Obtaining public input for health-systems decision-making: Past experiences and future prospects

Interest in finding more effective methods for public involvement in decision-making about health systems is more widespread than ever in Canada since significant aspects of health-care decision-making were devolved from provincial governments to regional health authorities. Involving the public can be risky business, however, as the accountability and legitimacy of decisions made by governing authorities are often assessed against the nature and degree of interaction that occurs with the public. Consequently, decision-makers in a variety of policy domains routinely struggle with questions about when it is appropriate to involve the public, what the most effective means are for doing this, and how to measure their success. The authors analysed these issues by documenting the experiences of health-systems decision-makers in two Canadian provinces (Ontario and Quebec) with public consultation and participation over the past decade. Their findings illustrate that despite the different roles and responsibilities held by Ontario and Quebec decision-makers, decisions to consult with their communities are driven by the same basic set of objectives: to obtain information from and to provide information to the community; to ensure fair, transparent and legitimate decision-making processes; and to garner support for their outcomes. Decision-makers also acknowledged the need to rethink approaches for involving the public in decision-making processes in response to the perceived failure of past public participation and consultation processes. While these experiences have clearly left some participation practitioners feeling beleaguered, many are approaching future community consultation processes optimistically with plans for more focused, purposeful consultations that have clear objectives and more formal evaluation tinged with a healthy dose of pragmatism.