Učešće javnosti u kreiranju sigurnog zdravstva

Sažetak

Ovaj članak je teorijska rasprava o poređenju nekih definicija i praktične primene uključivanja javnosti u zdravstvenu negu zasnovan na pregledu literature. Njime se namerava izneti kritička analiza učešća javnosti u zdravstu, razmatrajući pitanja kao što su značaj i prednosti, nivoi i načini uključivanja pojedinaca ili zajednice, načini na koje stručnjaci utiču na uključivanje ljudi, kao i barijere u vezi sa uključivanjem ljudi u zdravstvo. Gore navedena diskusija zasnovana je na pregledu literture upoređujući učešće javnosti u zdravstvu u Velikoj Britaniji i posleratnoj jugoistočno-evropskoj zemlji Kosovu.
Sve ovo ima za cilj otvaranje diskusije u kosovskom zdravstvu o budućim potrebama razvoja.
Ovaj rad je o modernom javnom zdravlju, koje promoviše i ističe značaj učešća javnosti u zdravstvu. Postoje različite definicije i raznovrsni nivoi javne i društvene uključenosti u zdravstvo.To je obrazložilo da veće učešće javnosti vodi više demokratskom odlučivanju i boljoj odgovornosti. U modernom zdravstvu postoje raznovrsni metodi uključivanja javnosti u cilju poboljšanja zdravlja i načina na koji zdravstveni stručnjaci utiču na učešće javnosti. Učešćem u zajednici, osnovne organizacije, akcione grupe i pojedinci uče i stvaraju svest o sebi dok promovišu društvene promene.
Konačno, politika unutar zdravstenog sistema je okrenuta ka unapređenju uloge pacijenta i učešća javnosti u donošenju odluka u zdravstvu. Sada postoji i zakonska obaveza da se, o značajnim promenama usluga, uključi i konsultuje pacijent i javnost .Porast učešća javnosti doprineće stvaranju usluge koja je odgovornija prema pojedincima i zajednici, što će dovesti do poboljšanja zdravlja.
Zdravstveni radnici imaju pravu priliku da zastupaju svoje pacijente i građane pomažući im da razumeju o njihovoj nezi i lečenju, i da kao klijenti mogu uticati na svoju budućnost.Njihovo angažovanje (učešće) može da napravi razliku u njihovim životima i životima drugih članova zajednice.
Učešće javnosti se obično definiše kao proces komunikacije između građana i vlade u cilju izgradnje demokratskog i odgovornog zdravstvenog sistema (SZO, 2003), takođe ističe značaj učešća javnosti u procesu donošenja odluka u zdravstvu. Zdravstvene organizacije i agencije igraju značajnu ulogu u informisanju javnosti i ulaganju sredstava kao faktora za donošenje odluka.

Ključne reči: učešće javnosti, zdravstvena nega, sigurnost pacijenta

Summary

This paper is a theoretical discussion about the comparison of some definitions and practical applications of public involvement in health care based on literature review. It intends to state a critical analysis of public involvement in Healthcare by discussing issues like the importance and benefits, levels and ways of getting involved as an individual or community, the ways practitioners influence in people’s involvement, as well as some barriers related to people’s involvement in healthcare. This above mentioned discussion is based on literature review comparing public involvement in Healthcare in United Kingdom and a post war southeast European country Kosovo. All this is aiming at opening discussion in the Kosovar Healthcare for future needs of development.
This paper is about modern public health, which promotes and emphasizes the importance of public involvement focused in healthcare. There are different definitions and various levels of public and community involvement in healthcare. It has been reasoned that greater public involvement will lead to more democratic decision-making and better accountability. In modern healthcare there are various methods of people’s involvement in order to improve health, and the ways of practitioners influencing in public involvement. Through involvement in community based organizations and action groups, individuals learn and create a sense of themselves while promoting social change.
Finally policies within health systems seem posed to future advance the role of patient and public involvement in healthcare decision-making. There is now a legal duty on trust to involve and consult patient and the public on significant service changes. Through increasing public involvement will contribute to make service more responsible to the individuals and communities and this will lead to improved health.
Practitioners have a real opportunity to advocate for their patients and citizens by helping them to understand about their care and treatment and as clients they can influence their future. Their involvement could make a difference in the live of them and other community members.
Public involvement is normally defined as a communication process between citizen and government in order to build a democratic and accountable health system (WHO, 2003) also outlines the importance of public participation in healthcare decision-making processes. Health organizations and agencies play a significant role by informing the public and using input as a factor for decision-making.

Keywords: public involvement, health care, patient safety

Introduction

Public involvement is normally defined as a communication process between citizen and government in order to build a democratic and accountable health system (WHO, 2003) also outlines the importance of public participation in health care decision-making processes. Health organizations and agencies play a significant role by informing the public and using input as a factor for decision-making.

This paper is not a research. Rather it is a theoretical discussion about the comparison of some definitions and practical applications of public involvement in health care based on literature review. It intends to state a critical analysis of public involvement in healthcare by discussing issues like the importance and benefits, levels and ways of getting involved as an individual or community, the ways practitioners influence in people’s involvement, as well as some barriers related to people’s involvement in healthcare. This above mentioned discussion is based on literature review comparing public involvement in Healthcare in United Kingdom and a post war southeast European country Kosovo. All this is aiming at opening discussion in the Kosovar Healthcare for future needs of development.

Definitions of “public involvement in healthcare”

As indicated by Hanley, patient and public involvement refer to the involvement of the public, where patients, carers, service users, consumers of services, lay people, citizens, or organisations represent the views of patients in health decision-making and research (Hanley, B. et al. 2004). According to Florin and Dixon (2004) public involvement is different from patient involvement, and refers to the involvement of individual patients, together with health professionals, in making decisions about their own healthcare. In a rights based perspective, communities and individuals are seen as having a right to participate in determining health priorities and action and this is linked to the notion of social justice (WHO, 1978). In addition, Milewa et al. (1999) points out that people’s involvement can also be regarded as essential to the democratisation of health and healthcare and enduring local accountability for services (cp. Also Zakus & Lysack, 1998).

Importance and benefits of public involvement in healthcare

When we analyze why community participation is important for the whole society, we find a number of different reasons, for example that community participation can achieve a more democratic solution, by developing a culture of participation, this and other factors result in better decisions and more effective and efficient services and improve health outcomes (HeBE, 2002). It aims to ensure that people’s involvement in NHS, public health, and social care research improves the way that research is prioritised, commissioned, undertaken and disseminated.

HeBE, (2001) concludes that public involvement is “a process by which people are enabled to become actively and genuinely involved in defining the issues of concern to them, in making decisions about factors that affect their lives, in formulating and implementing policies, in planning, developing and delivering services and in taking action to achieve change…” (HeBE, 2001)

A good public involvement process is to inform citizens about planning process and activities that are important for public health the incorporation of citizen input into the decision process. The decision-making process must be open and clear and must reflect citizen input (Farrell, 2004). There are examples of positive claims for user and public involvement in health services. Wilson (1999) highlights the strength of involving users in health services and emphasized that clients can be the best judges of the services strengths and weaknesses.

The barriers identified contain staff’s negative perceptions of involvement, a lack of understanding of the nature of user and public involvement, skill and knowledge deficits, resource issues, and a lack of joint working. Due to these reasons the history of public involvement in health services is for example in Kosovo a bit disappointing but there is a promising time to promote better public involvement with the aim to improve and democratized the health services. But even despite an increase in ‘involvement’ activity in the UK NHS, there is little evidence of any real shift in power or that local people can hold health services to account Ridley, J. et al, (2001). Socio cultural barriers to and facilitators of community involvement are like motives for participation, poverty and stigma for different illness, perceived opportunities (Ramirez J & Walles (2002).

Qualitative distinctions can also be made between different levels or degree of interaction. For example, Charles and DeMaio (1993) as cited in McCrae (2002) identified three main levels: consultation, partnership and ultimately control. The Scottish Association of Health Councils (1999) differentiates between communication (establishing meaningful dialogue), consultation (asking users’ views) and partnership (equal relationship between users and professionals). For instance, Arnstein (1969) argued that consultation was nothing more than tokenism and that partnership would be a better route to citizen empowerment.

A well-conceived and well implemented public involvement program can bring major benefit to the public health for example by involving citizens in the assessment of needs and solutions and identifying troublesome issues early, public involvement can promote “ownership” of programs or policies. The public involvement model involves consultation with many segments of community. Because this is a more collaborative process, decisions inevitable are more reflective of community values (Kosovo Case Study, 2001-2003).

In theory public services are more approachable and accountable to the needs of the people who use them, but it is generally acknowledged as not that easy to achieve this in practice (Department of Health, 1999).
Supporters of public involvement have identified diverse benefits to individuals, organisations, communities and society. It is important to mention that some of these benefits will be easier to substantiate than others (Callaghan and Wistow, (2006).

According to Doyal (1998) benefits have included: Empowering individuals and communities and increasing their sense of ownership of health services; better outcomes of treatment and care; services become more appropriate, responsive and more effective as they become more modified to people’s real needs. In addition, other benefits are the improvements in staff and patient moral; increased accountability of public services leading to increased confidence of the public in health services, as a result democratic deficit could be reduced and the development of alternatives in involvement as for example an agent for change. Furthermore, benefits as well are: the improved health and a reduction in inequalities; for organisations, greater understanding of the links between health and the circumstances in which people live their lives and more attention given to cross cutting issues and close cooperation between agencies with a role to play in health improvement (NHS Executive et al, 1998).

On the other hand the authors of a scoping study for Welsh (2005) points out that there are individual and collective benefits, for example: better access to care; clarity of understanding of rights and responsibilities; transparency of service provision; better understanding and confidence in NHS. This leads to patient choice and patient centred care; accountability to patients and communities; contributions to effective clinical governance; service appropriateness and involvement in treatment decisions.

Methods of people’s involvement in improving care

The public involvement form, involves discussions with many segments of the community. Mclver et al. (1999) explains three main ways in which users and the public can be involved in healthcare decisions: As individual patients making decisions about their own treatment and care, as nurses used to involve the patient in decision about their treatment and care for getting the better health outcomes; as service users and carers, in decisions about how services should be provided and as taxpayers and citizens, in decisions about service priorities and changes to services.

However, the literature review by Ridley, J. and Jones, (2001) has identified four main types of involvement: the direct involvement of individuals and carers in their own healthcare; user and public involvement in service quality; in policy and planning; and involvement through community development approaches. Involving users/patients in their own care has a range of benefits that it results in better health and treatment outcomes, and increased user/patient satisfaction. It is worth mentioning that, even though it is usually agreed to make differences between individual and collective involvement, in this case both individuals and groups can be involved in assessing service quality, service development and strategic planning. We can conclude that involvement is a multi dimensional concept, by sharing information through to user participation and direct user-control.

Furthermore, some authors make a distinction between involvement at a national level, as well as involvement in locality commissioning and in defining health needs (McCrae et al, 2002).

Based on the research findings of Andrea et all, (2002), the appropriate public involvement in the patient level was seen to be much more limited, furthermore he indicated that public should be involved in assisting in the setting of criteria for deciding between potential beneficiaries of treatment. The authors suggest that the decisions themselves should properly be taken by health professionals who have the relevant knowledge, skills and qualifications. However, service users and carers have much to offer from their experience. They have an important contribution to make in identifying needs to be met and how best to meet those needs (Barker Ph.1999). Involvement of service user and carers and working in partnership, would significantly improve the quality of health services.

Through involvement in community based organizations and action groups, individuals learn and create a sense of themselves while promoting social change. An effective public involvement can act as mechanism for change through helping to achieve a considerable improvement in the health of the public and strengthen public confidence in the NHS (Scottish Executive Health Department, 2000). “Health policies that are open to public accountability, in which citizens and users have a strong voice, are likely to lead to a healthier society where health is put before healthcare and commercial interests” (Hogg, C.,1999).

Many studies emphasise that person-centred approaches require time, information and training, better interpersonal communication, mutual understanding and trust. The main barriers to increasing the level of partnership are time pressures, the lack of training, skills and experience, and lack of information (Ramirez J & Walles, 2002).

Public information campaign is a form of one-way communication from the practitioners to the public (top-down), generally striving to inform the public about ongoing issues or developments and information.
Public involvement programs can also be multidirectional channels; from practitioners to public and vice versa. Those programmes should include as many groups and individuals in the community as practicable. Many of those groups and individuals will easily participate because they are interested in the decision outcome. The good practitioner of public involvement knows the community and is proactive, seeking out groups and individuals, particularly those who will be affected significantly.
The Department of Health (1999) claimed that involving people in influencing decisions that affect them had a positive impact on self-esteem and self-confidence. The success of the latest healthcare policies will be highly dependent upon radical changes in the interaction between users and professionals (Foote and Plsek, 2001). The challenge to the core concepts of service and entitlement that have so far been the bedrock of the health service should however not be underestimated.

Comparison of public involvement in healthcare in the uk and in kosovo

On one hand we have Kosovo, a post war, southeaster European country, which has started immediately after the war (1999) to build new institutions. It has also been made a change in the political system from a social-communist country it became a democratic one – which is still slowly developing. On the other hand we have the UK, which is a highly developed country in many aspects. The countries certainly differ a lot and are not directly comparable but this is an attempt to compare the public involvement in healthcare of both above mentioned countries, so that the needs for improving Kosovo’s health system can be found out.

While in the UK the public involvement in healthcare has a long tradition, in Kosovo the first steps in public involvement have been made only after 1999. For instance in the UK the Patient’s Charter was launched in 1990 that gave patients some procedural rights in their use of services. In Kosovo a similar document has been ratified by the parliament just in 2005.

In Kosovo of today many approaches towards democratizing all levels, institutions and structures of the whole country are going on, including re-building the health system where the basis is the ratification and implementation of the Kosovo health law (2004). Kosovo Health Law (2004) is promoting the citizens and patient’s rights through participation of the community in decision-making and encouraged through involvement of the groups interested in the health care activities.

Based on second recommendation from the Alma-Ata conference, the local government of Kosovo has encouraged and ensured full community participation through developing the necessary institutional arrangement through which individuals, families and communities can assume responsibilities for their health, WHO, (1997). The Policy Statement on Primary Healthcare (2004) aims to implement the abovementioned recommendation. Also, development is made in approving and implementing different strategies like the strategy for HIV/AIDS Prevention (2009-2013), where an important part is focused on involvement and empowerment of youth in HIV/AIDS prevention activities.

Patient and Public Involvement Forums (PPIFs), who ensure that patients and the public get the opportunity to decide about their daily running health services. The Forum is independent of the NHS and their purpose is to supervise and review the services in the area; to ask for and collect the opinions of the public about the services and based on these findings to make recommendations to the NHS, how to improve the services.

Another mechanism of involving the public into healthcare services is the NHS Foundation Trusts, which are a new wave of NHS Trusts. The highest performing NHS Trusts have the chance to take on Foundation status and expand noteworthy their services in the way that best benefits their local communities. Local people, patients and/or NHS staff have the opportunity to become members of their local NHS Foundation Trust and take an active part in their local hospital’s future. All NHS Foundation Trusts have a responsibility to cooperate with local communities and encourage people to become members of the organization. They are also trying to make sure that membership is representative of the community so that all groups in their locality can be reached (NHS, UK).

These abovementioned options of involvement in the UK, can not be realized in Kosovo at the moment, because of the political and economical circumstances and the nonexistence of health insurances. Having in mind Kosovo’s circumstances to have an efficient public involvement in healthcare, first of all the awareness of the population has to be raised, because most of them don’t even know their rights and therefore they can’t expect to be involved in planning or making decisions about their own healthcare. Also the health workers need to be aware of their and the patients rights and all the ratified and implemented documents and laws, in order to work properly and correctly.
Meanwhile the cooperation between health institutions, NGO’s, INGO’s and Health Organisations has to be increased and strengthened, with the aim of drafting the strategy for implementation of this important issues – public involvement in healthcare, to involve the population in decision-making processes.

Conclusion

To summarize it briefly, this paper was about modern public health, which promotes and emphasizes the importance of public involvement focused in healthcare. There are different definitions and various levels of public and community involvement in healthcare. It has been reasoned that greater public involvement will lead to more democratic decision-making and better accountability. In modern healthcare there are various methods of people’s involvement in order to improve health, and the ways of practitioners influencing in public involvement.Through involvement in community based organizations and action groups, individuals learn and create a sense of themselves while promoting social change.

Finally policies within health systems seem posed to future advance the role of patient and public involvement in healthcare decision-making. There is now a legal duty on trust to involve and consult patient and the public on significant service changes. Through increasing public involvement will contribute to make service more responsible to the individuals and communities and this will lead to improved health.

Practitioners have a real opportunity to advocate for their patients and citizens by helping them to understand about their care and treatment and as clients they can influence their future. Their involvement could make a difference in the live of them and other community members.

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