Educating the educated – and improving public engagement
Why do highly intelligent and accomplished professionals get things wrong? Of course, everyone makes occasional mistakes – the surgeon operating on the wrong body part, the consultant not spotting the deteriorating patient – but I’m thinking of things where many of them get it wrong a lot of the time. In particular, public engagement.
There have been a number of examples recently, involving experienced academics and medics. First there was the event to get feedback from stakeholders on regional plans for research. Mostly, it was a professionally run event. But from the engagement perspective, opportunities for input were very limited: nothing before and after the event itself and general discussions in groups of 20 (and, incidentally, no offer of expenses for members of the public and those there in a voluntary capacity).
Then there was the experienced GP, talking about primary care networks. Though clearly committed to public engagement, he talked about going away to set things up and only coming back after a year or two to ask for help from the patient participation groups, rather than engaging with patients from the start. He also spoke rather disparagingly about not asking for help on GP funding (the DES) as patients wouldn’t understand it. To be fair, he couldn’t be expected to know how members of the public have got to grips with much more challenging topics in citizens’ juries and citizens’ panels.
There was the event described as ‘co-production’ when it was no more than (quite mediocre) consultation. And the GP surgery not accepting they have a problem with appointments (despite the national GP patient survey showing a statistically significant gap with the CCG and national averages) and refusing offers of help to address the problem.
So why do they get it wrong? In one way there’s no mystery: public engagement is not within their sphere of expertise; they don’t necessarily have any experience of it and they don’t know what they don’t know. Like many things, you can muddle through, use common sense and copy what you’ve seen done elsewhere. But good public engagement isn’t simple and straightforward and many of the examples people will copy may themselves not be very good.
But lack of awareness and not knowing what to do may not be the only reason they get it wrong. There may also be a lack of will. I don’t think this is as straight forward as a simple cynicism and tokenistic approach. I suspect there is a spectrum in terms of the degree to which people lack commitment and the reasons for their view. A few maybe are completely sceptical. But perhaps (and I don’t have any hard evidence for this, just listening to what people say and watching how they behave) there are more who see something in it, are prepared to go along with it or think it could in theory have benefits. However, it takes resources, carries risks and has no guarantee of bringing benefits. So, it is not a priority.
I also suspect there is generally an instrumental perspective. Any value in public engagement is seen as learning something you didn’t know (because patients are ‘experts’ in their own experience), and then changing something as a result. One response to this is to work with the professionals to make sure all engagement is as effective as possible and leads to valued results. While that is probably not a bad thing to do, the risk is of stripping the positives to this one, instrumental aspect and ignoring other benefits like increasing accountability, greater confidence and wellbeing through participating in engagement, more social capital and releasing resources through co-production. By being involved, patients and members of the public may feel more engaged and bought into management of their own health – critical if we want people to do more to keep themselves healthy.
So, how do we get the various professionals to be more committed to patient and public engagement and to do it more effectively? An important start is to understand what their view of it is and why they hold it (which may be difficult because being against public engagement is not the kind of thing it’s generally acceptable to declare). It may then be necessary to increase their awareness and knowledge. Rather harder is to develop their individual and organisational skills to be able to do it better. Or alternatively to signpost the availability of such skills externally, such as by contracting an external facilitator.
But before launching into any of those approaches it may be worth revisiting the argument being advanced here and apply it to this situation. Even if I, or you, do know how to do engagement better than any given medics, academics or managers, it doesn’t mean we know best how to, or are practically able to, change the professionals and their organisations. Who are the experts and those best experienced in organisational change? It may be the organisations themselves (assuming we’re not going to pay management consultants to come in and do it for them), or certain individuals within them.
So perhaps the best approach is to engage with the professionals: to sit down and discuss it. To have an honest conversation. To set out the benefits but recognise the costs and pitfalls. And to offer help if they do genuinely want it, to improve their approach to public engagement.