LHINs a critical engagement opportunity
Wednesday, January 24, 2006 -- Peter Pula
The Ontario government’s initiative to recreate how it plans and funds health care is shaping up to be an extensive stakeholder engagement effort.

The first steps in the LHINs were to hold open spaces meetings in 14 regions, each included 300-400 people. During these sessions, seated in a circle in a large room, participants were invited to step into the centre and write on a large piece of paper the health care issue they felt most needed to be addressed. As they left the circle, large piece of paper in hand, they announced their issues by microphone to the entire gathering. Those who did this then posted their issues on the wall, and were then to lead a session on that topic sometime during the day. Session leaders negotiated with other each other to combine sessions if necessary and to sort out scheduling. Then the rest of us visited the wall, self-scheduled which discussion groups we would attend and the games were on.

After the sessions were over, session leaders typed a summary of their group’s discussion and this summary was posted on the wall again, with an envelope beneath it. When all of the summaries were posted a marketplace of discussion followed. Each participant was provided a number of votes, and we could put as many as two votes into any one envelope to vote that issue to the top of the region’s agenda.

The votes were tallied and the top ten issues were then considered to be the top priorities for the region. Volunteers were then sought to join a planning group in each of the ten top priorities to work into the details of getting the issues addressed.

The process was extremely organic and emergent. It naturally identified leaders, and provided them a vehicle and a small starting network of people interested in the same issues. Being self-organizing it was also motivating and engaging.

Approximately 20 planning partners in each LHIN met in the months that followed and prepared a planning report to the newly appointed LHIN leaders. Now, LHIN leadership in the regions continue to circulate and meet members of their community.

As the LHINs effort unfolds, if it continues to operate on the same principles as those early open spaces sessions, it has a hope of creating a completely different approach to health care. And a different approach is sorely needed. With the health care budget in this province exceeding our economic growth by 4% we have a serious need to find synergies, provide better health care options, with less money. To allocate an estimated 53% of our provincial budget to health care, a portion that seems likely to increase unless something is done, is a great danger to the ability of the province to manage its other social questions.

Only by creating a framework for involvement and providing the means for people from the grassroots up to meet each other, focus on the most pressing care needs they see, and to work with each other in new ways can the ‘system’ become vibrant and effective. Both the needs of people and the assets in our communities are increasingly diverse, and so they cannot be managed with a one-size-fits-all approach.

In time, provided the engagement piece of the initiative remains a top priority, grooves will develop, patterns will emerge that will help integrate smaller pieces into a larger system. This will take time and even when the patterns do emerge any supportive systems put in place must remain subject to change.

As in the open space gatherings, leaders will emerge from unexpected places.

The danger is in over-organizing. There is a fear of ambiguity and a patch-work of answers, but it is a fear we will have to become comfortable with for now, because the alternative, the inevitable hitting the brick wall in health care, is even more daunting.

We reside in a highly educated society. A well-facilitated engagement strategy is our best bet for tapping the wisdom of those closest to the needs and the community assets. It can also break down the silos and ideologies that set up artificial boundaries to an integrated health ecology.

Expectations have been raised as a result of the current engagement strategy. People expect to be involved and to be supported when they find successes. With 22 billion dollars to be flowed annually through the LHINs beginning in 2007, this is an engagement opportunity of immense importance and great potential.

Reprinted with persmission from commentary previously published at www.axiomnews.ca.