Changing health care with, for, or against the public: an empirical investigation into the place of the public in health service reconfiguration

Abstract

Objectives This study sought to understand the different approaches taken to involving the public in service reconfiguration in the four United Kingdom health systems. Methods This was a multi-method study involving policy document analysis and qualitative semi-structured interviews in England, Northern Ireland, Scotland and Wales. Results Despite the diversity of local situations, interview participants tended to use three frames within which they understood the politics of service reconfigurations: an adversarial approach which assumed conflict over scarce resources (change against the public); a communications approach which defined the problem as educating the public on the desirability of change (change for the public); and a collaborative approach which attempted to integrate the public early into discussions about the shape and nature of desirable services (change with the public). These three framings involved different levels of managerial time, energy, and resources and called on different skill sets, most notably marketing and communications for the communications approach and community engagement for the collaborative approach. Conclusions We argue that these framings of public involvement co-exist within organisations. Health system leaders, in framing service reconfiguration as adversarial, communicative or collaborative, are deciding between conceptions of the relationship between health care organisations and their publics in ways that shape the nature of the debates that follow. Understanding the reasons why organisations adopt these frames would be a fruitful way to advance both theory and practice.

Contributors are representative, as long as they agree: How confirmation logic overrides effort to achieve synthesis in applied health research

“…38 , 39 This may be particularly necessary for applied health research settings, where a lack of awareness of or resistance to involvement can significantly limit the potential for impact. 40 Indeed, definitions of impact themselves are likely to vary depending on the logics held around public involvement, as demonstrated in health service improvement by Greer and colleagues, 41 and these therefore need to be surfaced and understood.Frameworks for involvement that acknowledge the different roles, processes and impacts that can be anticipated could be usefully employed to support this (e.g., Oliver et al 42 and Harris et al 43 ) Poland et al 44 adopted a critical case analysis approach to make visible the challenges and conflicts of embedding PPI in a health research programme, to explicitly discuss how different ways of knowing were managed and reconciled, observing that such work is rarely reported. Irrespective of value and impact, it can also be argued that it is unethical for current systems to fail to transparently report decisions back to contributors and that an accountability mechanism should be introduced, which ensure that researchers communicate their decisions back to contributors themselves, which should be followed by facilitating a meaningful dialogue between the two groups.The contributor co‐authors in our team reflected on how hearing at a later time or second hand that their input had been disregarded could severely damage their trust and willingness to engage in the future.…”

“…38,39 This may be particularly necessary for applied health research settings, where a lack of awareness of or resistance to involvement can significantly limit the potential for impact. 40 Indeed, definitions of impact themselves are likely to vary depending on the logics held around public involvement, as demonstrated in health service improvement by Greer and colleagues, 41 and these therefore need to be surfaced and understood.Frameworks for involvement that acknowledge the different roles, processes and impacts that can be anticipated could be usefully employed to support this (e.g., Oliver et al 42 and Harris et al 43 ) Poland et al 44 adopted a critical case analysis approach to make visible the challenges and conflicts of embedding PPI in a health research programme, to explicitly discuss how different ways of knowing were managed and reconciled, observing that such work is rarely reported.…”

Participatory codesign of patient involvement in a Learning Health System: How can data‐driven care be patient‐driven care?

“…Such a process is likely to be crucial in achieving the goal of a ‘trusted and valued’ LHS, recognizing that trust is relational and negotiated 48 . This will require professionals, including academics, who are involved in data‐intensive research, to more mindfully consider how and why they are engaging with patients and the public, as aiming to ‘persuade’ the public of benefit can be in conflict with aims to work collaboratively with them 49 . The latter approach requires understanding that ‘trust’ cannot be established as a discrete and static quality of the system that can then be communicated to patients, but is instead a dynamic process that occurs with patients.…”

Integrating evidence and public engagement in policy work: an empirical examination of three UK policy organisations

“…Questioning the value of public engagement is evident in adversarial approaches (Greer et al 2020) and agonistic modes of participation (Dean 2019), in which there is significant distrust of participation processes. For many Cluster 3 interviewees, distrust stemmed from a concern with generating 'robust' data in line with organisational approaches to evidence and data.…”