SHA Engagement Framework

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SHA Engagement Framework Circle. Click to enlarge.

SHA Engagement Framework Circle. Click to enlarge.

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The Engagement Framework is portrayed as a wheel, reflecting that engagement is a non-linear process with many interconnected parts. The wheel rotates clockwise around the centre circle beginning in the east and travelling to the south, west and north.

The framework begins in the centre circle with People-Centred Engagement, putting people and communities at the centre of health systems. Evidence shows that when this is done, health systems are more effective, cost less, they improve health literacy and engagement and are better prepared to respond to health crises. The middle circle represents the key elements in an engagement process, adapted from the steps of engagement outlined by the International Association for Public Participation (IAP2). These steps can be used for all levels of engagement planning, from creating an overarching vision of engagement strategies, to more detailed planning for particular sessions. The outer circle illustrates the Saskatchewan Health Authority's (SHA’s) key engagement groups. Each group is distinct yet overlapping, with both unique and complementary approaches to engagement.

The Engagement Planning Worksheet below can be used to support your engagement planning. 

The components of the engagement process are:

1. Commitment to engagement: reasons and purpose of engagement
2. Who to engage: engagement partners and level of engagement
3. Plan for engagement
4. Engagement actions: engagement methods and techniques
5. Learn from experience: engagement outcomes and evaluation
6. Report back

Engagement process

1. Commitment to engagement: reasons and purpose of engagement

Before developing an engagement plan, it is important to reflect on and document:

1. Your reasons for engaging and desired outcomes of engagement. These could include:
   • Enabling patients, residents, families, and communities to be partners in decisions that affect their health.
   • Improved quality of care by early identification of critical issue 
2. Your commitment to engagement. This includes your overarching commitment to the principles of engagement, as well as your commitment to using engagement outcomes in planning and decision-making.
3. How to build relationships in places where trust has been damaged. 
4. The risks of engaging and mitigation strategies for these risks, as well as the risks of not engaging.
5. The benefit of engagement to your key milestones.

2. Who to engage: engagement partners and level of engagement

Engagement can range from single events to ongoing engagement with specific groups. Identify which key partners or populations you need to learn from in order to improve your service delivery and approach. Use an equity lens and think about whose voice is underrepresented in service delivery. Consider the issues or needs of partners and to learn how they want to be involved, what their expectations are, and what success would look like to them. Consider how you will engage respectfully with groups such as First Nations and Métis partners and how you can help to overcome barriers to engagement with underserved populations. Before attempting to engage, ensure you have taken the time to create an engagement-prepared environment.

The Partnership Map can help identify which sub-population groups might be disproportionately affected and/or who experience the highest social and health inequities. Parties could include:

• Patients, residents, families, and health care workers
• Community-based organizations, municipalities, community associations and rural communities
• First Nations and Métis Communities and/or organizations
• Intersectoral partners (e.g. Education, Justice, Social Services), businesses and faith-based groups

In choosing partners to engage with, consider:

• Existing/ongoing commitments to partners or groups as well as establishing new relationships;
• Established forums and approaches for engagement; 
• Groups that may benefit from more tailored approaches (e.g. First Nations and Métis); 
• Staff, physicians, and other care providers.

Reflect on the relevant level of engagement for each opportunity: to inform, consult, involve, collaborate or co-lead (refer to the SHA Engagement Continuum). All levels of engagement are important and necessary. Decide which level is most appropriate and ensure you can justify that decision. Be transparent and ensure the goal and level of engagement is clearly understood by all parties and create clear expectations about how the outcomes of engagement can and cannot be used.

3. Plan for engagement

When creating your engagement plan, consider whether you have:

• Created an engagement-prepared environment.
• Incorporated trauma-informed approaches to engagement.
• Created psychological and cultural safety for participants.
• Considered how to include underserved and hard-to-reach populations.
• Considered how to meet people where they are at, both psychologically and geographically.
• Considered how to overcome barriers such as socio-economic limitations, and cultural differences.
• Identified the logistical and resource requirements and timeline for your engagement activities. 

Consider using the SMART principle to help develop objectives that are clear and measurable:

• Specific – state what will be done, the outcome expected and those involved;
• Measurable – define outcomes that can be measured;
• Achievable – ensure that the expectation is realistic;
• Relevant – determine outcomes that will support the overall goal of engagement; and
• Time sensitive – set an expectation related to when the objective will be achieved.

4. Engagement actions: engagement methods and techniques

There are many different techniques that can be used for engagement. The choice of techniques should factor in the differing needs of the people involved, the preparation needed, and the diversity and complexity of perspectives being captured. Where possible, design techniques with guidance from those who know the community or group you are engaging. Your engagement techniques should take into consideration what will help to restore trust and build better relationships, for example, identify gatherings already happening, such as community roundtables, and ask to be involved.

Considerations for engagement:

• Clarify and communicate your purpose and potential outcomes of the engagement session.
• Make sure those you engage with understand their value and role in the engagement process. Understand the needs and interests of those participating and share whatever relevant information you are able to with them.
• Communication, facilitation, and conflict resolution skills are important skills needed to engage effectively in face-to-face settings. Honestly assessing your strengths and weaknesses in engagement and connecting with others to support your engagement work will improve your chances of success.   
• Be flexible. Be prepared to adapt your engagement plan to unforeseen problems or needs. Your objectives, techniques, and population groups may shift based on the information you are learning. Engagement needs to be emergent, evolving and unique in each community and situation.
• Be personable and pay attention to relationships. This is just as important as, if not more important, than achieving your outcomes. Being as transparent, vulnerable, honest, and reliable as possible will help to build relationships and open doors to better collaboration. 
• Acknowledge and mitigate power differences where appropriate. Facilitate inclusivity and equal participation so all voices are heard. 
• Allow people to voice their anger. When people’s voices have been ignored and discounted and they are finally invited to be at the table, those voices are often angry, frustrated, or disappointed. 
• Try to build trust by listening, acknowledging, and demonstrating how things will be different. 
• Look for early wins in the engagement process that can help to build momentum. 
• Consider seeking support from other health system departments for planning and delivery of events. 

To request support with your engagement activities, please complete the Engagement Support Request form below.  

5. Learn from experience: engagement outcomes and evaluation

Outcomes of Engagement Sessions
The outcomes from engagement ensures that the voices of patients, residents, families and communities have an impact on the quality of services we deliver. In order to achieve maximum impact from your engagement activities, ensure you: 

• Involve patients, community, and other key population groups in identifying the lessons learned.  
• Consider where learnings can be incorporated into decision-making, planning, and implementation of strategies in order to improve quality of the services.
• Consider where learnings might be applicable to other health areas and how you will share those results.
• Integrate metrics of patient experience and patient outcomes into service delivery planning as well as planning for Accreditation.  

Evaluation of Engagement Sessions
Planning for evaluation should be done at the same time as planning for engagement. For each engagement opportunity, it is important to evaluate if the objectives were achieved in order to learn from experience. When planning the evaluation, consider how you will assess whether you successfully engaged with all relevant partners, especially sub-populations who may be disproportionately affected and/or who experience health and social inequities. It will be important to plan how to support inclusion of populations experiencing inequities in the evaluation (e.g. economic, literacy, cultural barriers etc.). Review evaluation data from each engagement opportunity and take steps to implement improvements to future engagement opportunities.  

6. Report back

Communicating with partners is critical to building trust and relationships that supports high quality engagement. Your engagement partners want to hear back from you; not doing so will further erode trust and make it unlikely that they will want to engage further. Provide your engagement partners with a report about what you heard and what you are doing with the information. Work with your partners to determine the best way to share the findings. Use language that is appropriate and consider ways to make data easily accessible (infographics, stories, etc.). Share your learnings from the engagement process and the plan to improve upon future engagement activities.