Achieving health equity has been the goal of governments and healthcare providers around the world for many decades. The idea that the level of healthcare one can access should not depend on personal circumstances is a popular one. Organisations such as UNESCO and the WHO have repeatedly called for international co-operation in improving global health equity, particularly for nations with poor access to healthcare.
Despite this, around the world – and particularly within the Asia-Pacific region – there remains significant disparities in healthcare provision. Improving health equity is a complex issue, and requires a multi-faceted approach including policy and practical changes. However, a key but often overlooked component of improving health equity is the engagement of frontline staff themselves.
What does health equity really mean?
According to the World Health Organisation, health equity can be described as “the absence of unfair and avoidable or remediable differences in health among population groups defined socially, economically, demographically or geographically.” In simple terms, health equity is the idea that everyone should have the opportunity to be as healthy as they can be.
It is important to note the use of the word equity here, and how it differs from equality:
- Equality is where everyone is treated the same way. In the context of health equality, this may mean everyone having the same resources allotted to them.
- Equity is the idea that everyone is provided for in such a way as to fit their individual needs. So the resources would be allotted within a healthcare setting as needed to get individuals to similar levels of health.
The healthcare needs of someone who is young, able-bodied and without pre-existing medical conditions are vastly different to someone who is elderly, disabled or already suffering from ill-health. Treating different groups of people the same would actually be disastrous for a healthcare provider, but treating patients with equity in mind should be the ultimate goal.
Ensuring public health equity means taking a people-centred approach to healthcare. There are many barriers that can prevent people from having access to good healthcare. Just a few examples include:
- Economic barriers: Poverty is one of the single largest determinants of lifetime health and predicted mortality.
- Cultural barriers: Many groups of people have had poor experiences with healthcare services, and it may take decades to rebuild relationships following this broken trust.
- Geographic barriers: Those living in remote locations may find it difficult to access regular healthcare support, particularly if they need specialist treatments.
- Educational barriers: Knowing what is and isn’t normal, and knowing when to seek medical help is an issue of education that not everyone has equal access to.
There are significant health disparities in places like Australia, for those living in rural areas and people from an aboriginal and Torres Strait Islander background. It is therefore a priority in Australia to combat health inequity by overcoming the barriers faced by these groups.
Identifying these barriers is the first step in addressing them. For identifying barriers, flagging individuals who may need specific support, and implementing tailored services, frontline staff are the first port of call.
The role of frontline staff in achieving health equity
There are few people more qualified to see inequities within the healthcare system than frontline staff. While patient engagement and input can provide a detailed account of an individual’s personal experience, healthcare staff have a view of many cases every day. They are also the people most likely to see the impact inequity has on patient wellbeing, and the strain it can put on health systems in the long term.
Frontline staff work directly with patients. Often, they will work with the same patient for a long period of time, and see patterns emerging out of health inequalities.
For instance, they might see a patient who is frequently late to appointments because they have no car, and public transport in their area is poor. Or, it may be a patient that is unwilling to share key information with their doctor, out of fear they will be discriminated against. It could also be a patient whose condition is worsening due to factors that aren’t anticipated by their health plan, like poor nutrition. Chances are in fact, that many frontline healthcare workers will see all of these issues on a regular basis.
Staff also have the ability to see where it is their own systems that are making things worse. For example, assigning early morning appointments not long after buses start running.
When staff have a way to share these observations, it can be used to inform service provision going forward. Changes can be made that reduce health inequalities, or allow individual issues to be mitigated before they lead to worsening health outcomes for patients.
Unfortunately, traditional methods of engaging staff often fail to capture the insight they have gained from their day-to-day work in any meaningful way.
Improving staff engagement
Frontline staff are uniquely positioned to provide expertise on the causes of inequity, and the best placed to combat existing access barriers. Consulting them regularly on these issues, and involving them in strategies to tackle them should therefore be a top priority. Despite this, staff consultation is often carried out in a haphazard and uneven manner, using outdated techniques and legacy technology.
In many hospitals and healthcare environments, staff engagement is limited to an annual survey. While this input can be useful, it is rarely able to capture the full complexity of staff-patient interaction. There is little scope for nuance or space to provide additional context.
This is particularly the case when healthcare providers use paper-based survey methods. Not only does this limit the breadth of answers that can be provided, it also leads to an excessive administrative burden. While the growing use of digital health services is improving this considerably, many healthcare environments are still stuck in the past.
Often, there is little transparency on how this information is even being used. An inability to “close the feedback loop” can lead staff and co-ordinators alike to approach these surveys like a box-ticking exercise, rendering them largely useless.
If engaging staff is essential to providing quality care, but traditional methods of engagement aren’t working, what then can be done to improve staff engagement?
Structured, internal consultations
The first activity to consider when attempting to increase staff engagement is running a structured, internal consultation. This allows staff to share their views on a defined topic or area, with clear timelines and processes for feedback. Unlike a simple survey, a consultation will generally use a mix of broad and specific questions, and gives space to provide relevant context and detail.
Internal consultations like this should be conducted regularly, and can be used to target specific issues.For example, a consultation could be run for staff working regularly with those who have physical disabilities about how accessible the hospital building is for their patients. Staff could suggest changes that may make access easier for their patients.
While running multiple consultations in a given period would in the past have been too resource-intensive using legacy technology, it can now be far simpler. Purpose-built digital engagement platforms can be used to make consultations easy to view, take part in and receive feedback from. Once familiar with a given platform, staff would be able to return to it regularly, taking part in consultations relevant to their work. They would also be able to easily see how consultation contributions have influenced the healthcare providers policies. Over time, this has the potential to significantly increase engagement.
Creating safe, inclusive spaces
Some engagement activities should be conducted in person. Staff meetings, in-person consultations, and other opportunities to get involved and share ideas can be very beneficial for everyone. Sometimes, it is easier to fully “hash out” an idea or issue in person through discussion with others. However, to do this it is necessary to create safe, inclusive spaces.
Healthcare can sometimes feel very hierarchical. Junior members of staff may feel reluctant to speak up. Creating safe, inclusive spaces means ensuring everyone present is treated with respect. There should be opportunities to “think aloud” without worrying about potential repercussions, and facilitators should be mindful of the power dynamics at play.
It is useful to gather anonymous feedback after these events, to ensure any potential problems are flagged and fixed early.
Ensure continuous engagement
Something as complex as inequity in healthcare systems cannot be fixed with a single consultation. That’s why it is so important to ensure that engagement is not a one-off, and staff remain involved with the process.
Some methods of ensuring future engagement includes:
- Define the purpose and scope of each consultation clearly.
- Provide background information for each consultation. Don’t assume prior knowledge where possible.
- Always provide in-depth feedback following each consultation, explaining how contributions have informed policy.
- Accommodate different shift patterns and ensure accessibility for staff with different needs.
- Use technology to assist. Make participation possible from any device where possible.
How Citizen Space supports health equity initiatives
Citizen Space is a digital engagement platform used by public sector organisations around the world, including healthcare providers across the Asia-Pacific. It supports frontline staff to get involved in improving the services they help run by providing a one-stop platform for staff engagement.
By running digital consultations, Citizen Space makes it simple for staff to contribute from anywhere and on any device. Healthcare workers are often pressed for time, so being able to take part from a phone on a bus can be a big factor in whether staff will participate.
The platform enables facilitators to share contextual information alongside consultation questions. This could be pre-existing data, guidance on scope, or guidance on how best to respond.
Citizen Space also has inbuilt analytics, which can quickly identify common themes from contributions. Data provided via the platform can be analysed in-house and exported to compatible software. Then the same platform can be used to provide feedback to participants, showing the value of their contributions.
Reducing the level of inequity within healthcare is a priority in Australia. That’s why the Government of Western Australia recently chose Citizen Space to conduct a consultation on cancer prevention.
“This consultation process has generated momentum in bringing together a range of organisations and individuals, including the general public, to discuss cancer prevention in WA.”
Chief Health Officer’s report, Government of Western Australia Department of Health
Citizen Space is the go-to platform for connecting governments, developers, and citizens. If you’d like to learn more about how our software can be used in a healthcare setting, book a free demo and we’ll walk you through it.
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