through quality of care reports).

Areas for attention included incorporation of consumer participation aspects into position
descriptions and performance appraisals. This needs to be linked to acquisition of relevant
skills.

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Consumer and community self-assessment project Acute Services 2002-03 - Summary - April 2004 (671kb, pdf)

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