Different ways for different purposes

Among the case studies, there were many different ways of involving consumers and hearing from
them. There was no ‘one best way.’ Hospitals and health services used a range of approaches to
obtain consumers views. These included:
• involving consumer representatives on planning committees;
• involving consumers in management committees, consultation committees, steering committees,
quality committees;
• working with consumer organisations on service planning;
• conducting workshops of staff and consumers;
• involving consumers in analysing complaints and making changes;
• establishing community forums;
• establishing hospital forums;
• consulting with consumers and communities;
• going out to consumers to the places where they meet;
• talking to individual consumers;
• conducting focus groups;
• performing patient surveys.
Different mechanisms worked for different groups of people, and for different purposes, but these
various ways were complementary. Adelaide and Illawarra have used patient surveys, for example,
alongside other forms of feedback and participation, but in the context of a broader strategy.
Consumers can participate by adopting various roles, and in a range of ways. Different consumers
will also feel comfortable about participating in different ways and at different levels.
Consumer participation can be part of:
• strategic planning;
• policy development;
• service planning;
• service delivery;
• quality management;
• service development; and
• review and evaluation.

Lesson 5: Hospitals need to use a range of ways of getting feedback from consumers
and involving consumers in participation.

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Board level consumer committees
One particularly thorny issue is the question of involving consumers at hospital board level, or in
advisory capacities to boards and other management structures, which in contemporary health
services are corporate in culture and structure. The Women's and Children’s Hospital, Adelaide, has
a consumer council on its agenda, but started its change process at service delivery and planning
level. In other words, there has been a bottom-up approach to consumer participation.
Illawarra is currently debating the way a consumer council might work, an idea it has accepted in
principle. But the initial work was done at a more grassroots level, establishing local consumer
processes. Consumers in Illawarra have wanted a say in how such a consumer council might work.
A tentative conclusion of this research is that consumer councils and such structures are not enough
on their own, and need to be accompanied by projects and processes at service delivery level. This
is because all sides to this partnership—consumers, nurses, doctors and other health professionals—
need tangible outcomes to be confident of the process. Consumers, like clinicians, need to see
tangible change. This also allows for a broader range of consumer participation and provides an
opportunity for consumers to develop confidence in their capacity and skill in representing consumers.
A demonstrated value of consumer input is the information they are able to provide on the concrete
impact of illness and health service delivery on everyday life.
In addition, the existence of processes for consumer participation at service-delivery level provides
a context in which consumer councils at hospital-board level are likely to be more effective.
It is clear that consumer involvement is different for different purposes, and the nature of consumer
representation will change with the structure and purpose, as chapter 2 argued. The type of consumer
representation on a consumer council is likely to require more experienced consumer representatives
with a feel for the detail and broader issues of policy and planning. The higher level committees are
likely to involve people from consumer organisations but the nature of this representation needs to
be negotiated, as hospital and consumer representatives can bring different perspectives to this. A
key issue for such structures is the potential for tension to arise between the confidential nature of
some hospital board business and the accountability of consumers back to other consumers. These
issues need to be carefully thought through.
What is necessary to make consumer councils and such bodies work effectively needs to be the
subject of further research.

Lesson 6: Consumer councils/advisory committees have an important role to play,

but they are unlikely to be effective, unless participation processes are in place at
service planning and delivery level, and there are processes in place to consult
with consumers. These high-level committees need to have a process of consumer
representation.

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