At BDO we know that user involvement is a key part of any commissioning process or service redesign.  Nonetheless I recently had a unique experience working with patients as part of a review of an integrated care programme.  This engagement was particularly challenging as many of the patients were frail, elderly or had complex health conditions including mental health issues.  Despite this, working with these patients was one of the most insightful and rewarding experiences of my career to date.  In the spirit of best practice sharing, I thought it would be useful to pass on some of the things I learnt during this process:

Start Early – In order to give yourself the best chance of engaging the largest group of people possible, start putting out the feelers early.  Its likely that you will have to go through a range of organisations and agencies who may have other demands on their time.  Be clear on your time-scales and deadlines but equally be prepared to be flexible and move things around to suit your service users’ schedules.

Provide incentives – Is there anyone who can hold their hand up and say that they’ve never attended event because they were tempted by free drinks or nibbles?  Make your focus groups attractive by providing food and refreshments.  Not only will this improve the atmosphere and help make participants feel more relaxed, but it will also demonstrate that you value their input and are prepared to invest in them.

Tailor your interview style – I come from a school of consulting where (on the whole) open questions are good and closed questions are not so good.  Working with vulnerable clients challenges this because you might be speaking to someone who might feel more comfortable answering “yes” or “no” questions.  Adapt your interview style to ask more direct questions whilst ensuring that you are not eliciting leading answers.

Try a range of approaches – Understand who you are engaging with and what might work best for them.  Online surveys are a good way of gathering quantitative data but this medium might not be appropriate for service users who do not have internet access.  Similarly, one to one meetings might be good for one person because you can build a connection but feel intimidating for another person who would prefer a phone conversation.  Lastly, Focus groups can be a good way of gathering the view of multiple people at the same time and encouraging debate, but make sure they aren’t dominated by louder voices through good facilitation.  Think about what you are trying to get out of your engagement and tailor your approach accordingly.

Don’t let great be the enemy of good – As consultants or project officers, we have spent the majority of our careers thinking about what good data looks like.  When working with vulnerable service users, many of whom have chaotic lives, it quickly becomes complicated to achieve a perfectly representative sample group: people drop out, fall ill or simply don’t show up. I would advise focusing on seeing as many relevant stakeholders as possible within your allotted timeframe whilst ensuring that you caveat your findings to reflect any weaknesses in your data.

This is by no means an extensive list and I’d love to hear your suggestions about approaches that have worked for you.  Feel free to comment below or tweet us @bdolocalgov.


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