As we seek to address the rising demand on our services, one of CMDHB’s biggest challenges is how we empower members of our community to take charge of their own health and make the choices that will keep them well and out of hospital. We could build the best and most efficient health service, but if people continue to take risks with their health and continue to use services not to keep themselves healthy but only when they are in crisis, then we will be no better off. Unfortunately, it’s not as simple as telling people they need to eat well and move more. If it was, we’d all be healthy and active with a perfect BMI and we wouldn’t need campaigns like 20,000 Days to address the rising demand for hospital services. It’s also not a case of the problem being solved by us as a health system becoming more technically efficient. The problems we’re facing are much more complex and require us to think about how we engage and empower patients and their families to take charge of their health. It also needs a plan – it isn’t something that will happen automatically or by accident.
This week, we’ve hosted Hahrie Han at Ko Awatea. Hahrie is an Assistant Professor of Social Sciences in the Department of Political Science at Boston’s Wellesley College. She’s also acted as co-convenor of a Policy Advisory Committee for Obama’s 2008 campaign and helped design his campaign. I am sure you will remember the dramatic images of the campaign and how people previously uninvolved in politics helped shape history and elect the first African American to the presidency – something many people thought would never happen.
She’s been working with us to share her expertise around mobilizing communities of interest – some of you may have heard her public talk earlier in the week. Today I’ve asked her to tell us more about her work around Organising, which we are beginning to apply in order to engage and mobilise our community to break the mould and take charge of their health.
One of the basic ideas of Organising is that people and communities are more powerful when they work together than when they work alone. So Organising works by developing leaders, creating a community around those leaders and drawing power from that community. The key lies in bringing people together to generate more power than they would have working alone so that the community can act on its own behalf.
As I have learned from my mentor Marshall Ganz, Organising is based on five key leadership practises: teaching people to develop a narrative or story in such a way that will inspire others to take action and get involved too; building relationships which foster a shared commitment to work towards a common goal; creating a structure (team) in families and communities within which people can work towards those shared goals; strategising to turn what you have into what you want; and taking action in a meaningful and measurable way.
Organising is one of many different ways to make social change, but it is particularly useful when the people who want to make change do not have the resources to do it alone. This is relevant for some of the work CMDHB is doing and the challenges around community engagement and health promotion that CMDHB is confronting. Solving these problems is not just about providing services but also developing capacity to create new resources that can help communities become accountable for their own health and wellness. There are also a diverse group of stakeholders that need to come together around a shared vision to take common action. We have begun developing nine leaders – CMDHB staff who have completed a distance learning course focusing on the Organising approach which is offered by Organising For Health. These emerging leaders seem energised about what they’ve learnt and excited about applying it to their workplaces , and also spreading it out into communities. They will form the core team for planning, mobilising and building our capacity to implement.
I’ve been really pleased during my visit here to see that Geraint and CMDHB’s Executive Leadership Team are focused on working with the community to develop its capacity in new ways. You’ve recognised that you need to change and reconsider the way resources are allocated in future. Organising works well when people are willing to recognise power imbalances which exist and think about reconfiguring the way resources are distributed.
As Hahrie has mentioned, this approach will help us develop the way we work with our community, be it in regards to patient safety, our 20,000 Days campaign or other pieces of work. It’s not simply about us providing services and assuming that our patients will feel confident and empowered to use them correctly – if that were the case, ED attendances would not be increasing in the way that they are. We have to think radically differently about how we engage with people. What skills and capacity do we have to develop? How and where do we empower communities and patients? What opportunities do we need to create so that people can take more control of their own health?
We want patients to be the experts at managing their own health and welfare. If members of our community can take control of their health, not only will they enjoy better wellbeing and continue to work, but we’ll also be able to better manage the demand for healthcare. Remember the patient I mentioned a couple of weeks ago who had been given $3500 of medication but had no idea what to take or why it was important? I’d love to get to a point where people like him go to their doctor and ask what they have to do to maintain and improve their health, rather than operating in crisis mode and getting lost in a system which can be disillusioning and disempowering.
Part of delivering Better, Sooner, More Convenient services is allowing patients to determine what is better, sooner and more convenient for them. As we strive to become excellent, we need to also empower our community so that change is happening with them rather than to them.
I would be really interested in your thoughts – firstname.lastname@example.org.