Meaningful community engagement will foster the support you need to transform services
Jason Helgerson, the man at the helm of New York State’s Medicaid programme, has spent his professional life driving health and social care transformation in the United States. Here he shares why he believes STPs can improve care and contain costs in a way that’s supported by local communities.
Are you scared yet? NHS England has asked you to do the impossible: transform health and social care without enough money. As if that isn’t enough, the organisation is asking you do it in a highly charged political environment and demanding that you engage the community in plan development and implementation. All of this all the while doing your day job, because there is no one else to care for the public while you try to plan for the future. In America, we call this trying to build the airplane while flying it.
Is your task impossible? I dare to say it is possible. I think you and your community partners can actually develop a sustainability and transformation plan (STP) that can both improve care and contain costs. I also think you can do it in a way that is supported by your community.
At this point you may ask: Jason, have you been trying some medical marijuana? Nope. I just believe – based on personal experience here in New York and elsewhere – that transformation, even in the most difficult of budget environments, is possible. In fact, I think it’s easier to do when your back is up against the wall and you have no other options.
I especially believe this to be true in your case. This is England we are talking about, right? The nation that built one of the world’s most cost effective healthcare systems while digging itself out from the worst war in human history. If you can build the NHS, you can certainly save it.
So, what do I recommend? First, you must own the problem. Each of the 44 STP ‘footprints’ (I strongly suggest you don’t call yourselves a ‘footprint’) must first accept that this cost and quality challenge is yours and that only you and your community partners can solve it. Dwelling on the problem gets you nowhere.
Next, you must decide that while you own the problem you are not the keepers of all good ideas and in fact the ‘solution’ must be developed through meaningful community engagement. This requires you and the leaders of your effort to LISTEN. You must develop a community engagement process in which you not only gather feedback but actually integrate that feedback into the plan you ultimately implement.
Many community engagement efforts hold public hearings, create websites and host meetings and say they care about what the public thinks but ultimately ignore the advice they receive. This false approach often leads to overall project failure for two reasons. First, it often ignores good ideas, and second, prevents the possibility of key stakeholders actually seeing themselves in the final product. This second point is crucial. The path to community support is found when the community actually sees its ideas reflected in the plan.
Why is community engagement so often neglected? The reason is most often fear that if you ask the public and the provider community what they want out of their health and social care system, they will ask for the impossible. Their demands will far exceed the budget or they will want outcomes that are simply impossible to meet.
My response to this fear is that – based on my own experience – the public is usually very reasonable and that if you frame the questions appropriately, you get the feedback you need.
We human beings are pretty good at weighing trade-offs and picking options. Every day we live in a world with limited resources – not all of us are as wealthy as J.K. Rowling – so we are good at weighing the pros and cons in tough decisions. We may not always make the right decision but I believe that an effective community engagement process can get you constructive feedback, good ideas and help you build community support.
So what gives me confidence in saying you can be successful in this difficult endeavour? For the last ten years, I have spent my professional life driving health and social care transformation in the United States. I have done it in two states and under the worst of budget situations. I have found ways to bend the cost curve while also achieving community-wide consensus and I have seen measureable improvement in patient outcomes.
While the ‘solutions’ in each state in which I worked were different – no two communities face the same challenges – the process for developing the solutions was the same: meaningful stakeholder engagement implemented in a thoughtful, rigorous and transparent way so as to ensure that the impacted community actually sees itself in the final product.
I have suggested some process tips for how to pursue successful community engagement. I wish you the best of luck and look forward to seeing the tremendous work coming from each ‘footprint’ in the coming weeks and months to come. That said, I do hope you call yourselves something other than ‘footprint’.
Jason Helgerson is New York State’s Medicaid director. Follow him on Twitter @policywonk1
Originally posted on the NHS Confederation website