Rural health services and the task of community participation at the local community level: a case study
Elena Wilson A B , Amanda Kenny A and Virginia Dickson-Swift AA La Trobe University, PO Box 199, Bendigo, Vic. 3552, Australia. Email: a.kenny@latrobe.edu.au; v.dickson-swift@latrobe.edu.au
B Corresponding author. Email: e.wilson@latrobe.edu.au
Australian Health Review 42(1) 111-116 https://doi.org/10.1071/AH16169
Submitted: 27 July 2016 Accepted: 9 December 2016 Published: 30 January 2017
Abstract
Community participation in health service decision making is entrenched in health policy, with a strong directive to develop sustainable, effective, locally responsive services. However, it is recognised that community participation is challenging to achieve. The aim of the present study was to explore how a rural health service in Victoria enacts community participation at the local level. Using case study methodology, the findings indicate that enactment of community participation is desired by the health service, but a lack of understanding of the concept and how to enact associated policy are barriers that are exacerbated by a lack of resources and community capacity. The findings reveal a disconnect between community participation policy and practice.
What is known about the topic? The need to involve communities in health service planning, implementation and evaluation is a feature of health policy across major Western countries. However, researchers have identified a dearth of research on how community participation is enacted at the local service level.
What does this paper add? The study that is presented herein addresses a gap in knowledge of community participation policy enactment within a rural health service. Insights are provided into the challenges faced by rural health services, with a disconnect between policy ideal and the reality of implementation.
What are the implications for practitioners? Health service staff need clear direction from chief executive officers about the purpose of community participation policy and the expectations for individual roles. Community advisory committees need clarity about the community member role and the processes for making decisions. Services and their boards would benefit from targeted government funding to resource community participation activity.
Additional keywords: partnering with consumers, policy.
References
[1] Kenny A, Hyett N, Sawtell J, Dickson-Swift V, Farmer J, O’Meara P. Community participation in rural health: a scoping review. BMC Health Serv Res 2013; 13 1–8.| Community participation in rural health: a scoping review.Crossref | GoogleScholarGoogle Scholar |
[2] Kulig J, Williams A, editors. Health in rural Canada. Vancouver: UBC Press; 2012.
[3] Australian Commission on Safety and Quality in Healthcare. Australian charter of healthcare rights. 2008. Available at: https://www.safetyandquality.gov.au/wp-content/uploads/2012/01/Charter-PDf.pdf [verified 27 July 2016].
[4] World Health Organization Ottawa charter for health promotion. Charte d’Ottawa pour la promotion de la santé. Canadian J Public Health 1986; 77 425–30.
[5] Department of Health. Doing it with us not for us: strategic direction 2010–2013. Melbourne: Department of Health Victoria; 2011.
[6] Kilpatrick S, Cheers B, Gilles M, Taylor J. Boundary crossers, communities, and health: exploring the role of rural health professionals. Health Place 2009; 15 284–90.
| Boundary crossers, communities, and health: exploring the role of rural health professionals.Crossref | GoogleScholarGoogle Scholar |
[7] Eversole R. Community agency and community engagement: re-theorising participation in governance. J Public Policy 2011; 31 51–71.
| Community agency and community engagement: re-theorising participation in governance.Crossref | GoogleScholarGoogle Scholar |
[8] Australian Commission on Safety and Quality in Healthcare. National safety and quality health service standards. Sydney: ACSQHC, 2011.
[9] Department of Health Victoria. Victorian Health Priorities Framework 2012–2022. 2013; 1-92. Available at: https://www2.health.vic.gov.au/about/publications/policiesandguidelines/vic-health-priorities-framework-2012-22-rural-plan [verified 16 December 2016].
[10] Greenfield D, Hinchcliff R, Banks M, Mumford V, Hogden A, Debono D, Pawsey M, Westbrook J, Braithwaite J. Analysing ‘big picture’ policy reform mechanisms: the Australian health service safety and quality accreditation scheme. Health Expect 2014; 18 3110–22.
| Analysing ‘big picture’ policy reform mechanisms: the Australian health service safety and quality accreditation scheme.Crossref | GoogleScholarGoogle Scholar |
[11] Kenny A, Farmer J, Dickson-Swift V, Hyett N. Community participation for rural health: a review of challenges. Health Expect 2014; 18 1906–17.
| Community participation for rural health: a review of challenges.Crossref | GoogleScholarGoogle Scholar |
[12] Murray Z. Community representation in hospital decision making: a literature review. Aust Health Rev 2015; 39 323–8.
| Community representation in hospital decision making: a literature review.Crossref | GoogleScholarGoogle Scholar |
[13] Australian Commission on Safety and Quality in Health Care (ACSQHC). National safety and quality health service standard 2: partnering with consumers – embedding partnerships in health care. Sydney: ACSQHS; 2014.
[14] Poole N
[15] Pearson DDR. Victorian Auditor General’s Report, October 2012, Consumer participation in the health system 2012. Available at: http://www.audit.vic.gov.au/reports_and_publications/latest_reports/2012-13/20121010-partcipation-health.aspx [verified 19 July 2016].
[16] Balding C. Small rural and remote hospital issues with implementing the National Safety and Quality Health Service Standards Project: final report. Canberra: Australian Commission on Safety and Quality in Healthcare; 2012.
[17] Roos I
[18] Dunston R, Lee A, Boud D, Brodie P, Chiarella M. Co-production and health system reform – from re-imagining to re-making. Aust J Public Adm 2009; 68 39–52.
| Co-production and health system reform – from re-imagining to re-making.Crossref | GoogleScholarGoogle Scholar |
[19] Clark R. Government response to the Auditor-General’s Reports issued during 2012–13. Treasury and Finance Victoria: Melbourne: June 2014.
[20] Stake RE. The art of case study research. Thousand Oaks, CA: Sage Publications; 1995.
[21] Hyett N, Kenny A, Dickson-Swift VD. Methodology or method? A critical review of qualitative case study reports. Int J Qual Stud Health Well-being 2014; 9 1–12.
[22] Australian Bureau of Statistics. Census of population and housing: Socio-economic indexes for areas (SEIFA), Australia. 2011. Available at: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/2033.0.55.0012011?OpenDocument [verified 19 July 2016].
[23] Australian Commission on Safety and Quality in Health Care (ACSQHC). NSQHS standards guide for small hospitals. Sydney: ACSQHC; 2013.
[24] Ovretveit J. The contribution of new social science research to patient safety. Soc Sci Med 2009; 69 1780–3.
| The contribution of new social science research to patient safety.Crossref | GoogleScholarGoogle Scholar |
[25] Attride-Stirling J. Thematic networks: an analytic tool for qualitative research. Qual Res 2001; 1 385–405.
| Thematic networks: an analytic tool for qualitative research.Crossref | GoogleScholarGoogle Scholar |
[26] Bowen GA. Document analysis as a qualitative research method. Qual Res J 2009; 9 27–40.
| Document analysis as a qualitative research method.Crossref | GoogleScholarGoogle Scholar |
[27] Fereday J, Muir-Cochrane E. Demonstrating rigor using thematic analysis: a hybrid approach of inductive and deductive coding and theme development. Int J Qual Methods 2008; 5 80–92.
[28] Nunn J. ‘Consumer’ should be a taboo word in public services. Health Issues. 2015; 114 38–40.
[29] Martin GP, Finn R. Patients as team members: opportunities, challenges and paradoxes of including patients in multi-professional healthcare teams. Sociol Health Illn 2011; 33 1050–65.
| Patients as team members: opportunities, challenges and paradoxes of including patients in multi-professional healthcare teams.Crossref | GoogleScholarGoogle Scholar |
[30] Eversole R. Knowledge partnering for community development. New York: Routledge; 2015.
[31] Broussard M, Blackwell R, Caillouet LP, Nichols KH, Shipman M. Connecting our resources: Louisiana’s approach to community health network development. J Rural Health 2003; 19 372–83.
| Connecting our resources: Louisiana’s approach to community health network development.Crossref | GoogleScholarGoogle Scholar |
[32] Rifkin SB. A framework linking community empowerment and health equity: it is a matter of choice. J Health Popul Nutr 2003; 21 168–80.
[33] Perkins D. The Australian health care reforms: better services for rural residents? Aust J Rural Health 2011; 19 57–8.
| The Australian health care reforms: better services for rural residents?Crossref | GoogleScholarGoogle Scholar |
[34] Standing Council on Health. National strategic framework for rural and remote health. Canberra: Commonwealth of Australia; 2012.
[35] Johns S, Kilpatrick S, Whelan J. Our health in our hands: building effective community partnerships for rural health service provision. Rural Soc 2007; 17 50–65.
| Our health in our hands: building effective community partnerships for rural health service provision.Crossref | GoogleScholarGoogle Scholar |
[36] Kilpatrick S. Multi-level rural community engagement in health. Aust J Rural Health 2009; 17 39–44.
| Multi-level rural community engagement in health.Crossref | GoogleScholarGoogle Scholar |