So the reasons for pursuing consumer participation in service delivery are:

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1 CHAPTER 8 CONSUMER PARTICIPATION Contents 8.1 Why Consumer Participation? 8.2 What Is Consumer Participation? 8.3 Consumer Participation How To? 8.4 Complaints Are Ok 8.5 The Key Steps In Any Complaints Mechanism 8.6 Useful Resources Consumer participation in service delivery is about providing a range of ways for people using your service to provide feedback and influence how the service is delivered. The word consumer is used in this chapter for anyone receiving services, but clients, service users, customers, tenants, members and service recipients, are also used in different contexts. 8.1 WHY CONSUMER PARTICIPATION? Most community-managed organizations were formed in the 1970s and 1980s, often as a response to the inappropriate or inaccessible services provided by large public institutions. They were often small organizations catering to the needs of specific population groups that were neglected by traditional and inflexible public services. This was a period of strong citizen participation and many community agencies developed from social movements who advocated consumer rights and highlighted the needs of specific disadvantaged groups people with disability, Aboriginal and Torres Strait Islander peoples, women escaping domestic violence, people with mental illness, homeless people, etc. These organizations promoted principles of community and consumer participation, advocating strongly that mainstream service providers need to listen more to their consumers and respond to needs in the local community. In some areas most notably the indigenous and health sectors consumers created and controlled these organizations. During the late 1980s and 1990s managerialist approaches became popular with funding agencies, and the focus of community organizations shifted to case management, individual unit costs, and competitive tendering for services. Service delivery was preferred to community development or advocacy. Most recently this managerialist agenda has required community organizations meet quality standards and engage in continuous improvement strategies. Funding agencies now require evidence that organizations have connections to local communities and provide opportunities for consumer participation. Funding agreements also require complaint and grievance procedures to be implemented by community organizations. So the reasons for pursuing consumer participation in service delivery are: People have a right to participate in, and influence, services that are being provided for their benefit

2 A service designed and delivered with an understanding of the views and needs of those who are to use it is more likely to effectively meet their needs Consumers are expert in what they need, and have a wealth of knowledge on how best to provide services to them and their communities of interest. 8.2 WHAT IS CONSUMER PARTICIPATION? Consumer participation can be a one-off activity (eg seeking consumer input on development of a new service) or it can be ongoing (eg a monthly meeting of consumers to provide feedback). You may seek consumer feedback at a number of different levels of the organization: At the coal face between a consumer and their individual worker (eg consumer directed support services) At the service level (eg evaluation of service or program) and At the organizational level (eg consumer representatives on management committees) Finally, the level of consumer participation can also vary across a continuum, from simply providing consumers with information about the services available, through consultation processes to consumer control. None of these forms of participation is better than others: it is important, however, to be clear on the extent and nature of participation you seek from consumers. The following table is adapted from a consumer participation project undertaken by the Women s Hospital in South Australia 1. Degree Of Participation (High To Low) Consumer Control Partnership Consultation Information Seeking Explanation Consumers make the decisions Decisions are made jointly by consumers and workers Consumer views are sought and incorporated into decision making Workers seek information from Individual Worker Level An older person directs the activities of their home care worker A youth worker and client together identify priority issues and agree on a plan of support to achieve these over time A housing worker seeks feedback from tenants on their satisfaction with the support provided A disability support worker asks a client about the timing of Service Or Program Level An activity program for older people is created and managed by the clients themselves A team of youth workers and homeless young people design and produce a resource guide for young people sleeping rough A meeting is organized for tenants and potential tenants to provide feedback on a new funding submission An accommodation support service creates a suggestion box for Organisation Or Management Level An aged care facility is owned and operated as a cooperative of all residents The management committee of youth support service must include two client representatives, and at least half the committee members must be under 25 years Management committee has an annual meeting with tenants of the service to receive feedback A disability employment agency undertakes a satisfaction survey of ex- 1 Table adapted from the Women and Children s Hospital South Australia, and reproduced at p.37 in Consumer Focus Collaboration (2000) Education and Training for Consumer Participation in Health Care: Resource Guide Canberra: Commonwealth Department of Health and Aged Care

3 Information Giving consumers Information is provided to consumers various activities during their day A refuge worker gives information about consumer rights as a tenant consumer feedback A poster describing service standards is prominently displayed in the refuge 8.3 CONSUMER PARTICIPATION HOW TO? clients as part of org review The decision making structure of a crisis housing organisation is explained to consumers There are endless ways of doing consumer participation. There are many resources available to support organizations embarking on a consumer participation strategy (see below). This manual cannot provide a how to within one chapter. Instead a list of considerations is presented below, and a number of how to manuals listed. Involve consumers as early as possible in the process Assess your organisation s capacity consumer participation often fails to create change because the organization does not have the culture, structures or willingness to respond to consumer feedback Develop a budget and secure resources consumer participation is not always a cost neutral exercise Ensure your purpose and objectives are clear seek consumer agreement Document and plan your approach this provides clarity and enables evaluation Consider different strategies for different groups of consumers Identify the barriers consumers may face in participating and try to address some of these (eg place or time of meetings, language/cultural issues, child care/support requirements) Identify the barriers you may face (eg lack of management support, organizational rigidity, limited resources, hostile attitudes of some staff to consumer participation) and take these into account Review or evaluate your chosen consumer participation strategies against your original objectives Consumer participation has been strongest and most successful in the areas of Aboriginal and Torres Strait Islander organizations and health services (particularly for people with HIV/AIDS, people with mental illness and women). Resources are often focused on health services, but the tools, checklists and strategies they contain can easily be adapted to a range of human services. A selection of resources is contained in the Useful Resources section at the end of this chapter. 8.4 COMPLAINTS ARE OK Continuous improvement is now the cornerstone of high quality services. Given human services are designed for clients, continuous improvement can only occur if you have a broad range of mechanisms for client feedback and participation. The first part of this chapter focused on client participation. This section focuses on one form of participation: effective and constructive complaints mechanisms. A quality service does not perceive complaints as a threat to organizational integrity, but sees complaints as an opportunity to learn. Complaints are not just OK, they are a

4 key source of useful information on which to base service improvements. Quality services encourage and support client complaints. Translating these lofty ideals into practice, however, is not easy. A good complaints mechanism is more than just a client leaflet or poster on the wall. Those working directly with clients as well as the culture and hierarchy of the organization must support client complaints. Significant time and resources are required to establish an effective complaints policy and procedure and to ensure the system works for your clients. Once established, however, client feedback and complaints are likely to identify those areas of your service clients most appreciate, and those services they do not value. Key Issues To Consider In Your Complaints Mechanism Organisational Support There needs to be a strong commitment to the complaints mechanism and to acting on client complaints across the organization. This can be achieved by creating the mechanism with clients and staff, and then gaining management approval of a complaints policy and procedure. All clients should be advised regularly of the existence of the complaints mechanism and be encouraged to use it. This support needs to be reinforced by including discussion of the complaints mechanism in the induction of new staff and committee members. A budget for the complaints mechanism and promotional material is required to ensure there are sufficient resources to handle complaints. Finally, organizational support needs to be visibly demonstrated to clients through the manner and approach of staff, and the design of communication methods appropriate to your clients. Access and Equity The mechanism needs to be easily accessible to your clients, and needs to demonstrate fairness. This usually requires that clients feel they have been listened to, and that they are clear on what will happen once they make a complaint. It also means equity for the person complained about, who will receive information about the complaint and be given an opportunity to respond. There should be no costs to the complainant rarely will clients pay to complain! Resources may be required for interpreters and other assistance. Your service needs to encourage contact between your clients and external advocates, to ensure they can be independently supported through a complaint. Responsive and Solution Focused Complaints are best dealt with quickly with the client advised of the time frames involved (eg urgent - within 3 working days, non-urgent - within two weeks). Once the client s complaint is clear and documented, the process should focus on solutions and negotiating solutions. This should occur quickly and easily no delays, or cumbersome procedures it s a complaint mechanism, not a law court. Your complaints mechanism needs to enable your organization to determine and implement solutions.

5 Accountability and Review You need to publicly report on use of your complaints mechanism (eg in your Annual Report) including the service improvements and changes resulting from complaints. It is important that someone in your organization is named to collect information on complaints so that recurring problems can be identified. You may review the mechanism regularly, especially after a difficult complaint that has challenged your policy and procedure. 8.5 KEY STEPS IN ANY COMPLAINTS MECHANISM Some complaints are either very straightforward or very complex. Complaints can be about individual workers or other clients, or broad policy issues. Often complaints can be about issues for which there is no policy, and so the outcome can be to produce some organizational policy. Sometimes the first issue a client raises will not be the core complaint, or upon further investigation other issues arise. Each complaint is a new journey, and like all good policy and procedures, you will want to improve it as you use it. The following is simply a guide to some of the steps involved in handling complaints well. Step 1 Identify the complaint If a client complains about something and you are able to respond to their satisfaction, there is no need to record a formal complaint. Complaints mechanisms should not be invoked to remove responsibility from staff to respond flexibly to client needs. However if the client remains unhappy, you can offer them a complaints process. In resolving disputes it is critical that the complaint is clear, so you will need to: Ask the client to explain their concerns to you be supportive, empathic, and respond to their feelings as well as their thoughts After you have listened to them, repeat back what you understood they said Ask the client what solutions they want, how can their complaint be fixed? Document their complaint and proposed solutions, and seek the client s endorsement that this is a true record of their concerns Advise the client what you will do next, and when they will get a response Step 2 Investigate the complaint You will need to share the issues with those implicated in the complaint and seek their responses. You will need to involve your manager or someone else in the organization identified to handle complaints (eg Committee member). You may need to investigate organizational policy and whether there s any likelihood of the policy changing. You may need to interview other people involved and document their perspectives and concerns. Example: The complaint may be I m not happy that you won t let me into the refuge, even though I have nowhere to live. I don t think you want young people here.

6 Investigating this complaint will be as easy as obtaining copies of organizational intake, eligibility and service access policies. If you don t have these, you will need to refer to standard practice in the organization. One outcome of such a complaint is that you will have to document these procedures so you can explain them more clearly to other potential clients. Step 3 Resolve the complaint Here the nature of the complaint determines how this can occur. If the issue is about organizational policy and procedure, then ultimately the management committee decides. You may wish to engage in some negotiation between client and a committee member, as representative of the organization. Alternatively the complaint may be about the actions of a staff or committee person. Again an existing Code of Conduct makes this easier to resolve. But without this, you might seek to bring the complainant and the other person together to resolve the issue. In some circumstances (eg allegations of abuse) this may not be appropriate, and other means of resolution are required. It is important in this stage of the process to be aware of any power imbalances between the parties, and to ensure all participants have the support they require to feel comfortable through the process. In some situations a person independent of the organization may be required to facilitate resolution of a complaint. It is extremely important that the person taking action on the complaint is perceived by all parties as fair and impartial. Step 4 Report, record and take action It is important to document the resolution of the complaint, including all actions the organization has agreed to. This is not an opportunity to commit a client to particular action; the complaint is about the organization and the organization needs to respond. The client should not be punished or penalized as a result of making a complaint most organizations find this challenging. The record of the complaint should also be referred to the person in the organization responsible for reporting annually on the number of complaints etc. Finally, all these documents should be kept to ensure the privacy and confidentiality of those involved. 8.6 USEFUL RESOURCES Consumer Rights The National Resource Centre for Consumer Participation in Health provides an invaluable resource on consumer participation. You can download a large variety of resources on consumer participation from their web site Particularly recommended are publications in the Consumer Focus Collaboration series, particularly Improving health services through consumer participation: a resource guide for organizations.

7 Consumers' Health Forum (CHF) is the leading national organisation providing a voice for all Australian health consumers. CHF nominates and supports consumer representatives on government, industry and professional committees. Partnerships Online covers the processes of community participation and building partnerships between different interests. Health Issues Centre - Non-government health policy and research centre with resources. Our Community Good web site for general resources on community development and capacity building. Resolving Disputes - Dispute Resolution/Compliant Policy Documents Queensland Aids Council Lifeline Community Care or under training. Queensland Advocacy Inc Complaints System Operating Manual (refer Appendix B)

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