From community involvement to community engagement
From a report by the Robert Wood Johnson Foundation
There are three ways to create impact in a community:
Minimal Power Sharing: Community-informed engagement ignores differences in power. Addressing power dynamics is seen as beyond the engagement’s scope of purpose. The focus is on imparting information about policies or programs that are already planned or in place or extracting information to inform policy changes prioritized by the institution without community input. Institutions are the sole sources of information and knowledge. The goal is to keep communities informed and/or encourage specific actions. Examples: presentations, brochures, educational materials, media, public relations events.
Some Power Sharing: Community-involved engagement recognizes power dynamics without fully addressing them. The agency works with communities and trusted messengers to align the needs of the community with the engagement efforts and collect feedback. Community knowledge and expertise is recognized. There is a degree of exchange of ideas between some communities, particularly those who are deemed “easy to reach,” and the agency. Community members are offered limited channels through which they can influence decision-making and priority setting. These efforts often focus on a narrow aspect of a program or policy that has little flexibility to adopt significant input. Examples: Community focus groups, surveys, advisory councils or workgroups which include community members alongside healthcare providers and/or other stakeholders; town halls; public comment periods; public hearings.
Maximal Power Sharing: Community-driven engagement intentionally acknowledges traditional power dynamics by enacting processes to neutralize or subvert power imbalances. Community voices are recognized, treated as experts, and lead the agenda. Community members collaborate with the agency to form ideas and prioritize issues. Agencies provide infrastructure, financial support, and a commitment from leadership to support inclusive engagement and partnerships with diverse communities. The engagement’s design, priorities, implementation, ownership, and accountability are shared between the agency and community members through collaborative participation and ongoing relational partnership. Such efforts often address imbalances in knowledge by ensuring meetings are conducted in plain language and participants are offered support or background information in advance. Examples: Community-based participatory research and budgeting, democratic processes, robust consumer advisory boards, and building consensus.
Community-driven engagement is central to addressing the systemic inequities and structural discrimination entrenched in systems. By fostering trust and mutual respect, exposing unforeseen or unintended barriers, and improving program efficacy by accounting for the experiences of the people impacted by programs and policies, community-driven engagement can promote equity.
Transformational community-driven engagement shares power with community and is built on trust, transparency, and mutual accountability. Shifting power to the community can be done in a variety of ways. In addition to sharing decision-making power with the community, increasing access to the decision-making process is key.
Here is a case study from the USA that highlights a real world example of how health authorities can invest in coordinated community engagement strategies to amplify the voices of those directly impacted by policy decisions and drive improvements:
Virginia’s Department of Medical Assistance Services (DMAS) serves 1.25 million people (members). They instituted the following strategies to strengthen its member engagement initiatives.
1. Invest in internal capacity to support and carry out member engagement initiatives
Engagement work can be high impact and rewarding and, to be successful, requires sufficient staff and internal resources. One-third of the member engagement unit consists of part-time, wage-based Community Outreach Coordinators. These staff members are intentionally hired from the community and job requirements are tailored to accommodate their needs. At present, the role of these staff is to expand the agency’s capacity to build relationships with its members and the wider community. Their activities include supporting evaluation of measurable outcomes, strengthening the channels for member feedback, and strategic planning for the sustainability of community engagement workstreams.
2. Document existing work and establish a cross-agency workgroup to foster alignment and address gaps
Virginia’s program has historically focused on member outreach by strategic communications to improve education and dissemination of information. Now the agency is building a community engagement strategy that includes and distinguishes between outreach and engagement initiatives. These efforts within the agency are not always connected across departments or initiatives. Therefore, mapping existing efforts has been the first step toward implementing a coordinated community engagement strategy. The goal will be alignment of all community engagement activities regardless of which unit is spearheading the effort.
3. A robust Member Advisory Council (MAC)
The MAC has been active for four years. The current charter emphasizes the MAC’s role as an advisory group to the Director to provide “insights and recommendations” to affect tangible change for Virginia’s population.
4. Require regular attendance of Executive leadership at MAC meetings
The Director reinforces the influence of the MAC by attending all meetings. This is an intentional and overt signal to members that agency leadership is listening to and addressing their feedback. In addition to formal meetings, agency staff offer several channels for MAC members to provide feedback, for example through email and individual follow-up calls. Issues raised by MAC members that are not immediately resolvable are added to leadership agendas across the agency to include executive leadership. The Director has set the tone of the MAC by validating the importance of the issues raised by the MAC in communication with other state leaders and through concrete policy change.
5, Promote accountability through transparent tracking and reporting
Agency staff log all issues raised by MAC members. Issues are either resolved in subsequent meetings or, for issues that require more time to address, a status update is provided. A digital paper trail serves as an accountability mechanism ensuring members have a clear understanding of, if and how their participation yields change.
6. Intentionally recruit MAC participants to reflect diversity of member population
Staff and stakeholders who have direct interaction with members submitting complaints or feedback about their experience with the agency or care plans are encouraged to provide information about joining the MAC. This approach has yielded member candidates for the MAC. In order to further diversify the pool of applicants and better represent members across Virginia, the MAC has developed new recruitment strategies that tap into member engagement networks and leverage demographic data to benchmark representativeness.
7. Provide recognition of participation
DMAS does not offer direct compensation for participation on the MAC due to state limitations; however, transportation, hotel stays, and meals are provided. Member profiles are featured on the website and in newsletters (with members’ consent) and members receive certificates at the end of their term. Members have indicated that seeing changes in response to their feedback makes them feel valued
Read the full report and case studies here.
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From a report by the Robert Wood Johnson Foundatio, 11/04/2023