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The Health Canada Policy Toolkit for Public Involvement in Decision Making

Corporate Consultation Secretariat,
Health Policy and Communications Branch
2000
ISBN:0-662-29243-X
Cat. No.: H39-549/2000E

(PDF Version - 700 K)

Table of Contents

  1. Introduction
  2. Departmental Policy
  3. Information Toolkit
  4. Case Studies and Techniques
  5. Level 1
  6. Level 2
  7. Level 3
  8. Level 4
  9. Level 5
  10. Consultations with Health Canada Employees
  11. Conclusions
  12. Bibliography

Introduction

Foreword

The need to ensure meaningful public involvement in policy development and service delivery is recognized by Health Canada as one of the key challenges of governance today and in the years ahead. Canadians are better educated and informed than ever before and they expect to have more say in public policy decision making. This is particularly so in relation to health. There is widespread public demand for greater public involvement and access to information, and a sense that the resolution of most major national problems would be aided by engaging citizens.

In response to changing public expectations, we need to improve our ability to consult, engage, listen, persuade and reframe issues so that the results of our work better meet citizens' expectations and needs. This will require strengthened capacity to inform, educate and involve the public and to get feedback on how we are doing. Clearly, citizen engagement as a public involvement technique goes beyond communication and consultation. It involves citizens, and not just the public as represented by a multiplicity of stakeholders, associations, lobbyists and interest groups, in policy formulation, priority setting and program delivery. As Health Canada builds on the wealth of expertise in the department and adapts processes to better include citizens in decision making, we will be working to meet the needs of Canadians and to realize a key priority of government. However, citizen engagement is not a panacea or even a science for that matter. As with all public involvement techniques, there is a need to have a clear purpose and objectives and understand when, where and how to best use citizen engagement.

This document has been developed at Management Council's request to respond to the expectations of Canadians and the related needs of Health Canada employees around public involvement, including citizen engagement. It aims to build on the department's capacity to acquire and act upon good ideas, whatever their origins, in the following ways:

We pay tribute to Ian Potter and Don Ferguson, our Citizen Engagement Champions, for their leadership and dedication in bringing this document to life. We also thank the members of the Working Group and Sub-Committees on Public Involvement led by the Corporate Consultation Secretariat under the guidance of Carla Gilders and other key staff, many of whom are named in the document. We congratulate all of you for sharing your wealth of knowledge and experience that is reflected in this very useful resource.

The Departmental Executive Committee has approved this document. We encourage you to use it and, with further experience, improve it for the benefit of the health of all Canadians.

Deputy Minister

Associate Deputy Minister

Introduction - Acknowledgements

This document has resulted from the enthusiasm and knowledge of many individuals. Special thanks must go to all those who participated in the Inter-Branch Sub-Committees on the Policy Framework and Guidelines, Training, and Information Toolkit; the Focus Group Organizers; the Management Council Workshop Participants and the Inter-Branch Committee on Public Involvement.

Citizen Engagement Champions

Ian Potter, Assistant Deputy Minister - HPPB
Don Ferguson, Regional Director General - Atlantic
Carla Gilders, Director General - Communications and Consultation

PCB

Catherine Auger
Yves Auprix
Billie-Jo Bodgen
Jean-Louis Caya
Joyce Dale
Robert Douglas
Franca Gatto
Chris Hanchuk
Corita Harty
Dawn Hachey
Peter Hill
Ben Mills
Beatrice Mullington
Tracey Taweel

HPPB

Catherine Adam
Jim Ball
Ken Beaubien
Tammy Bell
Michel Boyer
Kin Choi
Tracey Donaldson
Claire Draper
Larry Flynn
Philip Forsyth
Heather Fraser
Timna Gorber
David Hoe
Ali Jakubec
Dominique Lemelin
MaryJane Lipkin
Jim Mactier
Kim McCarthy
Penny Mosmann
Jane Oram
Daniel Riendeau
Darcy Ross

HPB

Mary Bush
Ria Demos
Ross Duncan
Luc Fortin
Mary Hegan
Michelle Hiltz
Marion Law
Dave Norris

RDGOs

Patricia Burton - Central
Jasvinder Chana - Atlantic
Line Guibert-Wolffe - West
Kathy Kieley - Atlantic
Christine Lovett - Central
Linda Sachatsky - West
Christiane Tanguay-Lacombe - Quebec

MSB CSB

Florence Chumpuka
Judith D. Ross
Gilles Lemieux
Sylvie St-Onge

OHSA

Brad Kelso

Consultants

Barry Malmsten (Focus Group Facilitator) National Quality Institute
Mitchell Beer (Consultant on the Techniques) Infolink Consultants
Judy Kent (Consultant on the Techniques) Kent Consulting

* The names of branches and directorates reflect the Health Canada Structure prior to April 17, 2000.

Introduction - Purpose

The purpose of the Health Canada Policy Toolkit for Public Involvement in Decision Making is to support Health Canada's mission to maintain and improve the health of Canadians by providing direction for Health Canada employees on public involvement. The document affirms the department's commitment to public involvement. It provides principles, guidelines and information for the effective involvement of citizens in government decision making on health issues.

This document builds on the department's existing culture and capacity for public involvement in determining health priorities, policies and programs. It is intended to help Health Canada respond to an unprecedented call for public involvement relating to the department's mandate by clarifying the types and best uses of the array of public involvement techniques available. The document outlines departmental expectations, roles and responsibilities in fostering a citizen-focussed culture for the federal government's role in health. There are many benefits to public involvement, including stronger policy, programs and health outcomes. Over time, it is hoped that Health Canada will be well known and highly regarded as a leader for its citizen focus and track record for involving Canadians, together with other levels of government and health professionals, in developing ways to maintain and improve their health and build their confidence in the health system.

The components of this document are:

This document is not intended to be overly prescriptive. Rather, it should be used in the spirit of continuous learning. Public involvement strategies, including citizen engagement, are based on judgement, which may be improved with experience.

This document meets Management Council's direction to develop a framework and tools for public involvement. A Speaker's Series on public involvement has also been established in response to Management Council's direction. Management Council further directed the development of a training program, validation of the policy framework by external experts and the establishment of a virtual centre of expertise on public involvement. The Corporate Consultation Secretariat in the Health Policy and Communications Branch is working on these priorities in collaboration with other branches and regions.

Introduction - Context

Our working environment is changing. At present, four overarching challenges have particular relevance to Health Canada and its public involvement efforts:

While there is still much to be done, governments have made progress in recent years in ensuring that Canadians have a voice in developing and reviewing social policies and programs. In the health field, to name one of many examples, Canada's National Forum on Health has been effective in involving individual Canadians and key stakeholders.

Canadians, along with the citizens of other western democracies, are increasingly concerned that their democratic institutions are out of sync with their values and interests. There is a growing gap between Canadians' actual and desired level of influence in government decision making which is leading them to demand a greater voice in public policy formulation. National institutions are under pressure to make changes to their policy-making processes in order to address this disconnect and build public confidence.

Canadians want a new relationship with government at all levels. They want a direct, substantive and influential role in shaping policies and decisions that affect them. They want to be heard, and they want a commitment that leaders will take their views into account when making decisions. This is underscored by the facts:

Renewed legitimacy and public confidence in government will rest upon greater transparency and citizens' involvement in decision making. Canadians need an opportunity to express their views with respect to a broad range of issues surrounding this topic, including when it would be appropriate to launch a citizen engagement process, their expectations concerning the use of the results, how to reconcile the views of different groups of citizens, and the relationship and role of citizen engagement relative to other democratic or public involvement "tools" such as elections, referenda, consultations, communications and so on.

There is a communications gap that must be overcome if the public is to be more engaged. In some cases, the public is not well informed on the tradeoffs that are a key part of public decision making. Ways to bridge this gap include community-based approaches and the use of information technology as a public forum. These provide opportunities to inform, consult and engage individuals on issues.

In some instances, the mind-set of leaders of institutions has been an impediment to acknowledging the ability of the "average" citizen to contribute to shaping policies on complex issues. Research indicates that fewer decision makers than citizens believe that the public can offer useful advice. Half believe that the grassroots cannot present solutions to major national problems (compared to 68 percent of citizens who believe they can).

These are not insignificant obstacles. Canadian institutions must work hard to recognize and overcome them. Government decision makers - both elected officials and public servants - are expected more than ever to discharge, and be seen to discharge, their responsibility to effectively engage citizens, to listen, and to be accountable to citizens in explaining how citizens' views have been considered in the decisionmaking process. The input of citizens as individuals is increasingly being sought as governments recognize that the current decisions being made on major social policy issues, particularly health care, are not purely technical in nature, and therefore in the realm of experts. Current issues touch our values and could benefit from citizens' views and priorities.

Introduction - Government and Health Canada Commitments

The need to provide opportunities for meaningful public involvement and to engage citizens more effectively is recognized as one of the key challenges of government.

The Government of Canada has made several important and inter-related commitments to provide better opportunities for Canadians to participate in public policy debate and service delivery. Several key commitments, which provide direction for the department, are highlighted below:

Departmental Policy

This section provides a vision, principles and expected benefits or outcomes that together constitute Health Canada's departmental policy for public involvement in support of the department's mission and mandate.

Vision

Vision Statement

Canadians are informed on health issues and engaged on key federal decisions that affect health.

Principles

Benefits of Public Involvement

Health Canada expects to achieve a number of critical and long-term benefits as a result of its investments to enhance the involvement of Canadians in policy and program development and delivery. Several key expected outcomes are identified below:

Health Canada's public involvement continuum is illustrated below. It represents the core concept of this document. Five levels of public involvement and influence are identified on the continuum. The levels are not "air-tight" compartments. Rather, the features of the levels are generally cumulative as the public involvement deepens. The line between techniques is sometimes arbitrarily drawn.

Departmental Policy - Health Canada's Public Involvement Continuum

A visual representation of the various levels of involvement

Inform, Consult or Engage?

This section provides guidance that is useful to consider during the preparation phase of any public involvement initiative.

The delivery of health services is a complex, multijurisdictional responsibility. Success depends on collaboration and coordination among many partners and stakeholders, including federal, provincial and territorial governments; First Nations and Inuit organizations; the voluntary and community sector; health professionals; the private sector; and individual Canadians. Health Canada's mission - to help the people of Canada maintain and improve their health - goes to the core of the federal role in health and highlights the collaborative nature of health service delivery in Canada.

Before deciding to involve the public, one needs to ask fundamental questions:

It may be appropriate to involve the public in:

Levels of Involvement

Health Canada's five levels of public involvement are highlighted below, together with criteria for selecting each level. These criteria are intended to guide the planning process by highlighting the main objectives of the public involvement levels. Combinations or hybrids of techniques may be required depending on objectives, available resources and other factors.

Level 1 Inform/Educate when:

Level 2 Gather Information/Views when:

Level 3 Discuss or Involve when:

Level 4 Engage when:

Level 5 Partner when:

We want to empower citizens and groups to manage the process

Canadians expect their governments to provide appropriate opportunities for their involvement. The key word here is appropriate. Canadians do not expect their governments to involve them extensively in every issue. That would paralyze policy making and quickly exhaust citizen participants. A rough guideline on whether to involve citizens/groups at the higher level of the continuum is the extent to which the issues at play involve potential conflicts in values or identity, difficult choices or trade-offs that would entail a major impact on either citizens' health or the health system. The greater the impact in these areas, the more likely the issue should be considered for citizen engagement.

A key component at levels four and five of the public involvement continuum is also the potential political implications of an engagement process. In order to ensure integration of results from an engagement process into the policy making and program planning of the department, it is important that political support, as well as departmental, is strong and clear.

To summarize, the decision to inform, consult or engage and the related selection of a public involvement strategy is dependent on a number of complex, interrelated factors:

What Is Citizen Engagement?

This section provides an overview of what the department means when it refers to citizen engagement. Citizen engagement is a process that:

The process of engaging citizens may be differentiated from a more formal citizen engagement process.

Formal citizen engagement processes:

Citizen engagement processes or techniques may be distinguished from "traditional" public consultation methods. "Traditional" public consultation is known for the following:

Citizen engagement techniques are located at the high end of the public involvement continuum. The response to the Sydney Tar Ponds contaminants issue in Cape Breton, Nova Scotia illustrates a community based citizen engagement model at the partnership end of the public involvement continuum. This controversial health and environmental matter is addressed through a community-driven process, in which the government is invited to participate - rather than a government-led process in which the community participates. This approach allows the community to take on a major lead role in designing and implementing the process, and ultimately sharing responsibility for the success or failure of efforts to address this problem.

In summary, citizen engagement refers to the public's involvement in determining how a society steers itself, makes decisions on major public policy issues and delivers programs for the benefit of people. Citizen engagement is closely linked to the concept of social cohesion. Social cohesion refers to the building of shared values, reducing disparities in wealth and income, and enabling people to have a sense that they are engaged in a common enterprise and face shared challenges as members of a same community.

Information Toolkit - Guidelines

The following guidelines apply to all levels of the public involvement continuum. The guidelines bring some rigour to this field of activity but are not intended to be definitive or overly prescriptive. Employees may wish to improvise or tailor their approaches in order to meet their needs. The guidelines are intended to assist Health Canada employees to recommend, select and use the right public involvement techniques to match their objectives. They are intended to support all Health Canada employees with responsibilities relating to public involvement, including decision makers, advisors, practitioners and administrative support. They recognize that departmental employees frequently have multiple responsibilities in this area.

To benefit from the guidelines, Health Canada employees should consult them at the beginning and regularly throughout the process for planning, designing, implementing and evaluating their public involvement initiative. All of the guidelines below should be considered for a successful public involvement initiative. However, inherent intangible factors prevent the development of a "simple formula" that would always guarantee success.

The guidelines are divided into the following parts:

Guidelines

Operating Rules

This section provides operating rules as counsel to employees who may need to undertake public involvement activities.

Planning Process Overview

Successful public involvement requires careful planning, execution and evaluation. This section provides a standard six-point planning process. Employees may wish to adjust the planning process to meet their objectives. Being flexible with the planned process is often essential to meeting key objectives.

The first chart summarizes the steps and key success factors of the planning process in a checklist format. The second chart provides a series of key success factors to consider for each step in the planning process.

Planning Checklist

1. Preparation

2. Design

3. Implementation

4. Synthesis

5. Feedback & Follow-Up

6. Evaluation

Key Success Factors

1. Preparation

2. Design

3. Implementation

4. Synthesis

5. Feedback & Follow-Up

6. Evaluation

Who Should Be Involved?

Traditionally, the department determined who participated in a public involvement process. This approach continues to be appropriate in a range of circumstances. Increasingly, however, the department will need to use techniques that ensure greater representativeness and inclusion of the public. This may involve employing the random selection of individuals or groups (usually by an arms-length third party) to achieve a greater measure of representation of Canadian society. When the process is communitydriven, representation is usually determined externally to government and sometimes in partnership with government. The department continues to be accountable for determining how inclusive or how representative a particular public involvement initiative will be. In the future, these departmental decisions will more frequently be made in collaboration with other groups.

Health Canada's stakeholders and various other publics who want to interact with the department are increasingly demanding improved coordination of departmental public involvement activities in order to maximize internal and external resources, and minimize" consultation fatigue" felt by those being consulted. With numerous departments and all levels of government now assigning a priority to citizen engagement in their policy and program planning processes, coordination at all levels is increasingly important.

Whether the department manages the process directly or commissions a third party to do so, key questions to ask to ensure appropriate representativeness and coordination are:

As part of the overall commitment in the Social Union Framework Agreement to working in partnership, there are a number of provincial/territorial (P/T) considerations that Health Canada should bear in mind when planning future public involvement activities, including:

At the preparations phase for either consultation or engagement, it is important to identify the needs, issues and concerns of particular individuals or groups. Special care should be given to identifying and meeting the needs of populations that may be difficult to reach (marginalized) but can be critical to informing both the process and outcome. This knowledge forms a basis for determining who should be involved, communication processes and messages, and which mechanisms are likely to facilitate the effective participation of groups and individuals.

It is important to think very specifically about the different publics involved in an issue and how and when to best involve them. This means focussing on the nature of different audiences and what different audiences can and want to contribute. Experience shows that both sceptics and vested interests should be included. It is prudent to:

Health Canada's Public Involvement Continuum Matching Actions to Needs
High Level 1
Inform/Educate		 Level 2
Gather Information 		Level 3
Discuss/Involve		 Level 4
Engage		 Level 5
Partner
Citizen Engagement:
citizens' juries * * * * *
citizens' panels * * * * *
consensus conference * * * * *
deliberative polling * * * * *
search conference * * * * *
study circles * * * * *
study groups * * * * *
sustainable community development * * * * *
think tanks * * * * *
charrette * * * *  
constituent assembly * * * *  
delphi process * * * *  
retreats * * * *  
round tables * * * *  
Consultation:
advisory committee, board / council * * *    
computer-assisted participation * * *    
interactive www / e-conferencing * * *    
online discussion groups / list servers * * *    
televoting * * *    
issue conferences * * *    
nominal group process * * *    
workshops * * *    
bilateral meetings with stakeholders * *      
community or public meetings * *      
parliamentary committees * *      
people's panel * *      
polling * *      
public hearings and seminars * *      
questionnaires * *      
royal commissions * *      
surveys * *      
workbooks * *      
focus groups * *      
Communication:
advertising *        
calls for briefs / requests for proposals *        
community mapping *        
fact sheets *        
info fairs / exhibits *        
information kits *        
mailouts *        
media events *        
1-800 numbers *        
open house *        
press releases *        
site visits *        
Low Level of Time and Resources High

Lessons Learned

A few key lessons learned about public involvement are highlighted below. These lessons are closely linked to the principles outlined earlier in this document.

Information Toolkit - Terminology

Terms such as "consultation," "involvement" and " engagement" are often used interchangeably, although they mean different things to different people. The following definitions should help Health Canada employees to cut through the jargon around concepts relating to public involvement and develop a common usage of language in this area.

Citizen - an individual Canadian who is neither a delegate nor a representative of any government, organization, association or interest group.

Citizen engagement - the techniques that facilitate an informed dialogue among citizens and government officials, elected and/or non-elected, and encourage participants to share ideas or options and undertake collaborative decision making, sometimes as partners.

Communications - the techniques that inform the public about policies, programs and services. Consultations - the techniques involving a two-way flow of information that offer options for consideration and encourage feedback, such as additional ideas or options from the public.

Continuum of public involvement - the full range of public involvement in issues of public concern. This document refers to five levels of public involvement and pinpoints an array of public involvement techniques along a continuum. Communications techniques are at the "low end," consultation is in the " mid range" and citizen engagement is at the "high end" of the public involvement continuum.

Governance - the set of processes and traditions that determine how a society steers itself, how citizens are accorded a voice on issues of public concern and how decisions are made on these issues.

Involvement - the level of participation by the public, or the extent to which the public is actively involved, in understanding, assessing or resolving issues of public concern.

Partner - an individual, group or organization who participates in, or is responsible for, sharing responsibility for the implementation of various aspects of policy or program decisions.

Public - individuals, consumers, citizens, special interest groups and/or stakeholders.

Public involvement techniques - a broad range of strategies and methods used to inform citizens and/or accord them a voice on issues of public concern and/or include citizens in decision-making processes relating to these issues.

Social cohesion - refers to the building of shared values, reducing disparities in wealth and income and enabling people to have a sense that they are engaged in a common enterprise and face shared challenges as members of the same community.

Stakeholder - an individual, group or organization having a "stake" in an issue and its outcome (e.g. specific matters relating to health, environment, consumers, volunteers, industry, science).

Sustainable community development - communities empower themselves to achieve a hopeful and common vision of the future. Effectively responds to change through community-based decision making, economic self-reliance and environmental sustainability.

Case Studies and Techniques

The next section provides detailed case studies from many different regions and branches of Health Canada. It provides in-depth descriptions of many public involvement techniques covering all five levels of the department's public involvement continuum.

In some cases, examples of techniques having been applied in the United States and Europe are cited where sufficient Canadian examples could not be found. The toolkit is a culmination of insights gained from work experience across the department. To facilitate further enquiries and information exchanges, the toolkit provides departmental resource persons who may be contacted to guide the selection and application of public involvement techniques. The toolkit provides practical, "hands-on" information for Health Canada employees, as well as a means to develop relationships for ongoing collaboration. Health Canada's Corporate Consultation Secretariat will collaborate with all branches and regions to keep the toolkit up to date.

Level 1- When Do We Inform/Educate?

This section includes:

Level 1 Case Study

Level 1 Techniques

Level 1 Case Study: Focus Groups on Strengthening Health Care

Background

In the fall of 1998 and January 1999, Health Canada was considering various policies and programs to strengthen and modernize health care, ranging from enhancing health research and health information systems to working with provinces and territories to better integrate hospitals, doctors and community care. The department decided to test public reaction to these ideas in order to communicate them effectively, both in the short and long term.

Why Seek Public Involvement?

At the time the policy discussion was taking place, the public spotlight was on health care - long waiting lists, shortages of doctors and nurses, hospital closings, and fears that the publicly funded Medicare system was in decline. Provincial governments and health professionals were criticizing the federal government for cutbacks in health care funding in earlier years. Prime Minister Chrétien and Health Minister Allan Rock had promised more money for health care in the 1999 federal Budget.

In this atmosphere, it was important to communicate federal initiatives effectively to Canadians and to avoid fuelling controversies and feeding anxiety. To do this, the department wanted a more in-depth understanding of what Canadians thought about the future of their health care system, the federal role in Medicare and in health generally, and the various measures being considered in the pre-Budget period. The department decided to use focus groups because they allow for a broader exploration of issues than public opinion surveys. They also can be organized quickly when time is limited.

Who Was Involved?

Health Canada's Communications and Consultation Directorate took the lead, arranging for a consultant to conduct the focus groups. Communications and Consultation worked with the consultant in designing the questions and the format of the focus groups. The consultant then set up the focus groups, conducted them, and summarized and analysed results in a report to Health Canada. Health Canada representatives attended some of the focus groups to get direct feedback.

Objectives

Description of the Process

Sixteen focus group sessions were held in eight cities:

In each city, there were two focus groups:

Only those respondents who indicated they were moderately or very concerned about the future of health care in Canada were included. There was a roughly even split between male and female participants. The locations were chosen to give balance regionally and between large and small cities.

Each two-hour focus group session followed the same format. Participants were assured that results were confidential and that they would not be identified. Then, they were asked general questions about the biggest questions facing Canadians before moving to more specific issues about Medicare, the federal role in health, and various approaches to strengthening Medicare over the long term.

The consultant provided a preliminary report to Health Canada and a final report a short time later. The report has been deposited with the National Library so that it is available to the public.

Resources

The focus group testing was contracted out so that there was no demand on departmental staff apart from input into the focus group questions and format
The contract cost was borne by the Communications and Consultation Directorate.

Summary of Outcomes

The consultant's report helped Health Canada understand how certain initiatives would be received by Canadians and it guided the approach to messaging and long-term communications planning on the federal role in health. In effect, the objectives of the focus group testing were met.

Among the report's key findings:

Analysis

Some of the focus group findings were not unexpected while others were eye-opening. The in-depth nature of the discussions gave substance and credibility to the conclusions. The focus group results were useful in short-term communications surrounding the Social Union Framework Agreement and the federal Budget and its immediate aftermath. They also contributed to the department's long-term planning for communicating federal initiatives and the federal role in health. For example:

Factors contributing to success in this initiative include:

There were no significant barriers to success in this particular initiative. Conceivably, segmentation of the focus groups into even more demographic groups might have yielded further insights.

Policy Implications

Focus groups are useful in exploring the views of Canadians in a relatively unbiased and in-depth way. They are particularly valuable in preparing communications strategies where public opinion of various options is key to determining an approach that resonates with the public.

They are clearly not a substitute for broad public involvement in design of government policies.

Public Involvement Techniques Used

Contact information

Robert Douglas
Senior Communications Executive
Corporate Planning and Research
Health Policy and Communications Branch
(613) 957-1412
Robert_Douglas@hc-sc.gc.ca

Level 1 Technique: Advertising and Social Marketing

What Is It?

Social marketing is a planned process for influencing change. With its components of marketing, consumer research, advertising and promotion (including positioning, segmentation, creative strategy, message design and testing, media strategy, evaluation and tracking), social marketing can play a central role in promoting health and other important issues.

Social marketing combines the best elements of the traditional approaches to social change by utilizing advances in communication technology and marketing skills. It uses marketing techniques to generate discussion and promote information, attitudes values and behaviours. By doing so, it helps to create a climate conducive to social and behavioural change. In its truest form, social marketing is "the application of commercial marketing technologies to the analysis, planning, execution and evaluation of programs designed to influence the voluntary behaviour of target audiences in order to improve their personal welfare and that of their society." (Andreasen, 1995).

In recent times, social marketing campaigns have been launched on such diverse topics and issues as anti-smoking, drinking and driving, energy conservation, literacy, violence and racism.

How It Works

Anchored within a broad health promotion program, social marketing serves as a tool within an overall strategy. Ideally, it should work in synergy with other programs such as community intervention, legislation, etc. An overall Strategic Social Marketing Plan must be devised to drive decisions surrounding objectives, target groups, communication messages, budget requirements, promotional activities and timing. Audience analyses are essential to the success of all social marketing plans. Clearly stated marketing objectives that incorporate the overall goals of a health promotion program are key to ensuring a winning campaign.

When Is It Most Useful?

Social marketing is most useful for informing, persuading, influencing, motivating, promoting causes and communicating with specific and identifiable groups; in reinforcing behaviour; or changing it for social benefit. It provides the highest value when it is coordinated and integrated strategically within other programs, such as education and training, research and knowledge development, community support, legislative action and taxation.

Logistics and Limits

Social marketing requires resources: people, time, money and effort. Because it aims to reach specific target groups to initiate and effect changes in their ideas, attitudes and ultimately, behaviour, it is necessary to take steps to get to know the intended audience thoroughly through market research.Research efforts will be directed toward analysing the target audience's social and demographic makeup (e.g. economic status, education, age structure), its psycho-social features (e.g. attitudes, motivations, values, behavioural patterns), and its needs.

Once this research has been completed, efforts to effectively communicate key messages through appropriate vehicles can begin. Numerous vehicles can be used to communicate to any given target group: radio, television, print advertising in newspapers and magazines, posters, the Internet, outdoor billboards, etc. As a rule, the communication vehicles selected are ones that the target audience encounters regularly and perceive as being credible.

Cost Implications

The costs associated with social marketing vary widely, and are dependent upon many factors, such as the media chosen, the duration of the campaign, the difficulties associated with reaching intended audiences and the overall breadth and depth of the campaign. While traditional paid advertising continues to be a mainstay of many successful social marketing campaigns, their high costs can be prohibitive for many.

Several effective, low-cost marketing activities can be considered, particularly those that take advantage of new technologies, including the Internet. Forging partnerships, strategic alliances and sponsorship arrangements with other key players who share common objectives with you can also be cost-effective means to communicate your messages.

Expectations for Feedback or Follow-up Evaluating social marketing plans is important for a variety of reasons. A substantial evaluation will determine whether the plan is well implemented, is achieving the measurable objectives that have been set and is making a strong contribution to the overall health promotion program goals.

Engaging the intended target audiences in creating, assessing and evaluating communications products is an important element. Pre-testing your messages with the target group will help to ensure relevance. There exist a wide range of mechanisms for assessing the impact and evaluating the effectiveness of your social marketing effort, including polling, tracking and focus group testing.

Timelines

Timelines vary significantly in social marketing planning. Budgets, advertising schedules, deadlines for print and/or audio/video production, campaign duration and the time required to reasonably expect positive behavioural or social change all must be considered.

Potential Pitfalls

The following may act as barriers to the effectiveness of social marketing planning:

Contact Information

Health Canada's Partnerships and Marketing Division is the Health Policy and Communications Branch centre of expertise in social marketing, electronic information dissemination, Web marketing and partnership development.

Jim Mintz
Director
Partnerships and Marketing Division Communications,
Marketing and Consultations Directorate
HPCB

or refer to the Social Marketing Network, the single point of access to social marketing resources, publications, tutorials and other material at ( www.hc-sc.gc.ca/ahc-asc/activit/marketsoc/index_e.html).

Level 1 Technique: Call for Briefs/Request for Proposals

What Is It?

A call for briefs is an invitation to the public to address a project or policy idea by formulating alternative and creative solutions and submitting these in a formal presentation. A call for briefs may be preliminary to further consultation or another public involvement activity. Generally, within the government context, this is a process that asks for briefs to be submitted for a legalistic procedure such as a Standing Committee. However, in an extended form it could be a call for papers or presentations to be given during a symposium or conference (the procedures are virtually the same).

How It Works

Call for the submissions:
 Generally, a call for briefs is used when a conference or meeting has been scheduled to take place.

After submissions have been received:

When Is It Most Useful?

Logistics and Limits

Background information must be gathered and communicated in the preparation of the call for briefs.

Submissions will need to be collected, collated and analysed - it will be necessary to assign personnel to these functions. There is a likelihood that responses may be limited to interest groups, so "horizontal" issues may not be addressed. Moreover, when a call for submissions is put out, adequate information about when the submissions must be submitted and the proper form for submission must be provided to ensure the fullest response.

Cost Implications

Costs can vary a great deal depending on the complexity of the issue and the expectations of the host. The cost of an event is similar to other hosted events and might include room fees, the production and reproduction of materials, etc. There is usually no expectation of payment for briefs, although if the person is asked to come from out of town to present it, travel costs are usually covered.

Expectations for Feedback or Follow-up

A summary of how the briefs will be used and a collection of the briefs that were accepted should be compiled and distributed. Also, all those whose briefs were accepted should receive information as to the outcome of the event and/or the use of the briefs. If appropriate, the event could be published and results forwarded to the media and those whose submissions were not accepted.

Timelines

While it may not be an intensive public involvement technique, calls for briefs can be a very long process. Ideas and topics must be determined, the proper information communicated to the public, an event organized (if applicable), and enough time given to participants to respond. The timing on briefs for a government process, such as a Standing Committee, can be very tight, often less than three months. If asking for papers for a conference or a publication, the timelines may be much longer, sometimes as much as six months to one year.

Potential Pitfalls

Level 1 Technique: Community Mapping

What Is It?

Community mapping is a community development process that enables citizens to assemble an inventory of the resources at their disposal and identify the needs that they hold in common. Participants are often encouraged to locate the resources they identify on a physical map of their community, as a first step in understanding the potential connections among supports and services as well as any limitations in their existing capacity.

In a community mapping process, participating citizens and organizations develop detailed profiles of their resources, interests and needs. The focus can be broad, covering many or all aspects of community life, or more narrow.

The results of a community mapping exercise might enable participants to:

A community mapping project in Washington State distributed separate inventories to capture:

How It Works

Noting that "[s]he who owns the map owns the territory,"
the Los Angeles Learning Exchange suggests the
following steps for a community mapping process:

This description suggests the following questions that should be answered as early as possible in the process:

When Is It Most Useful?

An introduction to the Washington State community mapping process observed that "every single person has capacities, abilities and gifts. Living a good life depends on whether those capacities can be used, abilities expressed and gifts given. If they are, the person will be valued, feel powerful and well-connected to the people around them. And the community around the person will be more powerful because of the contribution the person is making."

More concretely, an Edmonton company involved in community mapping and capacity building cited the following goals for its copyright-protected workshop process:

The process has been undertaken with rural and urban communities, health and children's services groups, small businesses and non-profits, youth and youth groups, schools and corporations.

Logistics and Limits

Some of the literature on community mapping suggests that the success of the process may be limited by the resources in place - volunteers, money and available time - to complete the task. But this is not necessarily a severe constraint. "The more people, time, and money available, of course the more you can do," states the University of Kansas guide. "But even if you have just yourself, no money, and little time, you can still do useful work in identifying assets that will be helpful to the community - especially if nothing like this has ever been done before."

Cost Implications

The cost of a community mapping exercise depends on its breadth and duration. Specific cost items will likely include advance publicity and networking among participants, space rental for the mapping session, mapping supplies (small and large sheets of paper, pens and magic markers, possibly stickers to represent specific types of resources or needs), and payment for a professional facilitator.

Expectation for Feedback or Follow-up

Extensive use of inventories and interviews is intended to generate sustained community interest and participation. Community members who contribute their time and effort will likely expect a written report as soon as possible. The process also lends itself to ongoing progress reports, both to participants and to the wider community, which can become a catalyst for tangible follow-up activities.

Timelines

Timing depends on the needs and capacities of each participating community.

Potential Pitfalls

The effectiveness of a community mapping exercise is a reflection of the range of community interests and resources it captures - so a process with only limited community support or input will not have a great impact. If organizers inadvertently allow a community map to be taken over by a limited number of local stakeholders, the results may be considerably less meaningful or acceptable to the rest of the community. Like any other public involvement process, community mapping presumes a degree of sustained interest and attention on the part of participants and the community at large. If that interest wanes for any reason, the mapping exercise may not generate the ongoing discussion and action that might otherwise result.

Level 1 Technique: Fact Sheets/Backgrounder

What Is It?

A fact sheet is a list or document providing concise and factual information on a topic or initiative which is expected to attract considerable public attention.

How It Works

The fact sheets are disseminated to the public and the media either on a proactive or reactive basis in order to answer some of the most frequently asked questions on an issue. Efforts should be made to present information in plain language, and the overall needs of the audience need to be considered when developing fact sheets or any other public document. Fact sheets are issued to newspapers, TV stations, radio and emailed or made available on websites, to journalists and other stakeholders. They may also be included as supplementary material for a press release, media event or information kit. Before being issued, fact sheets require the appropriate levels of approval.

When Is It Most Useful?

A fact sheet is most useful as a strategic compilation of key information sources on an issue for the public. It may define an issue or promote discourse and informed debate on a subject. It is an ideal way to inform stakeholders and heighten awareness with a broad overview of an issue, policy or program.

Logistics and Limits

Cost Implications

Expectation for Feedback or Follow-up

Timelines

Potential Pitfalls

Level 1 Technique: Focus Groups

What Is It?

A focus group is a gathering of eight to 10 individuals with a strong interest in an issue or goal. Participants generally represent a cross-section of the public affected by this issue and may be chosen to represent specific interests. Focus groups are often used to test, evaluate and/or do a program review. They are frequently used by various types of marketing research. Focus groups are used to generate issues and to structure questionnaires or research methods. They are most appropriate to get a sense of regional, gender, age and ethnic differences in opinion.

How It Works

Planning is essential. The moderator and client agree on the meeting agenda (also termed a "protocol") which will guide the group discussion.

Guidelines for effectiveness:

How to select the group members:

When Is It Most Useful?

Focus groups are a highly specialized technique that can be a useful public consultation vehicle to:

Focus groups can be used in conjunction with several other public involvement mechanisms/techniques.

Logistics and Limits

Focus groups are good for initial concept exploration, creativity and for situations where qualitative data are required.

A focus group is not:

Cost Implications

It is not uncommon for market researchers to pay participants for their involvement in the process. As public involvement techniques become more popular, and the constraints on "key" people's time become more limited, payment may in fact become routine. Furthermore, skilled moderators have substantial fees. The cost of a single focus group can vary from $1,500 to over $7,000. Costs decline when the focus group is part of a general research program, or when several groups are conducted on the same topic.

Expectations for Feedback or Follow-up

Generally, there are few expectations from the participants for follow-up. However, it may be useful to share outcomes with participants in the interest of relationship building.

Timelines

Usually, specific product-based focus groups last one to two hours, while policy-based initiatives may be a day-long workshop. Locating and securing the cooperation of a single participant can often take 20 or 30 calls depending on the "expertise" required of participants.

Potential Pitfalls

A focus group needs to build synergy and secure cooperation from the members; thus, it is crucial that communication be open and that trust is built quickly. This helps encourage new ideas. It is necessary to choose the right focus group members, as well as facilitator, in order to make the information flow positively.

Note: A focus group may also be considered as a Level 2 Technique.

Level 1 Technique: 1 800 Numbers

What Is It?

A 1 800 number is a telephone transmission of a message or information made free of charge to the users. The goal is most often a facilitatory one, enabling institutions and the public to communicate quickly, effectively and inexpensively.

A 1 800 number, accessible throughout Canada, can be used to give out or collect information, request documents or information packages, and offers a two-way information exchange.

1 800 O CANADA is a permanent federal service which provides support to callers across Canada. Health Canada is currently participating in the 1 800 O CANADA program. Health Canada is providing up to a dozen publications that Canadians can access through this toll-free service. The service helps callers access federal programs and services across Canada. Orders for documents are recorded by the O CANADA staff and faxed daily to the Health Canada's Publications Distribution Unit for fulfilment.

Other examples of the Government of Canada's use of 1 800 numbers include a toll-free line to provide information on the New Tobacco Act, May 2, 1997. Health Canada has a 1 800 number to provide Hepatitis C information to the public.

How It Works

Decide on the type of communication which is desired. If information is routine, it may be possible to have an automated response. Some systems are automated and many callers may be served without speaking to an operator. If information is more complex, then a person(s) will be needed to respond to calls with or without an automated service.

When Is It Most Useful?

A 1 800 number is usually developed and maintained in response to a current issue. Therefore, most 1 800 lines will be temporary communications techniques. There are two ways to use 1 800 numbers:

A. To inform stakeholders

These 1 800 numbers have pre-prepared electronic answers to common inquiries or communication operators who can answer questions. In this way, the 1 800 number allows the government to fulfil its obligation to inform Canadians about its programs and policies and encourages social relations. It is an easy way for the public to have access to new government policies, programs and regulations.

B. To collect stakeholder responses

This type of 1 800 service is less frequent. These 1 800 numbers are used to determine stakeholder opinion about policies and programs which are proposed or already in existence. The number can either collect verbal responses from the callers or give the caller several choices of response to select from. These responses may then be analysed for policy planning and evaluation.

A 1 800 number is most useful to reach the public, who can call from any location at any time. The 1 800 number has the advantage of being used when the caller is unable to visit an office, or would be calling using long-distance telephone rates; thereby reaching people in remote or distant locations. Another benefit is that the 1 800 number can offer anonymity to callers when necessary, thus offering a sense of security.

By directing inquiries to the appropriate source, the 1 800 number can free administrative staff from interruptions by telephone inquiries.

Guidelines for effectiveness:

Logistics and Limits

A 1 800 number is good to provide simple answers to common inquiries, clarifications and concerns or to collect opinions on possible services. A 1 800 number communication may not be sufficient to resolve an issue or concern, but may succeed in directing a stakeholder to an appropriate source for resolution.

Cost Implications

Costs include the 1 800 number subscription, the number of lines into a call centre, the number of calls and where people are calling from. Staff costs include the number of required staff, staff training and the preparation of material for the staff answering these calls. A 1 800 line's costs are high.

Expectations for Feedback or Follow-up

Statistics may be collected on the line's use to give feedback about its effectiveness. Caller comments may be used directly to analyse stakeholder opinions about policies or programs. Moreover, data collection on the types of inquiries could indicate how well the department informs stakeholders of its policies and programs.

1 800 O CANADA asks each caller where they are calling from, the purpose of the call and if the person needs any other assistance. These data are recorded and are available for analysis of the 1800 O CANADA service.

Timelines

The 1 800 number can be maintained indefinitely, as long as it is useful and cost-effective.

Potential Pitfalls

Level 1 Technique: Info Fair or Exhibit

What Is It?

An info fair is a presentation or exhibit made by a governmental body to inform stakeholders of the existence of services, policies or programs. This technique is most useful for departments that are less known to their market, are presenting a new program or providing services which cannot be easily explained in brief. Moreover, if the stakeholders are broad or the specific users are unknown to the agency, direct advertising may be more difficult.

Health Canada participates in several exhibits/fairs on a yearly basis. It does so at a more corporate level for displays that need to be departmental in scope and directed to a wide range of audiences, but also at a branch or program level when the venue is more focussed on a file or topic and targeted to specific segments of the population. Health Canada also participates in info fairs to promote jobs among postsecondary students.

Human Resources Development Canada uses info fairs to promote job creation programs, and Industry Canada uses info fairs to promote its small business creation programs.

Health Canada anticipates an increase in its use of info fairs in the future. These include corporate exhibits as opposed to exhibits by each branch or for each program. The intention is to have each region equipped with a corporate exhibit.

How It Works

There are two ways to be involved in an info fair:

A. Promote Your Own Program

B. By Invitation

When invited to attend an info fair, it is important to learn about the nature of the fair and which agencies or programs are being included. Before creating the display, it is important to know the space and resources which are provided. It is also important to determine the stakeholders/public being targeted. This information will help determine whether or not to participate and the type of exhibit to produce. Further, it is important to communicate with the promoters, and agree on how your participation will be advertised.

Guidelines for effectiveness:

When Is It Most Useful?

Logistics and Limits

Cost Implications

Four types of direct costs may be incurred.

Indirect costs may be incurred by using staff time to prepare or represent your organization at the fair.

Expectations for Feedback or Follow-up

Exhibits and info fairs represent a good opportunity to feel the "pulse" of the audience on given subject matters. It could be done at the fair informally, for example, in face-to-face interactions, or using a more formal process, such as short questionnaires being handed out to people visiting the kiosk. This would help in learning the fair's effectiveness.

Follow-up evaluation of the fair can be made by asking people who took the information whether the info fair was useful to them.

Timelines

Usually the fair or exhibit will be part or all of a day, though some exhibits might last longer.

Potential Pitfalls

Level 1 Technique: Information Kits (see also Info Fair, Mailouts, Fact Sheets)

What Is It?

Information kits are prepared for significant or new announcements or initiatives. They often contain press releases, fact sheets, articles or pamphlets, a detailed report, ministerial cover letter and other communication materials to provide knowledge on a subject to stakeholders and other interested parties.

How It Works

Information kits are often used at media events such as press conferences, info fairs and technical briefings, as well as trade shows and other special events. They can also be distributed by mail and are increasingly being provided over the Internet. The appropriate approvals must be obtained, which depend on the content/subject of the kit.

When Is It Most Useful?

Information kits are used for communication, education and promotional purposes. The information provided will be more comprehensive, and contain more detail and context than a single press release or fact sheet. Information kits may provide technical and statistical data, policy developments and updates, program details and promotional materials. They may be targeted to the general public or to a specific group or issue. Kits may be used by stakeholders for planning, generating ideas and for decision making.

Logistics and Limits

The usefulness of the information kits will depend on the quality of the information provided and thus revisions may be necessary. In addition, information kits delivered over the Internet are limited to citizens who have the appropriate access.

Cost Implications

Expectation for Feedback or Follow-up

Timelines

Potential Pitfalls

Level 1 Technique: Mailouts (also see 1 800 Numbers)

What Is It?

A mailout is the distribution of department or branch documents to stakeholders or the public on a predetermined sign-up mailing list.

Health Canada's Mail Room Distribution Unit is available for the distribution of bulk quantities of departmental materials. Programs wishing to have new publications mailed to their stakeholders provide the Mail Room with a mailing list. The Mail Room charges the program for postage and materials that are used for the mailing.

In the future, this service will be personalized to the recipients' interests so they can be sent relevant information when it becomes available.

How It Works

Programs prepare lists of stakeholders in-house, from a variety of sources, often from regular correspondence. The stakeholders or public may be added to the list only with their permission. Programs, their stakeholders or members of the public may be added to a mailing list by telephone or mail request. Lists are rarely purchased. These lists are provided to the Mail Room or the third party contracted to provide this service.

I 800 O CANADA is also involved in the mailout process. Some requests for documents from callers are fulfilled directly through 1 800 O CANADA. If the documents are not ones available directly from 1 800 O CANADA, the program is faxed the request.

When Is It Most Useful?

This system is useful when large amounts of current information are needed about an organization or department and their programs or policies. Although much information is now available on-line, traditional mailouts still exist because not everyone has access to the Internet or some documents are not practical for webpages. Electronic list servers outlined in the Level 3 Techniques of this Toolkit fill a similar function to mailouts.

Logistics and Limits

Cost Implications

Secretarial services, including labour and supplies. If the mailout is contracted to an outside provider, the providers' charges must be included.

Expectation for Feedback or Follow-up

There are no established criteria for feedback or follow-up. However, two available methods to receive subscriber feedback are:

Timelines

Subscriptions could be offered on a term basis with a renewal requirement.

Potential Pitfalls

Level 1 Technique: Media Events (also see Information Kits, Press Releases, Fact Sheets)

What Is It?

Media events are used to introduce or explain initiatives to journalists in order to communicate and promote a department's objectives and mandate. They can incorporate written materials such as press releases and fact sheets for journalists and other stakeholders and also provide the opportunity for questions and comments from these parties. In practice, a media event is organized by the Media Relations Office in conjunction with branch Communications and the program area.

How It Works

Spokespersons from the program are normally required to provide journalists with both background and on-the-record information on the initiative being announced or explained. When the Minister is participating in a media event, program officials are often required to brief the Minister in advance and to provide technical information to the media following the Minister's announcement. All media events require prior approval by the Minister.

When Is It Most Useful?

Media events are most useful to publicize an important initiative when a large communication impact is required. Since it provides the forum for questions and answers, the event has the capacity to gather a high profile from journalists to help set the public agenda. Media events can raise awareness of issues and ideas and can be used to help publicize results of prior initiatives and policy successes. The potential for ministerial involvement also contributes to the media event's exposure. Media events are either used proactively to promote an issue or reactively to respond to a publicized subject.

Logistics and Limits

Cost Implications

Expectation for Feedback or Follow-up

Timelines

Potential Pitfalls

Level 1 Technique: Open House

What Is It?

An open house is a relatively informal event that enables people to drop in and obtain information, usually pertaining to a plan or project. Generally, open houses include handouts, display presentations and staff to answer questions.

How It Works

The first step in preparing and running an open house is to define the issues which are to be addressed. During this step, the appropriate audio-visual and written material related to the issue should be selected or developed. Next, an event coordinator needs to be assigned. The selection of this individual should be based on the purpose of the presentation. For example, someone more familiar with technical aspects of the project may be more appropriate if the project is to be announced or explored. Exploring a project involves presenting alternative solutions to a problem or issue. Thirdly, the date and time must be set according to those who have an interest in the project. Locating a suitable space for tables and traffic flow is the fourth step. A neutral location is favourable if the project is controversial. Some examples of locations are schools, city halls, hotels, conference centres, fire halls and university campuses. Presentations (e.g. videos, boards), copies of documents, and other information devices should be prepared by the organization holding the open house. The organization must also staff the event with people who have specific areas of expertise.

When Is It Most Useful?

Logistics and Limits

Cost Implications

Usually, the greatest expense is the staff time needed to prepare and reproduce materials. The more elaborate the presentations and advertising, the greater the costs. Also, the location of the event may be expensive.

Expectations for Feedback or Follow-up

Pamphlets, leaflets and other written material are generally used. Evaluation forms for people to fill out at the event or at home are also appropriate.

Timelines

The actual event usually runs for three to four hours. However, if a large number of people show up or the project is controversial, it could last much longer. Depending on the complexity of the project and presentation, preparation time can range from one or two weeks to several months.

Potential Pitfalls

Level 1 Technique: Press Releases (also see Media Events, Fact Sheets)

What Is It?

Press releases are used by a department to announce a brief narrative of a specific initiative, program or policy development. They are a form of print media, composed of written materials that may be supplemented with other attachments such as fact sheets or information kits. Press releases are a government's main tool for communicating directly with the media. Press releases are distributed to newspapers, radio, TV stations and posted on websites. The media, in turn, can communicate the information to their readers, viewers or other audiences. In most cases, press releases offer specific information concerning programs or policies, and identify a departmental contact whom reporters can call to ask questions or develop more in-depth storylines.

How It Works

As an example, press releases within Health Canada are prepared by communications officers in branch Communications and are assigned to departmental sectors/divisions and programs to service as clients. All news releases are distributed to the media through the Media Relations Office which is also responsible for coordinating approvals in consultation with the Communications office. Releases are sent both to specific news service organizations to be distributed, and directly to newspapers, radio, TV stations and Internet media sources. Depending on the distribution, the media can feature information gleaned from the press release in their stories. The press release is generally developed as one of a number of communications tactics within a communications strategy.

When Is It Most Useful?

Press releases are an effective means for communicating new departmental initiatives. Releases are targeted to both national and regional media representatives to be communicated to the broader Canadian public. An effective media strategy and press release can often be part of an overall strategic communications approach. Releases offer a convenient method of accurately transmitting the same information to many publications. Releases should be noteworthy and answer who, what, where, when, why and how, and can be developed in-house or contracted out.

Logistics and Limits

Cost Implications

Considerations include writing, editing and printing costs but these tend to be rather minimal. Costs will also depend on whether one or a series of announcements is necessary.

Expectation for Feedback or Follow-up

Timelines

Potential Pitfalls

Level 1 Technique: Site Visit

What Is It?

A site visit is a scheduled tour designed to give decision makers or members of a public involvement panel a more immediate, hands-on perspective on an issue or discussion point. The most common types of site visit include:

One or more site visits may take place as part of a
larger public involvement strategy.

How It Works

A site visit can last anywhere from a couple of hours to a couple of weeks, depending on the purpose, context and audience for the activity. The best site visits are scheduled well in advance and orchestrated carefully, with close attention to minute details of content, sequencing and logistics. Even if a site visit is requested by the host organization, advance discussion and joint design of the on-site process can help ensure full buy-in and cooperation by everyone involved.

If a group of participants must sign up for a site visit before it takes place, publicity materials should be distributed at least six to 10 weeks before the event and emphasize timing, cost (if any), and specific information related to comfort and safety (appropriate dress and any advance preparations required). At a conference, it may be necessary to supplement advance publicity with announcements on-site, from the podium and through the conference newsletter.

Participants should be fully briefed on any cross-cultural issues or other sensitivities that may arise during the visit. For example, for a group of non-Aboriginal participants about to visit a First Nations, Inuit or Métis community, the experience will be greatly enhanced and the potential for misunderstanding or embarrassment will be greatly reduced if the itinerary begins with a session with an experienced cross-cultural facilitator. The same would apply for a visit to an ethnocultural centre, an adult literacy program, a shelter for homeless people or battered women, or any other event that takes participants out of their accustomed cultural milieu.

Hosts may require time to prepare presentations or demonstrations, or to assemble the specific information that will make the program a success. Scheduling should be rigorous enough to give participants an intensive experience and make best use of limited time, while allowing sufficient time for rest and reflection.

When Is It Most Useful?

Site visits are a useful tool when:

Logistics and Limits

Logistics for a site visit are similar to the concerns associated with any conference, event or tour. For large, complex or high-profile visits, it may be advisable to involve an experienced meeting planner or special event organizer.

Cost Implications

Costs depend on the purpose, scale and overall design of a visit and on the number of visits in a series. Standard cost items will likely include travel, lodging, meals and incidental expenses for visiting panelists and support staff, staff time, telephone and telecommunication costs for the event organizer, and any specific expenditures associated with staging the visit.

Expectation for Feedback or Follow-up

Feedback mechanisms should be clarified from the outset, for hosts and panelists alike. If a deliberative or decision-making panel undertakes a site visit as part of a broader public involvement exercise, other participants will want to be informed of the panelists' findings, and the hosts will likely want to hear about the eventual outcome of the process.

Timelines

As suggested above, the time frame for a site visit can range from a couple of hours to a couple of weeks, depending on the purpose and context of the visit. For advance planning, it is best to allow at least four to six weeks for a simple site visit - or longer, for a more in-depth event.

Potential Pitfalls

While site visits can provide valuable perspectives on specific issues or experiences, it may eventually be necessary to place this information in a broader context. It is also important to avoid disappointment or disillusionment on the part of hosts, by clearly explaining the outcomes they can and cannot expect as a result of the visit.

Level 1 References

Advertising and Social Marketing:

1 800 Numbers

Info Fair or Exhibit

Mailouts

Press Releases

Media Events

Information Kits

Fact Sheets

Level 2 - When Do We Gather Information/Views?

This section includes:

Level 2 Case Study

Level 2 Techniques

Level 2 Case Study: The Northern Secretariat Aboriginal Diabetes Initiative

Background

In February 1999, the federal Canadian Diabetes Prevention and Control Strategy was announced in the federal Budget. The central component to this strategy is the Aboriginal Diabetes Initiative (ADI), which was developed in consultation with First Nation, Inuit and Métis peoples across the country. The ADI focusses on four specific areas:

  1. Direct care, treatment, and support programs
  2. Culturally appropriate education and training in diabetes care and prevention
  3. Health information and surveillance initiatives, to ensure Aboriginal needs are met
  4. Lifestyle supports to enhance community capacity to deal with diabetes and its complications in a holistic approach

The Medical Services Branch (MSB) of Health Canada is responsible for the ADI. The following case study relates directly to the consultations facilitated jointly by the Northern Secretariat and the governments of Nunavut and the Northwest Territories (NWT). It is an example of how a federal initiative was used to get feedback during a pre-budgetary process from a specific region on issues related to diabetes in Aboriginal communities and to gain information and insight from the public on a potential budget-related issue.

Why Seek Public Involvement?

MSB has a long history of involving First Nation and Inuit communities. As a result, using a consultation approach has become a policy of the branch. MSB is a highly decentralized, client-oriented organization which is responsible for several programs, particularly around providing health services to status Indians living on-reserve and to Inuit peoples. The ADI emerged out of the fact that diabetes has become a large problem in Canada, particularly in Aboriginal communities.

The following statistics outline the emergence of diabetes as an increasingly important issue in Canada:

High public expectations and strong media coverage on the growing problem of diabetes prompted the federal government to take visible action.

Who Was Involved?

The National Steering Committee (NSC), a committee with First Nation, Inuit and Métis partners, oversaw the consultation process. MSB and the governments of Nunavut and the NWT, in partnership with Inuit and First Nation organizations, consulted with health organizations, First Nation and Inuit organizations, NGOs (e.g. NWT Medical Association and the NWT/Nunavut Health Care Association) and other key stakeholders.

The consultations were focussed on four core questions to guide discussions:

  1. Is diabetes among Aboriginal peoples important to your organization? Why?
  2. What work (a) have you done in this area? (b) are you planning on doing in this area?
  3. What roles do you see your organization taking in the following areas prevention, education, care and support, research, and surveillance)?
  4. What will your organization offer to the ADI when it is implemented? Identify types of contributions; include linkages, coordination and integration.

Description of the Process

Consultation sessions occurred in Iqaluit, Rankin Inlet, Yellowknife and Cambridge Bay with approximately 15 to 20 participants per session. Sessions ranged in length from three hours to three days. People and communities which were to be involved in the process were sent joint letters from the territorial governments and MSB, while some stakeholders were contacted directly by a representative of MSB.

A MSB representative travelled to the respective locations and provided an overview of the ADI. Citizens and key participants who were involved in the consultation were selected by the federal and territorial governments based on their roles in the community and/or their expertise. The majority of the time was devoted to a roundtable discussion which related directly to the four core questions.

The consultations were held jointly by the two territorial governments and MSB. Tripartite sessions involving the national Aboriginal organizations were held in Yellowknife and Cambridge Bay.

Resources

The Canadian Diabetes Prevention and Control Strategy as a whole received $55 million over three years in the February 1999 federal Budget. The specific amount that will be devoted to the ADI has not yet been determined.

For the consultations within Nunavut and the NWT, MSB contributed two full-time staff, of which one was committed to travel to the two territories for the consultations. Accommodation, translation and other base costs were also provided by MSB, resulting in a total operating cost for the consultation of $21,000 (not including salaries). Other federal departments and territorial governments sometimes provided meeting rooms, while the Aboriginal communities provided experts, citizens and other notables in the consultation process. The overall approach to funding these consultations was to contain costs in order to maximize existing funding.

Summary of the Outcomes

The main objective of the consultation process was to answer the core questions and the organisers felt this was accomplished. Answers and discussions were presented in a report which was circulated among the meeting participants for validation. Instead of MSB sending out the information to each participant, it was often sent to the territorial coordinator, who was then responsible for circulating it to the participants.

Future plans will involve MSB working with territorial partners (both government and Aboriginal) on all budget announcements. The prospect of joint relationships was improved because of the positive experience in the two territories on this project. These consultations demonstrated that MSB has the capability of continually improving its consultation procedures in order to obtain the best results.

These consultations also enabled MSB to learn about diabetes programs currently being undertaken in various communities.

Analysis

This consultative strategy was deemed effective, as answers to all questions were obtained, and the joint consultation process generally worked well.

Factors for Success

Barriers to Success

Policy Implications

While public involvement is a standard MSB approach, the success of ADI in Nunavut and the NWT reinforces its validity and credibility. The success also makes this approach a useful model for understanding the consultation process.

The long-term impact of this model is, however, limited to some extent. MSB and its partners must wait for Cabinet approval and funding decisions to be made before they can report back to the communities. Despite these obstacles, some programs have already been initiated in communities building on existing programs.

Public Involvement Techniques Used

Contact Information

Judith D. Ross
Senior Program Analyst and Coordinator
Northern Secretariat
First Nations and Inuit Health Branch
(613) 957-6579
judith_ross@hc-sc.gc.ca

Level 2 Technique: Bilateral Meetings with Stakeholders

What Is It?

Bilateral meetings generally comprise one-on-one meetings between two groups that may represent organizations, sectors, regions or nations. They can be government-to-government, organization-to-organization or any combination of public/private bodies organized primarily to listen and gather information. Bilateral meetings with stakeholders involve groups with an interest in the proceedings, which may include multiple bilateral meetings with various groups. Consulting stakeholders aid the process of identifying and defining the relevant issues and increasing the knowledge base of the process by involving a number of key people and groups with multiple skills, broad experience and expertise.

One player, usually the government, assumes the responsibility for initiating bilateral meetings with other stakeholders to solicit their views and input. This, however, means that this player has the primary responsibility to act, devise policy or implement, and therefore make the final decision.

How It Works

Conduct briefings for stakeholders on relevant information well in advance. Bilateral meetings proceed by setting an agenda in order to inform all participants of their roles and responsibilities. While policy decisions may still be open for discussion, there may not be a commitment to follow through with the views collected. Therefore, the scope and parameters of the meetings should be defined beforehand in order to manage expectations.

When Is It Most Useful?

Bilateral meetings allow the main decision-making body to ensure that views are represented and understood. Bilateral or multilateral meetings are useful as a formal process to determine the nature of a problem, identify common ground among the parties involved, and discuss strategies for achieving objectives. They can serve to provide opinions, interests, values and objectives as the precursor to the policy development process or the implementation phase. Consultations resulting from bilateral meetings are often used for the establishment and organization of an advisory committee, or steering committee and working groups to represent various interests (e.g. consulting on how best to implement a government department's decision or a policy design process). Bilateral meetings with stakeholders could also be used to fulfil objectives, such as:

Logistics and Limits

Bilateral meetings must be distinguished from the more participatory method of multi-stakeholder consultations which usually include a wider range of interests and debate on issues. Multi-stakeholder consultations would represent a higher form of public involvement on the continuum and allow for more interaction between stakeholders.

Cost Implications

There could potentially be considerable travel costs associated with bilateral meetings, depending on where the meetings are situated. The location and venue should reflect the number and type of participants involved and generally would not require operational costs such as staff and equipment for the preparation of documents.

Expectation for Feedback or Follow-up

Bilateral meetings with stakeholders may be conducted at various times, such as:

There may be a need for further follow-up sessions. Furthermore, the government or stakeholders may require feedback on the effectiveness of the meetings, follow-up materials, and periodic written reports on the status of the meetings.

Timelines

Bilateral meetings may be used for a distinct phase of a process or as an ongoing reference base, and therefore may occur annually or semi-annually as a formal consultative process. The actual meeting typically takes place over a short time frame, depending upon the number of sessions scheduled. A meeting may be held anywhere from a few hours to a couple of days or week depending upon the number and complexity of issues on the agenda.

Potential Pitfalls

The possibility exists that the process would not be inclusive enough, and fail to adequately address the concerns of various stakeholders. The process may be seen as predetermined and used to achieve political "buy-in" and support rather than to share ideas and information.

Level 2 Technique: Community or Public Meetings

What Is It?

A community or public meeting is a forum where the consulting team makes a formal presentation to the public and the public is given the opportunity to respond with questions, reactions and comments. The meetings generally take place within the community in community centres, churches or schools. Community and public meetings are extensively used by government officials and agencies to solicit information and input on particular issues.

How It Works

There are several possible formats for public meetings, depending on the issue, the size of the expected audience, and the desired and expected level of interaction with and among participants. Essentially, members of a community are brought together to discuss a common concern. Notice of the meeting is imperative and the meetings should take place early in the consultation process to help reassure the public that their input is valuable.

Formats include:

Guidelines for effectiveness:

When Is It Most Useful?

Public meetings can be a useful public consultation vehicle:

Logistics and Limits

Community or public meetings must be well focussed and frequent enough for an organization to demonstrate real credibility. Moreover, meetings must be held early in the process to minimize fears that they are perfunctory.

Cost Implications

Community or public meetings are relatively inexpensive to hold, especially if the venue is a community centre, church or local public school.

Expectations for Feedback or Follow-up

Little formal follow-up through written means is generally required for a community or public meeting. However, depending on the issue, the community will likely expect that their concerns will be acted upon (e.g. through a change in legislation).

Timelines

A general meeting should not last longer than a couple of hours. Consider being flexible on the night/day of the week, as well as the time of day, based on your target audience. Often, meetings are held on a weeknight. Depending on the issue, you may consider holding a series of meetings which target different audiences, varying the locations and time of day.

Potential Pitfalls

There are real process challenges, including:

Level 2 Technique: Parliamentary Committees

What Is It?

In each session of Parliament, a great deal of discussion and debate takes place before standing committees that are established to oversee different aspects of federal government operations. The House of Commons and the Senate may also establish special committees to take an in-depth look at one or more specific issues. Committees are often the forum within the Parliamentary process where issues receive the most in-depth consideration, and where citizens and other stakeholders have the greatest opportunity to present specific views and positions.

As part of their review of proposed legislation, Parliamentary standing committees may invite written briefs or live testimony from members of the public. In some cases, they may travel to different parts of the country to hear first-hand evidence from local stakeholders. Committee meetings are scheduled very tightly, to make best use of limited time.

Lawyer Diane Davidson stressed the important powers of Parliamentary committees in a recent edition of Canadian Parliamentary Review. "While Parliamentary committees are often seen as just another player in the overall governmental process," she said, "they are an integral part of the House of Commons or the Senate." They can examine any matter referred to them by the Senate or the House, and have the right to launch their own study of any matter that falls within their overall mandate. In both instances, a committee has the time and resources to give an issue far greater attention than it would ever receive in Parliamentary debate.

As long as it is working on a topic within the jurisdiction of Parliament and its own terms of reference, a Parliamentary committee has virtually unlimited powers" to compel the attendance of witnesses and to order the production of documents," Davidson wrote. Witnesses can either be invited or compelled to appear before a Parliamentary committee, may be required to swear an oath and, in theory, usually have no right to refuse to answer a question.

Government relations specialist David McInnes, another author in Canadian Parliamentary Review, sees Parliamentary committees as citizens' best point of access to the legislative process. "Parliamentary committees are also the place where members truly roll up their sleeves to delve into the issues." Although committees "are unmatched in channelling Canadians' views to government," he stressed the importance of influencing the policy process at the earliest possible stage through departmental consultations, caucus briefings, and one-on-one meetings between stakeholders and MPs.

How It Works

McInnes observed that "witnesses, whether from the private or public sector, can face a daunting task in getting their message across to Parliamentarians and in ensuring that their appearance before a standing committee of the House of Commons or Senate is a meaningful one." His last-minute checklist for committee witnesses included the following points (please see the Internet reference at the end of this toolkit entry for the rest of the list):

Witnesses may be able to strengthen their presentations to Parliamentary committees by incorporating viewpoints from a large number of citizens or a wider range of stakeholders.

From a public involvement perspective, a public servant can play an important supportive role in helping stakeholders gain access to Parliamentary committee hearings, and to get the most out of the process. At minimum, enquiries should be referred promptly and efficiently to the clerk responsible for the specific committee (up-to-date contact information is available through the federal government's online telephone directory). If it appears that several stakeholder groups will want to take part in the same process, it may be worthwhile to assemble a standard information package that can be sent out as soon as a query is received. The package could include the committee's schedule and mandate, specific rules of procedure (advance submissions, duration of presentations, question and discussion format), a contact name for more current or detailed information, and reprints of the references listed at the end of this toolkit entry.

When Is It Most Useful?

Although full public access to committee debates may be limited by Parliamentary schedules or other constraints, timing and procedural rules are even more restrictive in the Commons and Senate. This means that committees provide citizens with the best opportunity for direct input into the formal but fundamentally important process by which laws are enacted in a Parliamentary democracy. Parliamentary committees may also be more likely to receive media attention than a less formal, community-driven consultative exercise, making them an extremely important venue for stakeholders seeking a wider public audience for their views.

Depending on local capacity and inclinations, Parliamentary committees can serve as a catalyst for communities to address issues in a less formal, potentially more inclusive format.

Logistics and Limits

Logistical needs related to the organization of Parliamentary committees are addressed by committee staff assigned to the House of Commons and Senate. For prospective witnesses before a Parliamentary committee, logistical challenges might include the announced deadline for written submissions, the time limits attached to live testimony, and the need to travel to the location where a committee is meeting.

Cost Implications

Costs associated with the committee process are included in the budget for Parliamentary operations. Stakeholders may incur costs associated with research, travel and follow-up contact with committee members.

Expectation for Feedback or Follow-up

Parliamentary committees generally issue written reports after completing their review of specific bills or issues. Stakeholders might attempt to organize their own follow-up in the weeks following a written submission or live presentation, by maintaining one-on-one contact with committee members and talking to neighbours or colleagues about the outcome of the committee hearing.

Timelines

The timing associated with the committee process is ultimately dictated by the four- to five-year life span of a Parliament. The scheduling of specific legislative measures may coincide with major government initiatives, like a budget or a Speech from the Throne. Governments often attempt to speed up the passage of legislation before the Commons and the Senate rise for the summer, or for major holidays.

Potential Pitfalls

The formality associated with the committee process may be intimidating for some potential witnesses. Time constraints may also limit the number of witnesses who can be heard, and the sheer volume of written submissions on a contentious issue may make it difficult or impossible for even the most dedicated committee members and staff to give due consideration to each viewpoint.

Because of the wide range of interests that must be reflected and reconciled in Parliamentary decision making, some stakeholders may become disillusioned if it seems that a committee report has failed to capture their particular concerns - or if a government appears unnecessarily slow in responding to a committee report that is seen to have captured community concerns.

Level 2 Technique: People's Panel (UK)

What Is It?

The people's panel was initiated in 1998 by the Service First Unit of the British Cabinet Office. It was prompted by government in recognition of the need to listen to and learn from people's views over time. The unit commissioned a market research company and the Birmingham University's School of Public Policy to set up the "people's panel." The purpose of the panel is to increase public involvement in government on a regional and national level, and to assure that government is responsive to public needs. This is an ongoing mechanism to involve ordinary citizens in a range of issues.

The people's panel:

The people's panel can be used to research a variety of issues, such as the impact of government policies on public service, information aspects of public service, and ideas or recommendations about public policy and services. This research is then used to inform the public service sectors, giving a real voice to the general public in policy making.

How It Works

The people's panel consists of 5,000 adults over the age of 16, randomly selected from across the country. The panel is designed to be a representative cross section of the population; by gender, age, background and other demographic factors. This panel then provides a database of individuals that can be used for a wide range of research and consultation, both quantitative and qualitative.

The database of individuals is a cost-effective means of identifying representative groups and service users. It is also large enough to do regional studies, allowing local research to be undertaken and compared with national norms. It is time saving and more effective as the members of the panel previously agreed to be consulted on a regular basis about public service issues.

When Is It Most Useful?

Logistics and Limits

The people's panel is a formula to be used on a national level, rather than for regional or local uses. Initial start-up is both timely and costly.

Cost Implications

Cost includes construction of a database of representative individuals, staff and office to run this ongoing mechanism. Each government organization would pay for use of the people's panel.

Expectation for Feedback or Follow-up

There is an expectation that all results from the people's panel should be published for public and government use and research.

Timelines

It is an ongoing mechanism, with long preparation time lines due to the number of people being contacted.

Potential Pitfalls

Although a representative cross section of the population, the people's panel is not meant to represent the people absolutely; rather, it is set up to inform the government on the ideas and opinions of the people on public service so that they may better assist the public.

Level 2 Technique: Polling

What Is It?

Often referred to as public opinion polling, polling is used to gauge public attitudes, values and perceptions on various issues. The polling technique utilizes a specific methodology to provide a statistically valid representation of a community, region or country's views. News stories are inundated with the latest information from polls and they are frequently used by political parties. In addition, there are many firms specializing in polling on various issues.

How It Works

Trained interviewers ask a random selection of the population a list of pretested questions. There are three main options when conducting a poll: in person at home, by telephone or by mail. Mail surveys can provide an excellent source of information, yet can be a timely process which means the results cannot be accessed and processed as quickly as a telephone survey. Furthermore, mail surveys are more susceptible than telephone surveys to low response rates. Polls are often conducted in call centres using Computer Assisted Telephone Interviewing (CATI) because it reduces the chance for coding errors.

Random samples are often obtained by professional polling firms through Random Digit Dialing (RDD), a process that employs computer technology to generate phone numbers from a database. Polls are statistically valid when they have a low margin of error and a high confidence level. The lower the margin of error, the more accurately the views of those surveyed match those of the entire population. This is usually measured using a 95% confidence level. The confidence level, in percentage terms, is the long-run probability that the results will be correct. For example, if 50% of a sample of 1,000 randomly selected Canadians said they favour gun control, in 95 cases out of 100, 50% of the entire Canadian population would also have granted the same response had they been asked, give or take three percentage points (the true proportion could be 47% or 53%).

Determining the sample size is dependent on the researcher deciding what level of accuracy is expected and how large the margin of error should be.

In order to determine the sample size for a simple random sample, the researcher must:

When Is It Most Useful?

Public opinion polling can be useful for gauging opinion, obtaining raw data and options from stakeholder or client groups, and for determining the public's level of understanding on certain issues. Decision makers can use polls to solicit positions, refine solutions and secure "buy-in."

Advantages

Logistics and Limits

Cost Implications

The cost of polling and the tabulation of results is generally high. There will also be a variation of cost between different methods of polling information.

For example:

Expectation for Feedback or Follow-up

Timelines

CATI-based telephone surveys grant quick information in terms of gathering data, although additional tasks include interpretation of the results. Polls offer timely results, yet external events can have a dramatic impact on polling results. Thus, interpretation of a poll should depend on when it was conducted relative to other relevant events. The size of the sample can also lengthen or shorten the process.

Potential Pitfalls

Polls are susceptible to the problems of other research methods, such as improper terminology, question phrasing and ordering, which can create biased results. The margin of sampling error (the amount of error the researcher is willing to accept) can be another source of inaccuracy. Other potential problem areas include inadequate interview training and supervision and data-processing errors. These errors, however, are less likely when a professional polling firm is used.

Level 2 Technique: Public Hearings and Seminars

What Is It?

A public hearing or seminar is a time-limited meeting, convened to gather community input or convey information on a specific topic. Each year, the Canadian public is invited to take part in hearings and seminars on a wide range of issues - from routine meetings dealing with licence renewals or bylaw amendments, to high-profile (and high-pressure) consultative sessions dealing with the most controversial questions facing society.

The focus of a public hearing or seminar can be narrow or broad, purely technical or largely philosophical. Discussion can be oriented primarily toward experts or can incorporate a wider range of stakeholder interests and types of knowledge. Depending on the issue, the context and the time available, a public hearing process can involve a single event or several dozen separate meetings in one or many communities. The events can be structured as formal or semi-formal hearings, where individuals and organizations make presentations to a panel and then engage in discussion with panelists, or as roundtable discussions. The Berger Commission is seen as a template for public hearings at their most ambitious, broadly based, and successful. However, one recent Internet posting describes a two-year process in Sauk County, Wisconsin, in which more than 70 public meetings were held to gather public input on a county development plan.

The overall category of public hearings and seminars includes:

How It Works

A public hearing panel can consist of elected officials, policymakers, subject specialists, members of the public, or any or all of the above. Panelists may be appointed by an elected body or nominated by stakeholders. The group's mandate may be limited to one specific issue or might extend over a series of unrelated hearings within a fixed period of time.

The composition of a panel should reflect the mix of partners involved in a decision, the range of expertise required to reach a thoughtful conclusion, and any representational issues related to geography, sectoral interests or conflicting viewpoints. If at all possible, both the composition and the mandate of a public hearing panel should be determined with advance input from key stakeholders - otherwise, special efforts may be needed to build trust in the process and its final outcome. The choice between a hearing or roundtable format - or the most appropriate mix of formats - may be determined by legislation, but should otherwise be decided according to the scope and objectives of a specific panel process.

Once a panel has been established and an issue has been identified, the hearing or seminar is publicized through the most appropriate combination of general, neighbourhood and specialist media. Prior to a hearing, it is important to identify any reference materials that are available to participants in advance. Specify whether the panel will accept written submissions or public presentations, indicate the time limits that will be applied to presentations or discussion from the floor, and allow enough advance time for prospective participants to hear about the event, register and prepare their statements. For a seminar, advance publicity should include information on the intended agenda, including presentation topics, names and qualifications of speakers and panelists, and time available for questions and discussion. If a topic is expected to be controversial, organizers should be particularly clear about the rules of procedure for the session, including start and end times, time allocation, and follow-up or feedback opportunities for anyone whose views have not been fully aired by the time the event concludes.

When Is It Most Useful?

A relatively linear style of public hearing is built into many regulatory and licensing processes, to ensure stakeholder compliance with legal requirements or community expectations. More open-ended, iterative processes can provide valuable insight to help guide the development of new policies, programs or procedures, or to determine an overall direction or philosophy on an emerging issue. Public hearings can also be organized in two or more stages, to allow interested parties to comment on the panel's initial findings or on the tangible results flowing from an initial round of discussion.

Public-hearing panels can gradually develop a broader view of the themes and principles that underlie a particular issue or controversy. This is especially the case if given the opportunity to visit several communities and get a sense of the common concerns that emerge. Using some of the specific techniques in this toolkit, such as televoting, it is also possible to design a public-hearing process that builds consensus or common ground on an issue, by helping stakeholders move beyond the initial positions that they bring to the table.

Logistics and Limits

The time period between the initial announcement and the actual hearing must be sufficient to allow stakeholders to find out about the process, consult with colleagues or constituents, and develop a position paper or verbal presentation. Ideally, the advance publicity period should be no less than three to six weeks - longer for more technical topics, or during the summer months. Depending on topic and target audiences, special efforts may be required to reach stakeholder groups that are sometimes less visible in consultative processes, such as recent immigrants, people with low literacy skills or lower-income households. It is best to start early and make contact with community associations, service agencies or other organizations with the required grassroot networks.

Cost Implications

Standard costs for public hearings include advance publicity, space rental, refreshments for participants and panelists, travel costs for panelists attending hearings outside their home communities, and per diems for panelists and staff.

For some types of hearings on some topics, it may be necessary to fund communities to conduct research and prepare their presentations to ensure full, meaningful stakeholder participation.

Expectation for Feedback or Follow-up

Stakeholders who participate in public hearings contribute significant time and effort to the process, and almost invariably expect tangible feedback in return. Different stakeholders may be satisfied with different types of outcomes, depending on the level of controversy and polarization associated with an issue and on the opening positions that they bring to the table. While some participants in a public hearing may simply be satisfied with the knowledge that their views were heard and incorporated within a consensus decision, others will be angry and disillusioned unless a public hearing process leads to a specific result. Either way, all participants should receive a print or electronic copy of the written report flowing from the hearing. Periodic updates may be useful, if they are feasible, as a means of measuring the ultimate impact of the exercise.

Timelines

The time frame for a single public hearing can range from a couple of hours to two or three days. A broader public-hearing process, including adequate preparation time, can run anywhere from six to eight weeks to two years or more.

Potential Pitfalls

The key challenge in any public-hearing process is to ensure that most if not all participants can see an acceptable progression from their own viewpoints to the eventual decision. If participants believe that their input has been ignored or trivialized, they will end up feeling betrayed by the process and cynical about the organization that hosted it. They will also be far less likely to participate in future consultative exercises.

In one Ontario community, a recent series of public hearings brought together a group of 200 volunteers who contributed more than 10,000 hours of research, negotiation and meeting time over a three- or fourmonth period. In the end, the volunteers were virtually unanimous that their findings had no impact on the host organization's decisions. Understandably, relatively few of them will be back for a second round.

Level 2 Technique: Questionnaires (also see "Surveys")

What Is It?

Questionnaires are a method of data collection using a sample of people and are generally used to gather information on the telephone, face to face, or by selfadministered means through the mail. The ultimate utility of a questionnaire will depend in part on proper problem definition and clear objectives.

How It Works

Questionnaire Construction

The questionnaire must translate the research objectives into the specific questions and convince the respondent to provide the information. The major considerations involved in formulating questions are their content, structure, format and sequence. Depending on the degree of sophistication being sought, an expert may be best able to design the questionnaire.

  1. Content: Most questions can be classified into either factual questions or questions about subjective experiences.

    • Factual: Designed to gather information from a respondent's background and his or her habits
    • Subjective: Inquires about the respondent's beliefs, attitudes, feelings and opinions
  2. Structure: There are three main types of question structures; open-ended, closed-ended and contingency questions.

    • Open-ended questions: There are no choices offered, and the respondent's answers are recorded. The advantage of open-ended questions is that respondents are not forced into abiding by categorized answers, yet they can be difficult to answer and may be hard to analyse.
    • Closed-ended questions: Respondents are asked to choose, among a set of answers, the one that most closely represents their views. They are quick to answer and easy to analyse, yet may introduce bias by making respondents choose from a set of predetermined options.
    • Contingency questions: This is a type of closedended question that applies only to a subgroup of respondents. The subgroup is decided by the answer of all respondents to a preceding filter question, which will either include or exclude them from the subgroup. They are useful because it may be necessary to include some questions that may be applicable only to some respondents.
  3. Format: There are many techniques for structuring the response categories of closed-ended questions.

    • Rating scales capture the intensity of the respondent for a set of ordered categories, such as "strongly agree," "favourable" or "very often."
    • Semantic differential is a rating scale that measures reactions to objects or ideas in terms of a bipolar scale defined with contrasting adjectives on each end, such as (Good 3 2 1 0 1 2 3 Bad)
    • Ranking is used to gain information regarding the degree of importance or the priorities that people attach to attitudes and objects. It helps to grant relative order, but does not give any information about the distance between the ranked numbers.
  4. Question sequence: The two most common question sequences are the funnel sequence and the inverted funnel sequence.

    • Funnel sequence: Each question is related to the previous question which has a gradually narrower scope. This sequence is useful when the survey's objective is to gather detailed information. When the survey is more exploratory in nature, the funnel sequence works effectively to ask the broad questions first.
    • Inverted funnel sequence: In this sequence, narrower questions are followed by more general ones. This method is used when a researcher wants to make a generalization regarding a specific situation and if the researcher is unfamiliar with the facts but the respondents know them.

When Is It Most Useful?

The questionnaire can be useful as a means of gathering information to measure attitudes and obtain opinions. As a general rule, questionnaires should not exceed six pages in length due to respondents' time constraints.

Logistics and Limits

Cost Implications

Mail questionnaires are low in cost relative to personal interviews or telephone surveys, yet they are not inexpensive, since additional mailings may be required.

Expectation for Feedback or Follow-up

Timelines

In terms of the speed of data collection, telephone interviews are the quickest, followed by personal interviews and mail surveys. The researcher essentially has no control over the return of the self-administered mail survey.

Potential Pitfalls

Level 2 Technique: Royal Commissions

What Is It?

Royal commissions, or commissions of inquiry, are appointed by Cabinet under the terms of the Inquiries Act in order to carry out full and impartial investigations of specific national problems. The terms of reference for the commission and the powers and the names of the commissioners are officially stated by an Order-in-Council. When the investigation is complete, the findings of the commission are reported to Cabinet and the Prime Minister for appropriate action.

Commissions are often referred to by the name of the chairperson or commissioner(s). For example, the Royal Commission on National Development in the Arts, Letters and Sciences is commonly known as the Massey Commission (chaired by Vincent Massey from 1949-1950).

How It Works

A royal commission is usually initiated by the federal government to address specific concerns or questions, but generally has powers under the Inquiries Act. A commission has an official mandate and objectives and has a separate budget and administrative process. Questions are usually determined by the commission, although often in conjunction with initial public consultations. Commissions often employ several public involvement techniques and the expertise of lawyers throughout their mandate in order to solicit more information from the public. Public involvement techniques can include witnesses, paper submissions and interviews. Commissions are independently run by appointed commissioners and are expected to have a report or recommendations for reform to be reported to Cabinet and the Prime Minister. Although not a process which necessarily uses public involvement techniques, a royal commission can provide the forum for discussions and input from stakeholders.

The following organizational considerations also apply:

When Is It Most Useful?

A royal commission is a useful public consultation vehicle:

Logistics and Limits

Among the key lessons learned about running an organization capable of supporting the work of a royal commission, in particular establishing and coordinating the work of the staff, are the following:

  1. Clarify the roles of the chair and the executive director, then respect the roles without exception.
  2. Decide early whether the situation calls for a large, expanding organization or a small, flexible one; then manage the choice strictly.
  3. Hire only people who really want to be there.
  4. Make internal communications and decision making easy and quick.
  5. Make the physical premises conducive to getting the work done.
  6. Pay attention to detail.
  7. Every quarter, think about when the next major shift of phases will occur, and begin planning for the organizational implications.
  8. Manage and provide information consistently and address problems quickly.
  9. Do not underestimate the time, skill, effort and resources required to publish major reports.
  10. Announce organizational changes early and directly.

Cost Implications

The cost of a specific commission depends heavily on the length and scope of the issue.

Expectations for Feedback or Follow-up

A public report and recommendations to the governing body are the results of a royal commission.

Timeliness

Many of the royal commissions are ongoing. Commissions which dissolve generally last from one year to a decade. The length of time that a commission is formed depends largely on the longevity of the issue being addressed.

Potential Pitfalls

Major challenges include the following:

Level 2 Technique: Surveys (also see "Questionnaires")

What Is It?

A survey is a method of primary data collection based on communication with a representative sample of individuals. Surveys are usually descriptive in nature, yet can also be used to provide casual explanations or explore ideas. A survey can be conducted using different information-gathering techniques such as mailout questionnaires, in-person interviews and telephone surveys. There is also an increasing use of technology driven fax, email and Internet-based surveys.

Determining which method is best to use depends partly on factors such as:

When Is It Most Useful?

Surveys can fulfil a number of objectives such as identifying a group's characteristics, measuring attitudes and describing behavioural patterns. The advantages of conducting mailout questionnaires, in-person interviews and telephone surveys are that they are:

Logistics and Limits

Comparing the three survey methods

Mailout Questionnaires

Mail questionnaires are quite structured and the questions should mean the same thing to every respondent; thus, questions and instructions must be easy to read and straightforward.

Special considerations must be made for people who will answer questions on their own.

Advantages

Disadvantages

Interviews

Face-to-face contact will most often provide higher response rates, and the opportunity to clarify ambiguities or misunderstandings and to monitor the conditions for completing the questionnaire. Inperson questionnaires and interviews share some advantages and disadvantages because they are both interactive and both rely on self-reported answers.

Advantages

Disadvantages

Telephone Interviews

The telephone interview, often called the telephone survey, can be described as a semi-personal method of gathering information. Telephone interviews used to be viewed with skepticism because of the high likelihood of a sampling bias by over-representing the population who could afford telephones. It is now a respected research method and may actually increase the quality of the data because the telephone interview can be supervised.

Advantages

Disadvantages

Cost Implications

Personal interviews are usually more expensive than both telephone interviews and mail questionnaires. Pretesting the questionnaire to a small sample helps to identify errors before they become costly to change. Additional cost considerations include:

Expectation for Feedback or Follow-up

Regarding mail questionnaires, follow-up letters may be necessary for reminding respondents to return their questionnaires. Furthermore, to increase the rate of survey returns, reference can be made in the covering letter regarding how the results of the survey will be sent to all respondents. As well, it can be advantageous to make results available upon request.

Timelines

Potential Pitfalls

Special care must be made to avoid general disadvantages of survey errors, such as:

Random sampling errors

Systematic errors

Level 2 Technique: Workbooks

What Is It?

A workbook is a publication, produced in print, electronic form, or both, that provides contextual information and invites users to suggest solutions to a set of problems or challenges. Workbooks can also be used to impart skills related to public involvement (or any other body of knowledge). Depending on the issues to be addressed and the scope and depth of input required, a workbook can be distributed as a stand-alone public involvement tool, or as one part of a larger consultative or deliberative exercise.

How It Works

The publication is produced by an agency or panel responsible for a specific issue, and distributed to any stakeholders whose awareness, support or participation will be required to address the issue. It should include any background data or information that readers/users will need to give an informed opinion. Detailed references should be summarized in plain language, so that there is no requirement to search a library or the Internet for supplementary content. Readers may be invited to fill out and return a questionnaire or reply form within a specified time period, or to take part in a face-to-face deliberative process after completing the workbook.

A workbook can be developed by public servants responsible for a particular issue or consultative exercise, with or without the help of outside writers, researchers or public participation specialists. From a public involvement standpoint, it may be extremely useful to involve key stakeholder groups in planning the workbook and approving its final content and layout - both to build trust and buy-in, and to ensure that the publication is suitable for the intended target audience(s). The package should be focus-tested before it is released, to ensure that it is useful and understandable for all target audiences.

A solid distribution plan is essential to the success of any workbook. If comments are required from a specific target audience, it may be necessary to buy and/or assemble an up-to-date mailing list - and to follow up by telephone with at least a selection of respondents. This task may be particularly important and time consuming if a workbook is expected to generate quantitative results. Mailing lists are available from commercial brokers, but the costs may be significant, and even the most current lists contain a proportion of inaccurate addresses by the time they are published. At the other end of the continuum, it may be possible simply to distribute workbooks as unaddressed mail within a specific geographic area, or to leave bulk copies at key gathering places in participating communities. In one recent consultative exercise, for example, Agriculture Canada found it useful to drop boxes of workbooks at rural postal stations. The department was also able to control printing and distribution costs by suggesting that respondents get together in small groups, at community centres or farms, to complete the workbook together. If a workbook is the first step in a face-to-face process, participants' responses can be collected when they arrive for the live session.

A clear, step-by-step plan for compiling workbook responses should be put in place before the final draft of the publication is completed. A particular process may require results that are quantitative, qualitative, or a combination of both - but the choice may also be dictated by logistics. Quantitative replies to questions that require a yes-no answer, or a response on a scale of one to five, are easier to compile, but a quantitative format may dictate a more aggressive, costly and time-consuming distribution plan if the workbook is intended to capture a representative sample of the target audience. Qualitative responses to open-ended questions will be more difficult to compile, but may provide greater insight into respondents' underlying needs, concerns and motivations.

Workbooks can also be produced in electronic form and distributed via the Internet, as long as a print edition is readily available to respondents with limited online access. Project scheduling should allow sufficient time to publicize an online workbook.

When Is It Most Useful?

A workbook can be distributed as a stand-alone resource or used in the context of a facilitated process. It can be designed to:

Logistics and Limits

A sustained effort may be required to ensure effective distribution of a workbook, particularly if existing contact lists are old or incomplete, or if the publication is intended to generate a statistically valid response.

Cost Implications

Beyond the development of workbook content, cost elements include printing and mailing for printed publications, long distance charges for toll-free telephone lines and faxback services, and programming costs for online forms.

Expectation for Feedback or Follow-up

If a workbook is one part of a larger deliberative process, participants' responses can be captured in the final report of that exercise. If a workbook is used as a stand-alone tool, all respondents should receive a print or electronic copy of the final, tabulated results. Either way, replies received by mail should be acknowledged by return post card as quickly as possible. It may be desirable or necessary to verify the summary report with participants before it is released, and to consider including their comments as an appendix.

Timelines

The time frame for developing and generating feedback from a workbook depends on the complexity of the content and the time available for the overall process.

Potential Pitfalls

A workbook may generate unanticipated responses from citizens or stakeholders if it is distributed far and wide as a stand-alone resource. This may or may not be a welcome result, depending on the purpose and design of the overall discussion process.

Level 2 References

Bilateral Meeting with Stakeholders

Community or Public Meetings

Parliamentary Committees

People's Panel (UK)

Polling

Public Hearings and Seminars

Questionnaires

Royal Commissions

Surveys

Workbooks

Level 3 - When Do We Discuss or Involve?

Level 3

This section includes:

Level 3 Case Study

Level 3 Techniques

References

Level 3 Case Study: Direct to Consumer Advertising

Background

Therapeutic Products Programme (TPP), within the Health Protection Branch (HPB), began a public consultation process in order to develop a renewed regulatory program governing the advertising of prescription drugs. The overall purpose of the consultation process is that it address the concerns of stakeholders and acknowledge present realities, while continuing to meet health and safety objectives. There are many conflicting views on the Direct to Consumer Advertising (DTCA) subject among stakeholders. Some would like to see no restrictions on DTCA while some would like a complete ban of DTCA - few are satisfied with the current situation.

Presently, DTCA of prescription drugs to the general public is limited under the Food and Drugs Act and Regulations. The Act includes an outright prohibition on the advertising of any drug to the general public as a treatment, preventative or cure of any diseases, disorders or abnormal physical states, listed in Schedule A to the Act (section 3). Schedule A includes such diseases as cancer, diabetes and heart disease. The Act also prohibits the sale or advertising of any drug in a manner that is likely to mislead or deceive the public (section 9).

The Regulations limit advertising of prescription drugs to the name, price and quantity of a drug. DTCA of non-prescription drugs is allowed, and is regulated under the Food and Drugs Act and administered by Advertising Standards Canada (ASC). As well, the Pharmaceutical Advertising Advisory Board (PAAB) administers advertising of prescription drugs to practitioners, which is allowed. The TPP retains authority for enforcement and compliance in relation to drug advertising, and provides advice and guidance relating to advertising as required to the PAAB and ASC. At this time, no single source of comprehensive, balanced drug information for consumers exists in Canada.

As prescription drugs are available only through the intervention of at least two health professionals, the physician and pharmacist, some parties may argue that the current health care system has enough checks and balances to ensure consumer health and safety. Thus, it is argued that the current provisions limit free commercial speech. Some stakeholders have even called for a challenge of the law under the Canadian Charter of Rights and Freedoms. If such a challenge succeeded, the current regulation would be struck down, allowing unlimited DTCA in Canada without any health and safety review of materials being possible.

Why Seek Public Involvement?

Increasingly, consumers are being encouraged to engage in shared decision making. Also, consumers are asking for a say in policy decisions that affect them. They are becoming partners with health care practitioners in making treatment choices and consumers are seeking objective information about prescription drugs. In addition, there is a trend toward self-care. Some good sources of drug information have been developed but these are not readily accessible or even known to all consumers.

The TPP Policy Development guide iterates that for significant and/or complex policy questions, consultations are appropriate during as many as three stages: on the issue analysis (definition of problem or issue), on the alternative solutions generated, and on the ranking and selecting of the solutions. Due to the scope and complexity of the DTCA issue and the impact it has on all Canadians, the TPP chose a process which included public involvement at each of these phases in the policy development process.

Who Was Involved?

The TPP worked internally with the Continuous Assessment Division of the Bureau of Drug Surveillance, the Bureau of Veterinarian Drugs, the Health Systems Policy Divisions of PCB, and Legal Services, Health Canada. In addition, there was communication/coordination with the Health Protection Branch Transition team and the TPP's Working Group on Advertising.

Direct to Consumer Advertising

Public consultations included key stakeholders from various sectors; provinces, government, academia, health practitioners, pharmaceutical industry, consumer advocacy groups, media, advertisers and non-governmental associations.

Description of the Process

The DTCA public involvement initiative has four distinct phases:

1. Initial Policy Analysis

The first phase, which took place from June 1996 until July 1998, included internal and external consultations to evaluate the issues and aimed at forming consensus around the goals and objectives regarding the dissemination of information on prescription drugs.

The TPP initiated the regulatory review process of DTCA with a multi-stakeholder consultation workshop that was held in June 1996. Attendees at that session included representatives from the provinces, academe, health practitioners, pharmaceutical industry, consumer advocacy groups and the media. The task for participants in this workshop was to provide their advice and opinions on the objectives for DTCA regulations.

The objectives reached through this public involvement initiative were to develop a regulatory framework that addresses key principles in relation to DTCA, including:

In response to the outcomes from the multi-stakeholder workshop, the provinces requested an opportunity to study DTCA from their perspective. Bilateral consultations with the provinces and territories took place in 1997-98. They reiterated their preference for a continued ban on DTCA for prescription drugs.

2. Generation of Solutions

In fall 1998, the next phase of the consultative process began when the TPP brought together a small group of stakeholders to look at the DTCA issue in order to generate a spectrum of available policy options and to assist the TPP in the design of the next multi-stakeholder consultation workshop to be held in April 1999.

3. Assessment of Alternatives

In phase three, a small number of options were assessed by estimating the pros and cons associated with each alternative. This was done through a broad external consultation. The consultation session on DTCA, hosted by the TPP, took place April 14-16, 1999. The views, concerns and comments of stakeholders with respect to the options developed during the second stage for a revised regulatory framework for DTCA of prescription drugs. An "As Said" report was produced in June 1999, and posted on the TPP website in August. All guidance documents and policy directives pertaining to drug advertising are also posted on the TPP website: this promotes transparency and enhances understanding of the federal government's role with respect to drug advertising.

4. Final Decision and Implementation

Analysis of the consultation materials will be undertaken in the hope of developing long-term policy propositions, and eventually to initiate a policy implementation plan. A small set of options will be put forward for further analysis. One preferred option was determined unavailable during phase three due to the breadth of opinion of participants. These options must be endorsed by TPP management and then further consultation on the subject can take place, coordinated with HPB Transition's Legislative Renewal. After these broader discussions take place, a preferred option will be selected and draft regulations, guidelines, codes of conduct, etc. will be produced. All of this will then be the subject of another round of consultations. Only then can a final decision be made and departmental approval requested.

Resources

Expenditures on the consultative processes used by the TPP over the past three years have totalled approximately $50,000. For information on other expenditures, contact Ross Duncan.

Summary of the Outcomes

As of the middle of August, the DTCA initiative is concluding phase three of the process. The April 1999 consultation session on DTCA of prescription drugs investigated a number of options. However, given the lack of data and breadth of opinion regarding DTCA of prescription drugs, no preferred option was agreed upon. The options which were reviewed during the workshop included:

Analysis

This consultative process was effective in informing and educating key stakeholders about the role of the TPP with regard to DTCA: its responsibilities; its working relationships with others; the current state of research on the health and safety effects of DTCA (via a literature review); and potential options. This process greatly enhanced a multi-sectoral dialogue on this health protection issue. It stimulated thinking and collaboration on key issues and approaches to advertising and information dissemination for prescription pharmaceuticals. To date, the consultative process has helped TPP determine what options were available, and has helped to TPP come to a better understanding of the opinions of the stakeholders on DTCA, in order to assist in the decision-making process.

Factors for Success

The consultation informed stakeholders of regulatory issues and concerns. The process led to a better understanding among the stakeholders of the perspectives and problems of each group that participated. Most importantly, it enabled the stakeholders to understand all of the issues faced by the regulator.

There is ongoing coordination of research into the health and safety effects of DTCA within the TPP itself and with other parts of Health Canada, as well as with the U.S. Food and Drug Administration.

Barriers to Success

The breadth of opinion was very great. There were areas where divergent opinions were evident among the group. Some parties believed that prescription drug advertising, if regulated effectively, can be a good means of disseminating high-quality information to consumers, patients and the general public. Other parties felt that the fundamental nature and goals of advertising make it an inappropriate mechanism for the dissemination of high-quality information to consumers, patients and the general public.

The selection process for participants at the TPP workshops relied to a certain degree on the interest of stakeholders in the issue and the knowledge of TPP staff as to parties that would clearly add to the quality of the debate. In order to fully capture the opinions of the broadest possible range of affected parties, however, a more thorough participant selection process might have proven useful.

The lack of evidence that DTCA would result in benefits which outweigh the cost implications, and the absence of data which show that DTCA has a positive or at least a neutral impact on utilization/health and safety, made it difficult for the groups to come to an informed, collective decision on the DTCA issue.

Policy Implications

This type of consultative process may be transferable to guide policy decisions on other health-related issues. The process can lead to better understanding and communication of the concerns and problems of stakeholders and government.

The long-term impact in this case, however, cannot be discerned at this time due to the lack of data on the health impact caused by DTCA of prescription drugs.

Public Involvement Techniques Used

Contact information

Ross Duncan
Policy Analyst
Therapeutic Products Directorate, Policy Division
Healthy Environments and Consumer Safety Branch
(613) 941-6226
Ross_Duncan@hc-sc.gc.ca

Level 3 Technique: Advisory Committee, Board or Council

What Is It?

An advisory committee, board or council consists of a group of representatives from a particular community or set of interests, appointed or selected by government bodies to provide comments and advice on an issue. Generally, this technique is used at the local or regional level, but can also be used to address national issues. Often, this technique is used to gather input on a particular set of policies or legislation requiring reform. The committee is also asked to provide recommendations to the governing body on potential reform.

How It Works

An advisory committee is asked to host and participate in public meetings and conferences. Also, it is expected to provide a sounding board to adequately reflect public opinion and to organize and coordinate the involvement and input of a wide range of people. Providing advice and input into the development of projects, policy and/or legislation are also functions of an advisory committee. An advisory committee helps to establish priorities, develop alternatives and select consultants. Also, all written material should be reviewed before being released to the public.

Selection of participants can be carried out by:

The selection of participants should represent a cross section of interests.

Guidelines for effectiveness:

When Is It Most Useful?

Advisory committees, boards or councils are used to:

Logistics and Limits

A committee's mandate, terms of reference, duration and the frequency and locations of meetings should be specified and limited to the scope of the task. Furthermore, the actual ability of the committee to influence change needs to be committed to from the beginning. The work of the advisory committee will lose credibility if there is little support for implementing or influencing the recommended reforms.

Cost Implications

Ensure a commitment of adequate professional staff, taking into account the amount of time needed to arrange meetings, write minutes and follow-up reports, and tend to administrative details and other practical concerns.

Expectations for Feedback or Follow-up

All activities undertaken by the advisory committee should be open and available to the public. Therefore, all reports and meetings should include public involvement at all stages, including review and feedback. There needs to be commitment for follow-up on the part of the governing body which appointed the committee in the first place.

Timelines

Often, the advisory committee members are appointed to terms of one to two years, although shorter terms could be adequate, depending on the particular issue or reform.

Potential Pitfalls

If the advisory committee is not open enough, or does not offer activities which include the public, it will lose credibility. Also, if the governing body is split about implementing the recommendations offered by the advisory committee, the inability to complete its mandate will also harm the committee's credibility.

Level 3 Technique: An Introduction: Computer-Assisted Participation I

What Is It?

Computer-assisted participation refers to a category of structures and strategies, in which email and Internet-based communication are used to enhance public involvement in decision making. A number of specific computer-assisted participation techniques are presented in this toolkit.

Relatively early in the development of Internet communications, one leading observer gave the following overview of the unique potential of this grouping of public engagement resources:

- Morino Institute, The Promise and Challenge of a New Communications Age, 1995.

At least one U.S. clearinghouse on electronic democracy rates computer-assisted participation techniques on a three-point scale, representing a continuum from citizen input to more or less binding decision-making authority.

How It Works

The step-by-step practicalities of computer-assisted participation may vary from one technique to the next. For the most part, computer-assisted participation exercises use email, websites or telephone hook-ups with computer-assisted voting to involve a wider group of citizens in deliberative processes. Questions and background information may be distributed in advance in electronic form or broadcast via local television. At some point, participants generally have the opportunity to express a viewpoint or cast a vote on the issue under discussion, so that their input is incorporated in the broader decisionmaking process.

Here are just a few examples of computer-assisted participation in action:

Please turn to the toolkit entries on interactive World Wide Web/electronic conferencing, online discussion groups and list servers and televoting for more detailed information on specific aspects of computer assisted participation.

When Is It Most Useful?

Computer-assisted participation is a valuable tool for reaching out to public audiences, fostering interaction among citizens on specific issues, and ensuring that public views and concerns are captured in policy decisions.

Logistics and Limits

Successful use of specific techniques may hinge on access to technology and technological expertise, and on an ability to distribute background materials to a large participant group in advance of a consultative or deliberative exercise. To some extent, it may be possible to bridge this gap using the community access terminals funded by two Industry Canada programs, Canada's SchoolNet and the Community

Access Program. However, depending on the breadth and diversity of a target audience, it may be necessary to combine computer-assisted participation with other public involvement techniques that rely on printed materials and face-to-face interaction.

Cost Implications

Cost items associated with different computer-assisted participation techniques may include technology and related support, space rental and local logistics for any live meetings associated with the process, and preparation and distribution of background documents.

Expectation for Feedback or Follow-up

Like other public engagement techniques, computerassisted participation creates the expectation that citizens' views and concerns will be reflected in public policy decisions. Although the available literature makes no reference to specific follow-up measures, participants in a computer-assisted participation exercise would likely appreciate periodic updates, in print or electronic form.

Timelines

No time frame is specified in the available literature, but the planning period for a computer-assisted participation exercise should be sufficient to allow for public notice, preparation and distribution of any advance documentation, and acquisition and testing of technology. The length of the actual discussion process could range from several hours, for a public meeting transmitted by cable television, to one or more weeks, for a moderated discussion group.

Potential Pitfalls

By definition, as noted above, most forms of computer-assisted participation exclude community members with limited access to computers, email and the Internet, or who are not comfortable expressing themselves in an online environment. Although use of the Internet has been growing explosively, and demographic limitations are not as clear cut as they once were, online audiences still tend to be disproportionately male, white and wealthier than non-users. World-wide, Internet use is still centred primarily in the wealthiest countries, and English remains the dominant language.

Communities that experiment with computer-assisted participation may also encounter institutional resistance - while the Honolulu electronic public hearing was deemed a huge success from a public participation standpoint, the local council never repeated the experience.

Electronic communication can be an extremely effective mechanism for sustaining a debate or a deliberative process that is already under way, but may not be the best means of launching the discussion or setting its initial parameters. For issues that are complex, painful or value-laden, computer-assisted participation may not be an adequate substitute for live discussion groups, though they may help prepare the ground for a live session or extend the discussion beyond a single day. With controversial topics, an online moderator can play a crucial role in keeping discussion on track, without unduly impeding the free flow of ideas.

Computer-assisted participation can be quite time consuming for anyone involved in moderating an ongoing discussion - and therefore quite expensive, unless the moderator is a volunteer. As noted elsewhere in this toolkit, the legal implications of allowing some types of information to be posted have not yet been clarified by the courts - but attempts to control or censor the free flow of electronic information can generate ferocious opposition and sustained mistrust.

Level 3 Technique: Computer-Assisted Participation II: Interactive World Wide Web/Electronic Conferencing

What Is It?

The World Wide Web is a major component of the Internet, originally designed to foster global interaction and shared knowledge.

The range of interactive applications on the World Wide Web and the Internet is limited only by citizens' ability to define their communication and information needs, and by the creativity with which those needs are met. A specific interactive tool can be designed to serve a geographic community, or a virtual community defined by a common issue or area of concern.

Websites and other interactive tools can be used to disseminate information rapidly, collect responses within hours or days, and mobilize large numbers of citizens around common concerns - particularly if the individuals involved have already expressed interest in the issue or in a related topic. This quick response can be extremely helpful in laying the foundation for a more formal deliberative process, such as a citizens' panel or a deliberative voting exercise.

Electronic communication tools can also be used to educate members of geographic or virtual communities on specific issues, when a public involvement process allows time to develop an online presence, publicize it extensively using a variety of targeted media (both electronic and conventional), and gradually build up a large group of repeat visitors. Websites can also include opportunities for visitors to sign up for online discussion groups or list servers, which enable them to receive information more frequently and play a more active role in framing or exploring an issue.

Specific World Wide Web and electronic conferencing tools include:

How It Works

The first step in using World Wide Web or electronic conferencing techniques is to become familiar with the technology, how it works and how it is currently used. To get started, you'll need an email account with Internet access - depending on your organization, you can make arrangements either through your in-house system administrator or contact a private Internet Service Provider (ISP).

Libraries, bookstores and the Internet itself are full of cutting-edge resources on electronic conferencing that will be out of date three to six months after you obtain them. Anyone contemplating a public involvement exercise that includes an online component should consider the following steps:

For specialized services, such as computer-assisted voting linked to a website, you will likely have to call upon outside resources. For somewhat less complex tasks, such as designing a website with a limited degree of audience interaction, you will likely be able to arrange in-house or in-kind support. You may find that learning to do the work yourself is easier and faster than you think.

When Is It Most Useful?

Interactive media allow facilitators and participants to share information, quickly and effectively, without the controls or delays traditionally imposed by gatekeepers or intermediaries. Participants in a deliberative process can take part in an ongoing discussion at their own convenience, rather than agreeing to meet for a limited time at a specific location. Interactive media can be used to generate broader interest in a topic, since a single message can conceivably reach thousands of readers in a matter of hours.

The anonymity of online fora can disguise or reduce the immediacy of surface differences that often hinder live communication, such as social position, physical impairment, gender or ethnocultural origin.

Logistics and Limits

The logistics behind technically simple interactive techniques are straightforward for anyone with access to email and/or the Internet. Programming expertise is required for educational games and other tools that involve specialized scripts and minute-to-minute feedback. Any public involvement plan that relies on the collection or dissemination of electronic information must allow sufficient time for thoughtful collection, analysis and synthesis of that information - and a reasonable budget for any paid staff time that may be required.

Cost Implications

The cost of interactive media depends on the complexity of each specific tool, and on the amount and quality of individualized design required to develop it.

Expectation for Feedback or Follow-up

The opportunity to interact directly with other stakeholders and with decision makers encourages many participants, especially those who are most active in a deliberative process, to expect regular written updates and tangible outcomes as a result of their involvement.

Timelines

The shelf life of an interactive tool depends on the public involvement process of which it is a part, and on the frequency with which it is updated. If a website is out of date, and there is no opportunity to revise it, it is far better to remove it from the Internet than to give the impression that an ongoing initiative is frozen in time. A website can be updated or deleted by obtaining the appropriate password from an in-house system administrator or private Internet Service Provider (ISP).

Potential Pitfalls

As noted elsewhere in this toolkit, the effectiveness of any online participation tool is limited by participants' access to and comfort with email and the Internet, and by their literacy skills. As well, the anonymity associated with online communication can encourage distribution of false, misleading or malicious content. The immediate, dispersed character of Internet communication requires users to develop more cautious habits - a message posted in a moment of anger or confusion might be distributed (and redistributed) across the country or around the world, with serious repercussions for the individual, his or her organization, and the overall process within which the discussion takes place. Finally, online resources can be difficult to find and almost impossible to prioritize without at least minimal search skills and experience.

Level 3 Technique: Computer-Assisted Participation III: Online Discussion Groups and List Servers

What Is It?

Online discussions groups, including list servers (listservs), are among the many public engagement tools that build on the interactive character of the Internet. They consist of a series of email messages or postings on one or more topics, allowing participants to explore issues in a relatively open-ended format.

Most discussion groups are organized in one of two ways:

In an unmoderated newsgroup, messages are posted as they are produced. In a moderated group, a designated individual reviews all messages before they are posted, and may block some messages according to a previously established standard based on relevance and etiquette. The moderator might be a paid staff member or a volunteer, but should generally be able to demonstrate a degree of independence and balance in relation to the discussion topic.

How It Works

As noted above, in the toolkit entry on World Wide Web and electronic conferencing techniques, the first step in using email as a public involvement tool is to become familiar with the technology, how it works and how it is currently used. To begin, you will need an email account with Internet access - depending on your organization, you can make arrangements either through your in-house system administrator or contact a private ISP.

Most printed and online resources on the Internet and electronic communication include sections on email, and may provide detailed information on list servers. Anyone interested in building email into a public involvement exercise should consider the following steps:

An informal email list requires a good deal of time and patience, but relatively little in the way of technical skills or resources, on the part of the administrator. Software packages are available to support more formal list servers. Either way, though, a considerable time commitment is required to keep a list current, filter out inappropriate or overly provocative messages (in the case of a moderated list), and help individual users with specific technical questions or problems.

When Is It Most Useful?

Online discussion groups can be an extremely valuable
mechanism for:

It can be extremely useful to provide periodic summaries of the comments generated by online discussion groups. The summaries can be produced by the moderator, although it is often worthwhile to call in an outside resource person with the time and distance to give participants and/or outside observers a streamlined, thematic snapshot of the discussion as it is unfolding. This strategy is particularly useful as a means of keeping discussion active and lively, while engaging participants in the process of synthesizing their own input to a broader deliberative process. A series of summaries can also foster communication across language groups - if a discussion is conducted in both French and English, for example, unilingual participants can update themselves on issues raised within the other language group by reviewing the summary.

Logistics and Limits

The logistics behind online discussion groups are quite straightforward for anyone with access to email and/or the Internet.

While online discussion groups are open to anyone who wishes to participate in good faith, the reverse is also true - discussion threads can rapidly lose momentum and wither away, and lists can lose their vibrancy and relevance if a large proportion of users lose interest or have limited time to participate.

To some extent, the legal boundaries for email lists and list servers have yet to be fully defined. For example, it may be prudent to filter out any messages from participants that appear to offer qualified medical advice on a specific topic. At the same time, most moderators learn to tread lightly into the realm of perceived or actual censorship of content. But unmoderated newsgroups lack a degree of protection against inappropriate content that could limit their credibility or lead to legal action.

Cost Implications

Except for the time required, participation in an online discussion group is free for anyone with prior access to email and/or the Internet. The software required to host a list server is often free or available at a nominal cost.

Expectation for Feedback or Follow-up

Within an online discussion, the fastest feedback is literally immediate. More broadly, participants in a discussion group can be expected to watch closely to ensure that their views and concerns are reflected in the public engagement process or policy decision in which they have been involved.

Timelines

Online discussions often lose momentum over a period of weeks or months, unless there is some shared interest or focus that keeps a core group of participants together.

Potential Pitfalls

Full, timely participation in an active online discussion group can take as much as an hour or two per day- sometimes to the surprise and dismay of participants.
Serving as moderator or facilitator for an email list or list server can be at least as time consuming. This can raise an issue of sustainability for many participants - leading to the possibility that issues will be evaluated or positions decided only by those who have the most time to contribute.

Online discussions can also evolve into peripheral correspondence of little or no relevance to the original topic. While moderators generally allow considerable latitude in this area, intervention is sometimes necessary to maintain the relevance and focus of the discussion group and to control the number of messages that participants must review in the limited time available to them.

Deliberative processes based on email and/or the Internet exclude citizens with limited or no access to the required technology, or who lack the computer experience or literacy skills to participate fully and comfortably in an online discussion.

Level 3 Technique: Computer-Assisted Participation IV: Televoting

What Is It?

Televoting refers to a variety of mechanisms that allow citizens to cast ballots on specific issues or questions - from home or from work, by electronic or regular mail or by telephone, from public polling places, or even from abroad.

Some observers see this form of "touch-tone democracy" as a public opinion research technique that allows for more in-depth, considered thought and deliberation than a regular telephone survey or focus group. Elsewhere, televoting is described as a broader, more radical application of the electronic voting machines that are already used in general elections in some jurisdictions.

Consistent with the wide variety of approaches that fall under this heading, the literature describes some televoting measures that would be binding on legislators, and others that would not.

How It Works

The first step in launching a televoting initiative is to contact local telephone companies and/or Internet service providers to determine the technical constraints and costs that would apply. If the basic approach is feasible and cost-effective, it is important to decide on the role of televoting in a broader public engagement initiative; the specific question(s) which will be put to a vote; the educational, deliberative and consultative steps that will lead up to the vote; the duration of the vote (hours, days or weeks); and the extent to which public deliberative processes can or should be broadcast to home voters via community cable or radio, or by other means. The ultimate question, based on past experience with televoting, is whether the partners in a public involvement exercise are prepared to be bound by the results of a televote or if not, how they propose to present the exercise in a way that will be meaningful and acceptable to public participants.

When Is It Most Useful?

Although "televoting" describes a number of distinct public involvement techniques, its advocates and practitioners generally present it as an opportunity to:

One recent publication suggests that the principles of probability and quantum physics can contribute to the development of successful televoting initiatives.

Logistics and Limits

Logistical implications vary across the different televoting techniques and depend in large part on the geographic scope and duration of the exercise. The degree of rigour required by stakeholders and the general public will likely hinge on the levels of controversy and complexity associated with the issue, and on the extent to which a televote is binding. In general, logistical concerns fall into two categories - the actual deliberative process (space rental, advance printing and publicity, travel and accommodation for out-of-town witnesses, on-site refreshments) and the technology, which will almost certainly be supplied and organized by the local telephone company or some other qualified contractor.

Cost Implications

Televoting is believed to be less expensive than conventional ballot initiatives, but costs vary according to the design of each exercise. Cost elements include standard aspects of the live event (space rental, printed materials, travel and accommodation for out-of-town speakers, facilitator's fee). Set-up and connection charges for the electronic aspects of the event should be estimated in advance by the local telephone company or other supplier.

Expectation for Feedback or Follow-up

Sustained, informed public participation is a stated goal for televoting advocates. With this in mind, a follow-up plan should be built into any televoting initiative and should be articulated to participants at the earliest opportunity. At a minimum, the plan should include written reports back to direct participants; ideally, results can be reported to the general public through community newspaper columns, householders or advertising.

Timelines

The Nova Scotia Liberal Party convention took place within the standard time frame for similar events and the Oregon primary was held within a 20-day span. Other initiatives, such as the Palo Alto discuss-andvote website, appear to allow longer periods for exploration and deliberation.

Potential Pitfalls

To the extent that televoting promises a representative sample of informed public opinion, its effectiveness can be limited by:

Although the Nova Scotia experience was considered a success, it showed that time-sensitive events can be vulnerable to equipment malfunctions. In Denmark, an electronic voting initiative generated strong opposition from some elected officials, who raised the possibility of voter fraud or untimely computer crashes.

Level 3 Technique: Issue Conferences

What Is It?

An issue conference is a formal meeting taking place over one or more days. It is convened to review issues related to a decision area and is a means to elicit and summarize formal analysis of research on the topic. Issue conferences are primarily mechanisms to involve experts in the analysis process.

How It Works

About 10 to 20 participants are selected based on their broad knowledge of the topic and usually for their specialty knowledge in a particular content area of the topic. As a group, the participants will represent a variety of approaches and points of view.

The conference follows a formal agenda based on key themes related to the decision area. It is usually facilitated by a chair who has been appointed by the organizers. The facilitator will possess subject matter expertise and should be skilled in handling group processes. A formal note taker will transcribe the proceedings. The facilitator proceeds theme by theme and elicits input for and against the wisdom of applying different aspects of the research to the decision area. Essentially, open discussion then takes place on each theme.

The output will be majority and minority opinions, and both will be conveyed to decision makers with their supporting rationales. A written summary of the proceedings with a section on key recommendations for each theme area will be produced after the conference.

When Is It Most Useful

Issue conferences are valuable early in the decisionmaking process where officials are seeking access to " best opinions" on the relative merits of the research available on the topic area.

Logistics and Limits

It is important to be clear on what the appropriate definition of "expert" is, given the topic area, and to ensure that experts represent a cross section of viewpoints at the table.

Cost Implications

As participants will be brought in from various parts of the country, travel and accommodation expenses can be high. However, the remainder of the costs will be affordable, as they are limited to the cost of the meeting room, flipcharts and fees for the recorder.

Expectation for Feedback or Follow-up

Participants will expect feedback from the host organization about how their input was applied in the decision-making process.

Timelines

Provide participants with at least two to four months' notice as you are dealing with experts who have numerous demands on their time.

Potential Pitfalls

By focussing on "experts," you are excluding the " ordinary" public. It is important to publicly convey the message that specialist views are being sought at an appropriate point in the decision-making process, and that these views will not preclude other consultative processes involving the public at large.

Level 3 Technique: Nominal Group Process

What Is It?

A nominal group process is a structured group interaction technique designed to generate a prioritized list of high-quality ideas within two hours or less. Contact between participants is restricted to specific steps in the process, so that individuals have sufficient opportunity to come up with their own ideas. The process makes it possible to assess individual participants' knowledge of an issue, monitor the similarity of ideas coming from different participants and encourage innovation.

How It Works

A nominal group generally involves eight to 12 participants and a facilitator, who must be very familiar and comfortable with the technique in order for it to work. Participants receive advance background information on the discussion topic or theme. The facilitator opens the session with an open-ended problem statement, along the lines of "The most important concern in (topic area) is..." or "The best way to increase public trust in HPB is..." The problem statement must not include any specific details that would direct or limit participants' responses.

From this starting point, the group goes through the following steps:

A wide variety of participants can be invited to take part in a nominal group process, although the small numbers involved usually mean restricting groups to local participants. All ideas belong to the individuals who put them forward and are given equal opportunity to be critiqued. While the process is designed primarily for information sharing, it can also be used to gather background data in support of an action plan or strategy.

When Is It Most Useful?

The nominal group process is used to:

Logistics and Limits

This technique can be used to address only one theme or issue at a time and participants must receive sufficient background information in advance. No more than eight to 12 participants can be included in a single group.

Cost Implications

Direct costs for the nominal group process include standard supplies, such as paper, pencils, pens, photocopies, postage and faxes. (Some advance costs may be reduced or eliminated if participants have convenient access to email.) Other cost factors could include travel for out-of-town participants and fees for facilitation and recording. It may be possible to absorb some costs by working with in-house personnel.

Expectation for Feedback or Follow-Up

Participants may ask for a final report on the process and for information on the sponsoring organization's response to their findings. The process may inspire some participants to take a longer-term interest in the issue.

Timelines

A nominal group can be assembled within two or four weeks, unless extensive advance research is required to identify participants. Charges for space rental and distribution of background information may be lower if a planning period is available.

Potential Pitfalls

The short time frame for a nominal group process may leave some participants dissatisfied with the amount of time they received to air their views. It may be impossible to fully clarify issues or problems, and the results of the process may suffer as a result.

Level 3 Technique: Workshops

What Is It?

Workshops are meetings at which participants expect to be involved in group discussion tasks. They are normally organized around one or more theme areas. The themes are often identified by a working group with representation from the interest groups which will be targeted as participants.

Workshops allow participants with differing values and priorities to build a common understanding of the problems and opportunities confronting them. The intent of most workshops is to either identify problems and expectations, or to recommend solutions.

How It Works

Workshops may last from one to approximately five days. The format is usually as follows:

Introductory Remarks

The chair of the working committee or the "workshop provider" will welcome participants, introduce the issues that will be discussed and present an agenda for the day.

Plenary Session

The workshop usually opens "formally" with remarks from a keynote speaker or a small panel of experts who introduce the issues and challenges to be discussed.

Working Sessions

At this point, participants normally head off to various mini-workshops clustered under the theme areas. These activities may consist of, for example, a series of panel or individual presentations on a specific portion of the issue followed by question sessions, or a request by the presenter(s) that participants break into further, smaller groups to flesh out potential solutions. Facilitators of these informal smaller groups are usually selected by the group itself. Flipchart recorders may also be appointed to capture key points of the discussion.

Another format might include small group work where participants move through experiential situations where they can develop and practise different strategies which may be used to address the workshop issues. The notion here is "if there is a particular political scenario involving this portion of the issue, with X players, at X point in time, how could we proceed?" Depending on the time available, there could be several scenarios, each handled by various smaller groups. Here, facilitators present the issue and "rove" to ensure the groups get going. The facilitators will thus provide encouragement, but not solutions. Each group would then present its scenario and the facilitator would lead ensuing discussion on the type of strategy demonstrated, its value and the challenges it poses. The facilitator and/or a group designated recorder would note key insights on the flipchart.

Often, there is a mix of the above activities. In most instances, workshops also have "roving observers." These can include the speaker or panel members, workshop organizers or acknowledged local experts who have a broad knowledge of the issues. Their task is to observe the flow of the discussion in all the mini-workshop or group activity sessions and pull out key themes. Prior to the end of the overall workshop, observers will meet to prepare a "report-back" which shows the major directions of the discussion and the key recommendations, or "next steps" in the problem resolution process.

Closing Plenary

This is the point where the roving observers, in a panel format, present their key themes/next steps as described above. Also, there is an open question session where participants interact with the panel.

Closure

The individual who opened the session now provides final remarks. The "chair" usually indicates how the proceedings of the workshop will be shared (e.g. by hard copy report, email, on a website) and may discuss potential plans for a future event to build on the learnings of this event.

When Is It Most Useful?

Workshops are most useful when it is important to bring together representatives from diverse groups who share a common interest in an issue but bring different perspectives on how it should be addressed. The format can be used for groups of varying size - for example, 20 to 30 people or as many as 80 to 120.

Logistics and Limits

The process works best when limited to people who are actively involved/working with the issue. They will have a true stake in the issue and are motivated to find realistic solutions to the problems posed.

Cost Implications

There will be the cost of meeting/accommodation space and catering. As well, keynote speakers/panels will receive honoraria and have travel costs covered. Workshop participants may or may not have their travel costs covered as well. Other ancillary costs include publicity (brochures, mailouts), workshop information folders, name tags, flipcharts, multi-media equipment, microphones (if a large number of participants), basic writing supplies, and costs for report preparation/distribution by mail or electronic means.

Expectation for Feedback or Follow-up

Workshop participants will expect feedback - first in terms of the proceedings and outcomes of the workshop and also follow-up later on concerning how their proposed solutions have been used - or if not, why not.

Timelines

Workshops may last from one to approximately five days. It is best to allow at least six to eight months to plan and implement a workshop, regardless of the number of participants involved. This allows time for busy people to fit it into their schedules. In particular, you need to contact your keynote speaker/panel and roving observers well in advance. Also, booking hotel meeting rooms, accommodations and food services needs considerable lead time.

Potential Pitfalls

Participants need to keep focussed on what is "doable" with the resources that are available, given the current political dynamics. There may be a tendency to recommend rapid, broad changes to the social and political fabric of the country. Facilitators must work hard to keep participants focussed and realistic in the solutions they suggest.

Level 3 References

Advisory Committee, Board or Council

Computer-Assisted Participation

Interactive World Wide Web/Electronic Conferencing

Online Discussion Groups and List Servers

Televoting

Issue Conferences

Nominal Group Process

Workshops

Level 4 - When Do We Engage?

Level 4

This section includes:

Level 4 Case Study

Level 4 Techniques

References

Level 4 Case Study: Joint Working Group on the Voluntary Sector

Background

Health Canada and voluntary health organizations have a long history of collaboration and cooperation. Voluntary organizations contribute to the health of Canadians through service delivery, public and professional education, research activities, participation in policy development and through public involvement.

The Joint Working Group on the Voluntary Sector (JWG) was initiated by several National Voluntary Health Organizations (NVHO) affected by the proposed elimination of the National Voluntary Health Organizations' grants and contributions program. The voluntary organizations banded together to consider how to respond to the proposed program decision and met with the former Deputy Minister of Health to discuss the impact of funding termination. At the request of the Deputy Minister, a Joint Working Group on the Voluntary Sector was established in March 1997. The mandate of this joint Health Canada - Voluntary Sector-led process was to produce a proposed framework to re-establish Health Canada's working relationship with the national voluntary sector in light of funding reductions.

Why Seek Public Involvement?

Given the vast number of voluntary organizations working in health in Canada, it was crucial to Health Canada that the viewpoints from organizations working on a diversity of health issues be reflected in the JWG process. The goal was to create an enduring framework for an improved long-term working relationship and ongoing dialogue between the department and national voluntary organizations working in health. Intensive involvement of the voluntary sector was therefore crucial.

Who Was Involved?

The JWG was co-chaired by a senior Health Canada representative and a senior official representing national voluntary organizations working in health. Members for both sides of the JWG were selected to be inclusive of departmental branches and voluntary organizations. In recognition of the important leadership role carried out at the national level, the decision was jointly made to concentrate work on a national framework, cognizant that this national framework would also be the basis for guiding work of voluntary organizations operating at the local and regional levels.

The efforts of the JWG were supported at the bureaucratic level by the Health Canada Inter-Branch Committee on the Voluntary Sector. Secretariat support was coordinated by the Policy Development and Coordination Division, HPPB. The Health Promotion Centre of Excellence in Toronto, because of its reputation for excellence both within government and the sector, was engaged as a contractor to conduct workshops on the Framework for Action document with approximately 160 national voluntary organizations working in health.

Description of the Process

The development of the proposed Framework for Action has been a groundbreaking activity representing almost two years of collaboration. The JWG asked the consulting firm PPF to prepare an initial draft of the Framework, which was presented to the JWG in December 1997. Interquest Canada worked on a followup document which was then distributed for comment to more than 160 national voluntary organizations working in health in May 1998. The following month, these same groups were invited to participate in a one-day plenary and workshop session on the Framework, organized by the Health Promotion Centre.

These sessions were scheduled in Ottawa and in Toronto, with approximately 70 of the 160 invited groups attending one of the two venues. Organizations that were unable to attend the meeting were provided with a questionnaire for written input. A generous time frame was provided for input in light of the summer timing of the public involvement activity.

The JWG then met in August 1998 to consider the findings from the workshops and produce a revised Framework. In mid-October, a revised Framework based on the findings was again sent for review and comment to the more than 160 organizations that received the previous draft. The final draft of the proposed Framework, based on the second round of input, was finalized by the JWG in December 1998. In January 1999, the Framework was formally submitted to the Deputy Minister of Health. Copies of the final draft also went to all of the organizations that participated in the process.

Resources

This public involvement process was not resource intensive - less than $50,000 was spent to support this initiative over two years. Resources were allocated to the consultants to hold the workshops, the writing of the document and travel expenses for the JWG members. The secretariat support provided by HPPB was responsible for supporting the work of the departmental co-chair, for organizing meetings and for coordinating the federal government policy response to the proposed initiatives under the JWG. Participation in the initiative involved significant amounts of volunteer time on the part of organizations.

Summary of the Outcomes

This public involvement process marks the first time that national voluntary organizations working in health have come together to work with Health Canada in developing a proposed Framework to strengthen the relationship between the department and the sector. Although the impetus for the creation of the JWG was funding pressures, the outcome of the JWG process was the creation of a joint Framework for Action which outlines recommendations for action on several fronts, as well as a strengthened and renewed relationship.

The proposed Framework for Action outlines the common goal to help people in Canada to improve their own health, the health of others and the health of their communities. Also highlighted are the shared principles of Health Canada and the voluntary sector: cooperation to benefit the health of people in Canada, recognition of diversity, respect, transparency and accountability.

Since the approval of the document, ongoing work has begun on joint incremental implementation of the recommendations outlined in the Framework. Discussions between voluntary sector representatives and the Deputy Minister have been held to determine how to best implement the recommendations. No formal evaluation of the process was undertaken.

This initiative has also had an impact on the relationship between national voluntary organizations working in health. It provided a forum for these organizations to come together on common issues and concerns. Furthermore, it has facilitated the building of national coalitions of voluntary organizations around common issues such as the creation of the Canadian Institutes on Health Research.

The JWG model has also been examined extensively by other federal departments. Specifically, the Framework for Action document served as a base for the Privy Council Office's Engaging the Voluntary Sector initiative in 1999.

Analysis

The JWG process provides a practical model for engaging stakeholder groups in long-term public involvement activities. The development of the Framework for Action promoted a better understanding of departmental and voluntary sector viewpoints and strengthened the lines of communications between the two sectors. The proposed Framework for Action now serves as the basis for future relationships between Health Canada and one of its most critically important partners in health promotion and program and service delivery.

Factors for Success

Barriers to Success

Policy Implications

The JWG mechanism is an appropriate process to engage the participation and solicit the views of many diverse interests. The Framework will have significant and lasting impacts on the policy development process in that it will serve as a basis for future relationship building and discussions between the department and the voluntary sector. This public involvement mechanism has been applied to guide both other Health Canada and federal governmentwide policy initiatives. This process also marked the beginning of a renewed relationship with national voluntary organizations critical to the delivery of health care in Canada.

Public Involvement Techniques Used

Contact Information

Mary Jane Lipkin
Policy Group Manager, Policy and Major Projects Directorate
Population and Public Health Branch
(613) 946-2067
Mary_Jane_Lipkin@hc-sc.gc.ca

Level 4 Technique: Charrette

What Is It?

A charrette is a meeting that convenes to address a specific issue or question, within a fixed time period. Participants work cooperatively to find a fresh and innovative solution to the issue at hand, in a setting where the time limit encourages quick, open and candid discussion.

How It Works

A charrette can accommodate 20 to 60 participants, depending on the breadth of the issue and the time available. Participants can include anyone with a stake in the issue, including experts and staff. A charrette should run at least two hours; most usually require a full day or more. Preparation for a charrette should be thorough and methodical, and an experienced facilitator is necessary.

A charrette usually involves the following steps:

Since a charrette is a one-time event, the participants' list and the timing must receive careful consideration, to maximize the value of the process. Goals and timing must be established in advance and made clear to all participants. Blank flipchart sheets are hung on the walls at the beginning of the process, so that participants can write down suggestions that might trigger new ideas in other group members, and emerging ideas are posted on flipcharts as the discussion unfolds.

Suggested ideas become the basis for deliberation. The debate continues until general agreement is reached. At the end of the process, a report is usually compiled to indicate how the proposed solution has been implemented.

When Is It Most Useful?

Charrettes are used to:

Logistics and Limits

Charrettes require discipline and may become difficult when particularly vocal individuals are invited to attend. Advance preparations are extensive, and can take a month or more. A shorter charrette (two to three hours) may yield only a limited number of ideas.

Cost Implications

Cost factors include ample meeting space, background materials, an experienced facilitator, resource people and on-site supplies. It may also be necessary to cover travel and accommodation, hospitality and compensation for individuals who must take time away from their regular jobs to take part.

Expectation for Feedback or Follow-Up

A follow-up report to participants is usually built into the process.

Timelines

At least two to four months may be required to gather background materials and expert participants. As already indicated, the process itself usually takes at least a day.

Potential Pitfalls

Depending on the definition of "expertise," the emphasis on specialist participation in a charrette may exclude community voices from the process. This could cast doubt on the credibility of the overall public involvement plan of which the group is a part. The continuous nature of a longer charrette may exclude some participants whose interest in a particular health issue relates to, or is hindered by, a disability or activity limitation.

Level 4 Technique: Constituent Assembly

What Is It?

Constituent assemblies are extra-parliamentary bodies convened to address major constitutional issues or reforms. This process allows citizens to feel as if they had a say in decision making around political reform. Constituent assemblies are increasingly being applied to a wide array of governance issues, both locally and nationally. Bringing together ordinary citizens and elected officials in a public and open process is key. Also, this process works best when it addresses a single compact issue, although suggested recommendations around reforms may be multifaceted.

How It Works

The constituent assembly consists of a number of citizen delegates and elected or appointed officials for a fixed term. Information on the main issues is usually provided at the conference and sessions should be facilitated by impartial experts on the topic (i.e. constitutional representatives).

A second form of the assembly (Community Working Group) can be applied at a regional level, consisting of citizen volunteers who undertake the job of researching and offering recommendations to a governing body. In this case, citizen volunteers offer advice to the regional council (elected officials) based on their findings. This type of assembly requires support from the elected body in order to carry out the mandate and is often initiated by government officials in order to have an external body enact necessary reforms.

When Is It Most Useful?

Logistics and Limits

The constituent assembly is a formula to be used primarily on a national level, rather than for regional or local uses. However, it can be successfully adapted to regional politics, as in the case of the municipality of Hamilton-Wentworth. Although the infrastructure can be initiated by a government body, the assembly needs to "take a life of its own" and be seen as independent from governing structures. Also, the process needs to be very public and open in order to generate public interest and support for the decisions.

Cost Implications

Initial start-up can be both timely and costly, but definitely worthwhile once the infrastructure is put into place.

Expectation for Feedback or Follow-Up

The assembly has to make every effort to encourage the community to participate fully and meaningfully by using a wide range of consultative methods. There is an expectation that all the research and recommendations should be published for public and government use. There is also a need for citizens to feel as if their participation counted for something; therefore, consultations may have to be ongoing.

Timelines

This is usually an ongoing process that could take upward of a year as a full-fledge commitment for public involvement. The actual assembly could be one week, or a series of smaller meetings between participants.

Potential Pitfalls

The assembly can be a labour-intensive process and, because of the amount of time required, may not generate the interest or resources necessary to maintain it. Also, if it does not gain support either by the public (seen as "top-down") or the elected officials (seen as releasing too much power), the assembly will not work. Furthermore, this particular process is not right for addressing issues that are very controversial or broad.

Level 4 Technique: Delphi Process

What Is It?

The Delphi process is used primarily to build expert consensus in attempting to forecast future trends, although it can also support group decision making on a variety of issues. The process relies on an orderly series of planned, facilitated discussions among participants. These can occur either face-to-face or by correspondence. Participation is limited to people with expertise or a common interest in a specific issue, and groups are structured to ensure that each member brings a unique perspective to the process.

How It Works

The facilitator opens the session by introducing the issue(s) under review. There is usually no need for background information, since participants have been chosen for their pertinent expertise. The facilitator must be well informed on the issue as well, since she or he will play a key role in building consensus among participants.

Following the introduction, the group enters into a facilitated debate, in which participants' views are expressed and verbally evaluated. The purpose of the debate is to produce informed judgement on the issue. This continues until participants and the facilitator feel that all aspects of the issue have been fully addressed and general agreement has been reached. All comments and opinions are recorded by the facilitator or an assigned note taker. This ensures that the information cannot be misconstrued or misinterpreted later on. Remote discussions must be kept fairly consistent (a teleconference each week or a mailing every two weeks), so that the issue remains fresh in participants' minds.

In the period following the discussion, the facilitator compiles a report that documents the group's response to the issue. Participants compare their individual comments to the group's normative response, then take part in a second discussion designed to share, support and test different viewpoints on the issue. At the end of the discussion, participants comment anonymously on the issue by writing their ideas on cards. A new report is written, and the process repeats itself until the group reaches a firm consensus or a stable disagreement.

When Is It Most Useful?

The Delphi process is used to develop fact-based decisions and strategies, reflecting expert opinion on well-defined issues. It is a particularly useful mechanism for capturing expert opinion at a distance, without organizing a live meeting. It can also help break down barriers in situations where differences between participants threaten to inhibit the free flow of ideas. Since input to the Delphi process is anonymous, there is less chance that some participants' ideas will automatically take precedence over others.

Logistics and Limits

The process is limited to participants with expertise or interest in a common issue, including the facilitator. Consistent and timely contact is crucial for remote consultations.

Cost Implications

Direct costs associated with remote consultations are limited to printing and distribution of correspondence and materials, report preparation, and fax and long distance charges. The budget for a sequence of live meetings will likely include meeting supplies, written materials, travel and accommodation. There is potentially the need to compensate individuals who must take time away from their regular jobs to take part.

Expectation for Feedback or Follow-Up

Participants may ask for a final report on the process. Follow-up information on the sponsoring organization's response to their findings is also appropriate.

Timelines

It may take two or three months to assemble a Delphi group, since expert participants will likely have other demands on their time. As already noted, the duration of the process varies. Face-to-face discussions usually take about a half-day.

Potential Pitfalls

Depending on the definition of "expertise," the emphasis on specialized debate in a Delphi group may exclude community voices from the process. This could cast doubt on the credibility of the overall public involvement plan, of which the group is a part.

Level 4 Technique: Retreats

What Is It?

A retreat is a meeting convened in a relaxing and supportive environment, often in a natural or rural setting. Participants stay together at the retreat with opportunities for recreational and social activities encouraged within the meeting schedule. The intent is to have a more enjoyable space, with fewer outside distractions, and time and space to complete the work.

How It Works?

Retreats require careful preparation and planning to ensure maximum benefit is made of the environment. Retreats will vary in size and length depending on purpose, but rarely last more than three days because family and other commitments can be suspended only so long. In the planning stage, it is important to identify when a retreat might be necessary, instead of a workshop or meeting. They are most often used when trying to bring staff closer together.

Most retreats begin with an ice-breaker or social activity. If a retreat is to be successful, it is important to set a comfortable and supportive climate and re-establish the norms from the workplace to fit the retreat environment (e.g. casual, dress no hierarchy among participants).

Clarity of purpose and desired outcomes is critical at a retreat so participants know what is expected. The agenda of the retreat should allow time for participants to socialize, participate in recreation and enjoy the environment, not just complete their work in a more pleasant setting. As a result, many retreats modify the work schedule to allow participants such time (e.g. working session in morning and evening with afternoon golf tournament).

Often, small group discussions are conducted outside of the meeting room in a more informal setting. With this format, tasks and timelines must be very clear for small groups so the flow and work of the meeting continues, while maximizing the retreat setting.

When Is It Most Useful?

A retreat is a useful technique when:

Logistics and Limits

Retreats require more preparation in finding the best location so that the meeting is maximized, not compromised, by being in a retreat setting. The design should ensure that time is set aside to enjoy the environment, but balanced with time to work. This work-play is a key factor in the success of retreats. An independent facilitator is preferred as the process guide, leaving everyone else the opportunity to participate in the content of the retreat.

Cost Implications

Cost for a retreat is usually more expensive than "intown" meetings. Costs include participant expenses, including travel, accommodation and meals (often done as a package); leisure expenses (optional); facilitator expenses; and increased hospitality costs, audio-video rental and ground transportation to get to the location. Preparation materials/documents, group exercises/assessment resources also need to be considered. Some experts may require a fee for service and other participants may require compensation for forgone wages.

Expectation for Feedback or Follow-up

Timelines

Potential Pitfalls

Level 4 Technique: Round Tables

What Is It?

Round tables are meetings at which a group of people gather to make decisions on an equal footing. The concept of "round" table comes simply from the fact that no one is the "head" of the table - everyone is equally empowered to contribute to the decision. Participation is limited to people with a common interest or expertise in a specific issue.

How It Works

Round tables usually involve about 10 to 20 people and a facilitator. Participants receive background information on the issue to be discussed prior to the gathering so that everyone will share a common context.

The meeting follows a formal agenda and is facilitated by an individual who can provide process guidance but who has no stake in the outcome.

The facilitator opens the round table by introducing the issue(s) to be discussed and the key question areas to be addressed. The facilitator also shares information about the group process that the participants will undertake, pointing out that the round table is seeking collective advice, choices and/or options for action from those assembled. Since decision making rests with the entire group, it is critical for the facilitator to help the group define their decisions and build agreement in a logical manner.

There is a formal note taker. As well, the facilitator often uses a flipchart to record the milestones where participants determine that decisions must be made and the decision criteria which must be used.

Subsequent to the round table, a report is drafted and submitted to the participants for verification of discussion content and direction setting. Ultimately, a final document is prepared. Normally, an executive summary is produced which outlines key elements of the discussion, the options for action with their pro's and con's and the final recommendations with an accompanying rationale.

When Is It Most Useful?

Round tables are used to gather input and ultimately develop recommendations on broad courses of action. They are most valuable if held early in the period when decision makers are seeking advice about community opinions on a particular area.

Logistics and Limits

The process is limited to participants with an interest or expertise in a particular issue. The facilitator should be knowledgeable about the issue, but the key element is that she or he remains objective and impartial.

Cost Implications

Round tables may last from one to several days depending on the complexity of the issue(s) discussed. In terms of meeting space, all that is needed is a comfortable room, flipcharts, a computer for the recorder to use, and other basic writing supplies. If the round table draws on national participants, there will be travel and accommodation costs, and possibly wage compensation for individuals who must take time away from their regular jobs.

Expectation for Feedback or Follow-up

Participants and the communities of interest/expertise which they represent will expect feedback on how/if their recommendations will be used and when they can expect this to happen.

Timelines

A round table may last from one to several days depending on the complexity of the issues discussed. Allow about two to three months lead time to setting the meeting date. Remember, experts are in demand.

Potential Pitfalls

The round table may lead to circular non-conclusive discussion unless you choose a facilitator who has demonstrated ability to guide the participants logically, but non-intrusively, toward areas of agreement.

Level 4 Technique: References

Charrette

Constituent Assembly

Delphi Process

Retreats

Round Tables

Level 5 - When Do We Partner?

Level 5

This section includes:

Level 5 Case Study

Level 5 Techniques

References

Level 5 Case Study: Joint Action Group on Environmental Clean-Up

Background

In Sydney, Nova Scotia, the deplorable environmental conditions of the Muggah Creek Watershed led to the creation of a citizen-based group entitled the Joint Action Group for the Environmental Clean-Up of the Muggah Creek Watershed. Formed in the summer of 1995, the purpose of the group is to find a remedial solution to the Sydney Tar Ponds, the former Coke Ovens site, and the impacts of the municipal landfill - all part of the Muggah Creek Watershed area.

Why Seek Public Involvement?

The Sydney Tar Ponds is a 33-hectare estuary in Sydney, Nova Scotia. This estuary, otherwise known as Muggah Creek, has been contaminated with the coal tar effluent from the local steel plant's coke ovens over the last 90 years. It is estimated that 700,000 tonnes of toxic sediment contaminated with PAHs and PCBs have killed aquatic life and led to the closure of lobster fishing in the area.

The tar ponds are but a small component of the site targeted for improvement. Buildings are partially demolished - the site also has a number of deep water holes, underground tunnels and trenches, as well as a marsh dump, the Domtar tank and many coal and coke piles. Contamination is extensive and hazardous; in 1986, it was recognized as one of Canada's worst environmental sites.

The conditions of the site indicated that immediate action was required. The initiation of a public consultation process ensured that policy developments and recommendations clearly reflect the needs of the immediate community.

Who Was Involved?

In August 1996, municipal, provincial and federal government officials met with community representatives to share concerns and suggestions, and evaluate the feasibility of a community-based approach to identify and evaluate remedial options for the Tar Ponds and Coke Ovens sites. That meeting clearly indicated a solid base of support for a community-based initiative, and a Joint Action Group (JAG) on the Environmental Clean-Up of the Muggah Creek Watershed, representing community interests in partnership with the three levels of government, was formed. In addition to being represented on the JAG, the federal, provincial and municipal governments have committed to support its activities.

Description of the Process

JAG was an initiative founded by the three levels of government: Health Canada and Environment Canada at the federal level, the Government of Nova Scotia at the provincial level, and the Municipality of Cape Breton at the local level.

JAG's mission is to educate, involve and empower the community through partnerships, to determine and implement acceptable solutions for Canada's worst hazardous waste site and to assess and address the impact on human health. As outlined in a Memorandum of Understanding signed in September 1998, all levels of government have committed to pooling their collective resources in order to support the activities of the JAG.

The citizen round table, consisting of 50 community members, is the ultimate decision-making body of the JAG. A smaller steering committee consisting of 18 members reports to the round table. A handful of smaller working groups report to the steering committee. The steering committee is incorporated and is supported by a chair, two-vice chairs, a secretary and treasurer. In addition, a small secretariat was formed, consisting of a coordinator, a public information officer, a community outreach officer, an office manager and one JAG chair, as well as four administrative support staff. All JAG meetings are public, as are all files, recordings and transcripts.

Resources

The federal and Nova Scotia governments pledged $750,000 over three years to support the JAG; the Municipality of Sydney agreed to provide services inkind worth $750,000 over the same period. A further $175,000 was also forwarded to respond to the recommendations of the Health Studies Working Group.

Health Canada offered $195,000 in support of the following:

Environment Canada, the Government of Nova Scotia and the Municipality of Sydney offered $250,000 to support the following:

The three levels of government also agreed to:

Most recently, the three levels of government reached a cost-share agreement and have pledged to invest $62 million over the next three years to fund JAG initiatives. The funding will support activities and projects already recommended by JAG - activities and projects which are environmentally sound, health conscious, economically responsible, publicly accountable and socially acceptable.

Summary of the Outcomes

The guiding principles of the JAG process are openness, transparency, representativeness and inclusion. These principles have provided the foundation for a community-based process to address the challenges presented by the contaminated site. The key issues to be examined, through a variety of working groups, include: environmental data gathering, health studies, security of the site, potential remedial options, future site use, and public education and participation.

To date, the JAG has undertaken several initiatives, including:

Many other studies and activities are currently under way.

Analysis

The committee structure is an ideal mechanism to address the complex and controversial issues raised. Solutions to provide long-lasting clean-up require the commitment of many interests and the coordination of professionals in many disciplines. The community-building approach was seen also as an effective response to reducing the overall dependency on government. As well, the process is seen as an effective response for such an interdisciplinary issue as environmental clean-up, which involves a range of issues such as health, social, economic, research, financial and legal dimensions. Thus far, the recommendations set forth by the JAG have received much public support and attention.

Factors for Success

Barriers to Success

Policy Implications

The JAG process is unique and innovative. The model which has been created has drawn attention from across North America and throughout the world. It is expected that this model of community involvement and empowerment will be used for other contaminated sites in Canada and beyond.

Over the long term, it is expected that the JAG's efforts will ultimately result in the clean-up of the Muggah Creek Watershed area. In addition, the inroads being made by all levels of government through the partnership they have formed with the JAG will prove to be invaluable in the coming years.

Public Involvement Techniques Used

Contact Information

Tracey Taweel
Senior Communications Advisor
Atlantic Region
(902) 426-2668
Tracey_Taweel@hc-sc.gc.ca

Level 5 Technique: Citizens' Juries

What Is It?

A citizens' jury, also known as a planning cell, brings together a group to represent the profile of a local community or the population as a whole. Participants are asked to consider an issue of local or national importance, usually involving a matter of policy or planning. Although participants are called "jurors," they also serve as lawyer and judge during the process. Information is presented and deliberated in a quasi-courtroom setting, and jurors are asked to reach consensus on the issue as representatives of a collective public voice.

How It Works

Twelve to 16 citizens are selected to represent a cross section of the population, usually based on national or municipal voters' lists. Jury selection should reflect the scope of the issue - a national jury for an issue of national scope; a regional jury for a local issue. Prospective jurors should clearly express their willingness to take part before finalizing the selection. No background information is given to the jurors to help ensure that their input will be evidence-based.

At the beginning of the process, the issue is introduced by a group of independent moderators, who subsequently help guide the discussion. Expert witnesses are brought forward to help jurors reach an opinion. Jurors are permitted to ask questions one at a time, and may cross-examine witnesses as they see fit. Deliberation begins after the testimony is complete and jurors are satisfied with the answers they have received. The process continues until the jurors reach consensus on the issue. Their findings are then compiled into a final report, which each juror must approve before it is forwarded to the sponsoring organization.

The sponsor is expected to publicize the jury and its findings, and to explain its reasons for accepting or rejecting the results of the process.

When Is It Most Useful?

Citizens' juries are used to:

Logistics and Limits

The process can take one to four days, requires independent moderators, and may call for several expert witnesses.

Cost Implications

Costs depend on the design of a specific process, with local juries generally costing less than national initiatives. Participants' expenses will likely have to be covered for the duration of the process. Standard budget items include meeting supply costs, hospitality, accommodation, and travel between the hotel and the meeting site. Some participants may require compensation for forgone wages.

Level 5 Technique: Citizens' Panels

What Is It?

A citizens' panel is a form of consensus process in which non-experts are brought together to reach a common opinion on a public policy issue. According to an evaluation of one U.S. citizens' panel, "its general aims are to improve decision making about science and technology by expanding access and perspectives beyond the normal elite, to increase public understanding of science and technology through informed public debate, and to enhance democracy by fostering civic engagement."

The approach is based on a European model for consensus conferences, and is considered particularly promising as a means of gathering valid and constructive citizen input on technically complex issues. Between 1987 and mid-1999, about 30 citizens' panels had been convened in a dozen countries (18 of them hosted by the Danish Board of Technology). The sessions have addressed such issues as bioengineering and genetically modified foods, food irradiation, air pollution, telework, consumption and the environment, education technology, the future of the automobile, the future of fishing, national electricity policy, telecommunications, and mandatory laptop computers in universities.

How It Works

A citizens' panel generally brings together a dozen to two dozen non-experts to arrive at a common position on a controversial issue. The required output may be an absolute consensus, in which all dissenting voices must be satisfied, or a more general consensus, where disagreements are noted and built into the panel report.

Key elements of a citizens' panel include the lay panelists, a steering committee selected by the sponsor that establishes the process for the event, a group of expert advisors and professional support staff. The selection of panelists reflects a variety of trade-offs between the value of a random sample and the importance of built-in diversity:

At the beginning of the process, panelists receive background readings reflecting a diversity of viewpoints on the subject at hand, and take part in two preparatory workshops with an independent facilitator. The advance sessions combine social, intellectual and procedural content, enabling panelists to get to know one another, become familiar with the topic, and help determine the content of the actual panel meeting. The Danish panel prepared for its assignment by developing a list of 10 major questions on genetically engineered food and asked each of the invited experts to focus on one or two of the topics.

The citizens' panel itself begins in public session, with expert presentations, discussion between experts and panel members, and informal interaction between panelists and audience members. Panelists hold private deliberations after the presentations and discussions are complete, and conclude the process by issuing a consensus statement.

The process often includes an opportunity for expert witnesses to comment on the consensus statement, to eliminate ambiguities and possible misunderstandings. In at least one instance, experts were able to advise panelists on ways of expressing their concerns more strongly. Sponsors of the Calgary panel on biotechnology also maintained an interactive website to track the progress of the exercise.

When Is It Most Useful?

Citizens' panels bring together groups of non-experts who can serve as a proxy for the public at large, developing viewpoints that reflect the conclusions their friends, neighbours, relatives and colleagues would have reached if they had the opportunity to study an issue in similar depth and detail. Some researchers have also highlighted the potential impact of citizens' panels on the attitudes, training and day-to-day work of expert practitioners - whether or not the process brings any change to public policy - and in building public awareness of technical issues.

Citizens' panels also demonstrate the ability of nonexperts to arrive at fairly rapid, well-informed judgements on complex issues. In contrast to expert committees that rely heavily on technical knowledge, citizens' panels are seen as an opportunity to build a wider range of perspectives, concerns and values into the decision-making process. According to the evaluation of the Danish process, panelists "understood that the disagreements among experts were ideological as well as technical," and succeeded in "locating the technology within a real social milieu."

Logistics and Limits

Standard logistical concerns for a citizens' panel include effective communication among the panelists, and between the panel and its various audiences, space rental for meetings (choosing an appropriate space for the event), travel and accommodation for out-of-town panelists, the professional facilitator or presenters, on-site refreshments for panelists, presenters and participants, timely printing of advance materials and the final report, and effective media relations and followup. A key challenge for any citizens' panel is to find a common language and build mutual trust and confidence among lay panelists and expert witnesses representing a wide range of viewpoints.

Cost Implications

The budget for a citizens' panel should allow for reproduction and distribution of materials, participation of a trained facilitator, space rental and refreshments for three (or more) sessions, and travel and accommodation for out-of-town panelists, if applicable. Per diems may be standard for expert participants, and may be required to enable a representative cross section of panelists to take part. However, citizens' panels are seen as a cost-effective alternative to deliberative opinion polls - one deliberative poll in 1996 brought together more than 600 Americans and generated a more scientifically rigorous result, but at a cost of several million US dollars.

Expectation for Feedback or Follow-up

Citizens' panels conclude by releasing a consensus statement to the public. Other follow-up mechanisms, beginning with wide distribution of a written report in print and electronic form, may be built into the process.

Timelines

Although specific panels may adopt a different timeline, the literature suggests a process consisting of two preparatory weekends and one deliberative session running two to three days.

Potential Pitfalls

An evaluation of the Danish panel suggested that the process had failed to adequately address cross-cutting concerns, and could not remedy a perceived lack of assertiveness on the part of public interest advocates. Lay participants in the Calgary panel raised an equal and opposite concern, stating that their recommendations had been distorted by commercial media.

The planning group for a citizens' panel can play an important role in building a balanced process, by helping to ensure that a wide range of interests are fully represented. However, the overall process can backfire if panelists come to believe that the promise of an independent, participatory process has no chance of being fulfilled. In March 1998, a citizens' panel reviewing local governance models for the Region of Ottawa-Carleton disbanded, citing "immensely destructive interference in the Panel's process by numerous municipalities."

Level 5 Technique: Consensus Conference

What Is It?

A consensus conference, or a citizens' conference, is where an unaffiliated group of individual citizens becomes informed about an issue and formulates a set of recommendations for policymakers and the public. Similar to a "citizens' jury" approach, this technique assumes that the general public can make sense of complicated issues when given the time and resources to do so. The main aim of the project is to influence the policy-making process by opening up a dialogue between the public, experts and government.

How It Works?

Ten to 20 participants are chosen to sit on a citizens' panel to consider and discuss an issue of local or national importance. These issues usually involve a matter of policy planning. Similar to the citizens' jury, information is presented, deliberated, and experts or witnesses are cross-examined. The consensus conference may occur over three separate weekends, allowing the participants to increase their knowledge and awareness of the subject before questioning experts.

The organization of the consensus conference must be prepared properly to ensure that conditions for an open, balanced and constructive debate are met. The process will lose all credibility if it is viewed as biased or partial in any way. For this reason, the process should be carried out by an independent facilitator.

The initial task is to recruit an advisory committee of eight to 10 members. This committee will oversee the entire process, ensuring its independence and integrity.

Key tasks of this committee are to:

The citizens' panel, selected by the advisory committee, begins by spending two preparatory weekends going over a comprehensive and unbiased information package which outlines the essential aspects of the subject.

These weekends allow the panel to:

The process concludes with a three-day public forum, which brings the citizens' panel face-to-face with experts. If marketed well, the forum can also draw the media and interested members of the public. This forum gives the citizens' panel a chance to listen to, interview and cross-examine the experts. On the first day of the conference, each expert speaks for one half hour, and then addresses any questions from the citizens' panel. The citizens' panel then retires to discuss among themselves what has been heard. On the second day, the group cross-examines the expert panel in order to fill any gaps and to probe further on the issue. The following day, a report on the group's findings is prepared and presented.

The citizens' panel works cooperatively through the use of open discussions. However, their "verdict" on the key questions of the issue does not need to be completely unanimous. The final report should reflect the citizens' panel's expectations, concerns and recommendations.

When Is It Most Useful?

Consensus conferences are used to:

Logistics and Limits

This is a two-step process requiring at least three to four months for the total process.

Cost Implications

Costs include the work of an advisory committee, preparation for approximately three face-to-face meetings of the citizens' panel, one meeting of the experts, and advertising to the public. Costs will also be incurred for an independent coordinator and a public meeting space.

Expectations for Feedback or Follow-Up

Policymakers need to report publicly how the results of a consensus conference were used.

Timelines

At least three to four months are required for the total process. The meetings of the citizens' panel take place over three weekends.

Potential Pitfalls

Since this process can be initiated and driven by citizens, rather than government, there is the challenge of assuring that policy recommendations flowing from the process are timely and used by policymakers.

Level 5 Technique: Deliberative Polling

What Is It?

Deliberative polling combines small-group discussions involving large numbers of participants with random sampling of public opinion. Its overall purpose is to establish a base of informed public opinion on a specific issue. Citizens are invited to take part at random, so that a large enough participant group will provide a relatively accurate, scientific representation of public opinion.

How It Works

Deliberative polling usually involves 250 to 600 participants, selected locally or nation-wide. The size of the participant group is determined by organizers, but this is one setting in which bigger is often better - a larger sample size usually assures a better cross section of views, and increases the confidence and credibility with which results can be seen to represent public opinion. It is advisable to hire a facilitator with specific experience in deliberative polling to help organize the process.

The sampling stage of a deliberative poll begins with a general population survey, to capture public opinion and demographics. Mail surveys can be conducted with the help of a market research firm, using voters' lists or subscriber lists purchased from telephone companies. Depending on the issue, the sampling component of a deliberative poll may be conducted in partnership with a television network, in order to reach a broader population base. In this case, the network might invite viewers to take part in a telephone survey by calling in to a phone bank.

After the survey results are compiled, small-group participants are recruited according to demographics and their attitudes on the issue, and are asked to review a package of background materials. They then take part in a series of consultative meetings over a two- to four-day period. At this stage, participants decide the agenda themselves, identifying issues of interest and putting forward specific questions that enable them to learn from each other and seek a deeper understanding of the issue. On the second or third day, any unanswered questions are addressed by a panel of experts in a news conference format. Following questions and discussion, a second survey is distributed, and participants' responses are analysed and compared with the views expressed in the original poll.

When Is It Most Useful?

Deliberative polling is designed to:

Deliberative polling is used to measure diverse public opinion by examining participants' views after they have been given the time and necessary information to understand an issue. It can also capture changes in public opinion that occur during the process. While deliberative polling is primarily a social research technique, designed to expose participants and organizers to a range of unique perspectives and expert arguments, the results of the poll can be interpreted to represent broader public opinion.

Logistics and Limits

As noted, deliberative polling is an expensive technique that relies on extensive surveying of relatively large population groups.

Cost Implications

The high cost of deliberative polling relates directly to the large number of participants involved. Significant costs include printing, distribution of poll materials, prepaid envelopes for completed surveys, and staff time for a qualified facilitator. Polls conducted in partnership with a television network will also have to cover the cost of air time and network personnel.

Expectation for Feedback or Follow-Up

Participants may ask for a final report on the process and for follow-up information on the sponsoring organization's response to their findings. As well, a deliberative polling process may generate considerable media attention if the topic is a matter of current news interest and a television network is involved as a partner.

Timelines

The duration of the sampling stage depends on the methods used. After suppliers and partners have been identified, at least two to four weeks should be set aside to put logistics in place for a large-scale opinion research project.

Potential Pitfalls

Level 5 Technique: Search Conference

What Is It?

A search conference brings together large, diverse groups in order to discover values, purposes and projects they hold in common. Rather than use experts to answer questions, participants practise shared learning, where mutual understanding is achieved by sharing information. By inviting individuals with a stake in the purpose, a search conference enables those involved to create a desired future together and a possible place for implementation. This process is most often used at a community level in addressing local issues.

How It Works

A search conference usually involves 60 to 70 people, large enough to include a diversity of perspectives and small enough that the full group can be in dialogue at each step in the process. Instead of having speeches by experts, the search conference has working sessions with a wide range of parties who have information, authority to act and a stake in the outcome, regardless of their status, skills or attitudes. In creating a level playing field and equal chance to participate, it is possible for people to see issues from many more angles.

There are 16 or more hours of work, over a period of three days, where five tasks must be completed. These include:

Throughout the search conference, the group must focus on the core meeting principles:

When Is It Most Useful?

Logistics and Limits

The search conference can be challenging to organize. For example, determining the appropriate task at hand and getting the right people in the room is a difficult process.

Cost Implications

Expectation for Feedback or Follow-Up

Timelines

The conference usually takes place in four or five half-day sessions.

Potential Pitfalls

Level 5 Technique: Study Circles

What Is It?

A study circle consists of a series of informal, face-toface discussions that take place over a period of time. The process emphasizes cooperative and integrated learning, democratic participation and mutual respect. It is usually used to share ideas and opinions on social, political and community issues. The format is flexible enough to meet a variety of participant and organizational needs in many different settings.

How It Works

A study circle is made up of five to 20 people who agree to meet three to five times to discuss a specific topic. The process can also be used to convene a series of weekly or bi-monthly sessions to deal with a longer list of topics. Meetings generally run one to two hours with the group sitting in a circle, with or without tables. The format is designed to be as comfortable as possible for participants. A facilitator opens the process by introducing a set of established ground rules: respect for all participants' views, no personalization of disagreements through insults or personal attacks, and adequate time for everyone to speak.

Background material is distributed to participants before a new topic is introduced. The facilitator also assembles a list of discussion questions, with the assistance of the organizer. Discussion flows around the circle, with the guarantee that each participant will have the opportunity to take part. Facilitators may choose to introduce a stone, a book, a stick or some other object, with the understanding that only the person holding the object can speak.

The facilitator gradually guides participants through the process, with the understanding that the group need not discuss all the questions or consider them in the order in which they are presented. A silent observer should be asked to record the flow of the discussion to help track the group's thinking as it evolves over several meetings. At the end of the discussion, the facilitator asks participants to list the most important outcomes of the process, identify any common concerns that emerged, describe any changes in their own views as a result of the discussion, and talk about the actions they might take outside the study circle in response to what they have learned.

When Is It Most Useful?

Study circles are used to:

Study circles can be asked to meet over a longer period of time, to provide advice to policymakers or maintain a watching brief on longer-term topics, such as the future of health care. Circles can be convened locally or nationally, although a geographically dispersed group of participants lends itself more to broader issues.

Logistics and Limits

The gradual process of building familiarity with an issue can make it difficult to generate a rapid response to an emerging issue.

Cost Implications

Local study circles are quite affordable. National groups may require travel and accommodation, hospitality and some compensation for individuals who must take time away from their regular jobs to take part. Background materials must be produced and distributed, and fees may have to be covered for the facilitator and recorder unless qualified personnel can be found in-house.

Expectation for Feedback or Follow-Up

Participants may ask for a final report on the process and for follow-up information on the sponsoring organization's response to their findings.

Timelines

Study circles can be assembled quite quickly, particularly if key participants have already been identified and if the circle is convening locally. The duration of the process depends on its design.

Potential Pitfalls

Continuing reliance on the same group of participants means that the fresh, original snapshot of public viewpoints may deteriorate. Evolving group dynamics can direct or limit the development of individual viewpoints and past discussions can unduly influence participants' perceptions of new issues as they are introduced.

Level 5 Technique: Study Groups

What Is It?

A study group consists of a series of structured and non-structured discussions which take place over a period of time. These discussions can take place through any/or all of the following means: face-to-face meetings, teleconferences or the use of electronic links. Participants are selected for their knowledge in a particular area. The process is used to share ideas and opinions on issue areas and to provide advice on direction setting to decision makers. Issue areas include (but are not limited to) the social, ethical, political, economic and scientific fields. The study group differs from a study circle in that it does not seek to track participant views on an unfamiliar issue as new information is introduced and participant expertise increases. It is similar to a study circle in that an important output is the generation of quality suggestions or recommendations.

How It Works

A study group can be made up of approximately five to 12 people. The group's work will likely be initiated with a face-to-face meeting. Future meetings may be primarily through conference calls or electronic means. Meetings will normally run from one to two hours, with the exception of the first session which may last longer. The location of the meetings may depend on whether the study group is composed of local or national participants.

The first meeting focusses on an introduction to the mandate of the group and the process which they will follow. The facilitator thus reaffirms that the group has been established to both "keep an eye" on the issue area over a particular period of time, and to alert decision makers on areas of concern and then provide recommendations on potential courses of action.

The facilitator will likely introduce broad question areas that decision makers are presently grappling with and make initial requests for recommendations on direction setting. Time frames for print and/or electronic feedback will be discussed and agreed upon.

The schedule for future meetings will also be established (e.g. a monthly basis). The facilitator may continue in these meetings as a resource person to move discussion along, or the group may nominate one of its members to assume this role.

When Is It Most Useful?

Study groups are used to:

Logistics and Limits

People selected for their expertise may experience other conflicting demands on their time and decide to withdraw from the group, thus taking away the richness of their perspectives.

Cost Implications

In most instances, study groups are quite affordable. Apart from an initial face-to-face meeting, most meetings will be via telephone or virtual in nature. If the study group is local, the face-to-face meeting costs will be limited to meeting space, standard presentation equipment and basic writing supplies. If the study group is national, initial meeting costs will include accommodation and travel expenses. Fees for the facilitator (as appropriate) will also need to be covered.

Expectation for Feedback or Follow-up

The study group normally sets up ongoing feedback loops with the sponsoring organization.

Timelines

Like study circles, study groups can be assembled quite quickly. This is especially the case if key participants have already been identified and if the circle is convening locally for an initial, face-to-face meeting. An initial meeting of this nature for a national group may require several months' notice to the participants.

Potential Pitfalls

Evolving group dynamics or existing dissonances among experts may stifle the development of insightful options for action.

Level 5 Technique: Think Tanks

What Is It?

Think tanks bring together creative thinkers to develop innovative solutions to current issues and problems. Although most often used for public policy and planning, think tanks have become a common technique when creative solutions and out-of-the-box thinking are needed in non-governmental organizations and private-sector organizations.

Think tanks can range in scope from:

How It Works

Participants are selected for their knowledge and expertise, creativity, ability to synthesize and analyse information, and prepare cogent recommendations. Success of any think tank is dependent on the selection of participants, ensuring a balance between expertise and creativity. Considerations include what is and what is not possible and a willingness to move beyond current thinking and boundaries as necessary.

Most think tanks provide some background reading or questionnaire to ensure that participants have a common base of knowledge and have done some thinking about the content of the think tank. Pre-meeting preparation is usually essential if complex issues are to be presented, discussed, analysed and synthesized into recommendations within a reasonable time frame.

Beginning with a clear statement of purpose and desired outcomes is critical so that all participants know what is expected of them. Often, a review or update of information is presented, prior to participants beginning the process of discussing, analysing, synthesizing and creating recommendations.

When Is It Most Useful?

A think tank is a useful technique when:

Logistics and Limits

An independent facilitator is preferred as the process guide, leaving everyone else the opportunity to participate in the content of the think tank.

Cost Implications

Cost depends on the length and location of the think tank and number of participants. Costs include travel, accommodation, per diem, facilitator expenses, and hosting expenses, such as meeting room costs, hospitality, audio-video rental and ground transportation. Some experts may require a fee for service for preparing pre-meeting information or presentations at the think tank and other participants may require compensation for forgone wages.

Timelines

Think tanks usually run for a relatively short period of time (e.g. half a day to three days), depending on the topic and desired outcome.

Potential Pitfalls

Level 5 Technique: References

Citizens' Juries:

Citizens' Panels

Consensus Conference

Deliberative Polling

Search Conference

Study Circles

Study Groups

Think Tanks

Consultations with Health Canada Employees

This section includes:

Consultation with Health Canada Employees: Case Study

Case Study: Occupational Health and Safety Agency

Background

The Occupational Health and Safety Agency (OHSA) is a government agency responsible for the provision of advice, consultation and service delivery to managers of public service departments on all aspects of occupational health and safety. OHSA became an agency in 1996; prior to this it was a directorate under Health Canada's Medical Services Branch (MSB) and included elements of the Indian health program. OHSA reports to the Deputy Minister of Health through MSB's Assistant Deputy Minister. OHSA is building partnerships through service agreements with government departments.

In response to the Agency's desire to increase its accountability and visibility of its services to its customers, OHSA initiated a process to develop service standards in December 1994. This came at a time when Treasury Board was requesting service standards from all departments that had provided some information on "Quality Service" and service standards. This case study will focus on the consultations surrounding the development of service standards for the occupational health and safety (OHS) programs of the Agency.

Over a two-year period, December 1994 to December 1996, OHSA developed a working committee of staff which steered the development of customer-based OHS standards for federal departments and agencies. This working committee consulted widely with OHSA staff, customer focus groups and existing consultation structures such as the National and Regional Advisory Committees supporting the OHS program.

Why Seek Public Involvement?

OHSA's mission statement is to work in partnership with customers and stakeholders to provide responsive, cost-effective occupational and public health protection and promotion programs. Most of OSHA's clients are public service departments and consultations occur with government employees rather than the Canadian public at large. However, the principles and mechanisms of this particular exercise clearly have many features which could be applied to a public consultation strategy.

Managers of federal departments are legally responsible for OHS programs for their employees. There were still many misconceptions about what is included in the health and safety programs and where responsibility lies. There was a need to involve the customers so that they could become aware of their responsibilities and the systems and programs needed to fulfil these responsibilities.

Who Was Involved?

OHSA brought together 10 employees who formed a working committee which was responsible for determining the service standards. Through a series of surveys and focus groups with staff and customers, the committee was able to create the occupational health standards.

Description of the Process

A set of service standards relating to various issues on OHS was created. The OHSA recognized that it did not have the expertise in service standard development in-house, although the working group members were all experts in their program or work areas. Therefore, the commitment was made to train OHSA staff to be able to create and consult on the service standards. Also, the decision was made to obtain information from various levels of government employees, soliciting information from those working in the affected departments. When consultants are used, they are used to facilitate and train OHSA employees, rather than to do the work directly.

First, the 10 representatives to the working committee were chosen from a range of occupations, professions and regions. No senior officers were chosen. The representatives were chosen by the executive group for their interest in the project. Once chosen, they were sent to the Canadian Centre for Management Development (CCMD) for a two-week training session. A consultant was contracted to help facilitate the committee later in the process when it encountered obstacles in developing service standards.

The committee examined other examples of service standards, attended conferences on alternative service delivery and compared international models of service standards and the British citizen charter. Next, they developed a survey tool to obtain information from departmental managers and OHSA's staff on the necessary indicators and service standards to include. The working committee and departmental managers identified key informants in the regions to participate in focus groups, which continued throughout the entire process. Also, those responsible for the project kept their colleagues informed of the process. Finally, the developed standards were passed around to the various committee members, clients and agency staff until agreement was reached.

In the second phase of the project relating to the performance indicators, the committee brought together the customer departments in a working group meeting to provide input, which was beneficial and also expedited the turn-around time. The customers found it very rewarding and informative.

This was an example of a situation where clients were able to provide direct input to the process. Agency staff were brought in to review the service standards and customers were involved throughout the entire process. Although this was not a process that involved public consultation, many of the methods used could be applied to a public consultation strategy. Furthermore, many of the issues dealt with by the OHSA have a direct impact on most Canadians.

Resources

The process was funded through the appropriation of the Agency.

Summary of the Outcomes

The first set of service standards was developed and released to the customers in December 1996. The initiative is now firmly into its implementation phase, which consists of delivering the services and making routine measurements of its performance against the benchmarks outlined in the Standards for Excellence publication. Evaluation of the standards is done through a series of performance indicators, such as questionnaires and reports. Tools are used to determine which services continue to be valuable to the clients and replace ones that are no longer useful.

OHSA offers similar cost-recovery services to both the federally regulated and private sectors. It is likely that their role in the future will be more advisory, while partners in the government department or the private sector will provide the actual services to their own organizations.

Analysis

Factors for Success

Barriers to Success

Policy Implications

Although OHSA does not directly develop policy, it does advise Treasury Board on how the federal government should see itself in relation to occupational health standards policy. One key area is whether or not Treasury Board should be leading the way with service standards, or following the lead of other industries. Nevertheless, the process of creating service standards for the federal government has allowed discussions on many different levels and so far the government has been on line with the standards being developed by the private sector.

A detailed synopsis of the OHSA is located on the Health Canada website at http://www.hc-sc.gc.ca/ohsa.

Public involvement techniques used

Contact information

Gillian Lynch
Chief Executive Officer
Occupational Health and Safety Agency
(613) 957-7669
Gillian_Lynch@hc-sc.gc.ca

Conclusions

Traditional consultation processes such as elections, referenda, legislative hearings, royal commissions, constituent surveys, town halls and opinion polls are longstanding political mechanisms for ascertaining the will of the public on key public policy issues. These approaches will continue to play an important part in governance and how government involves Canadians. However, the Canadian public is increasingly interested in securing an ongoing, meaningful and deeper role in key policy and program decisions which affect their lives.

The shift from traditional consultation - usually a snapshot of public opinion captured at a particular moment in time - to genuinely deliberative and interactive citizen engagement will require fundamental changes on the part of governments. These changes will take time and resources for Health Canada to implement. In the future, governments will be less likely to act unilaterally in deciding when to involve, on what and with whom. The public is demanding this as a prerequisite for a new relationship of trust.

In all phases of public involvement, an open process is required from the beginning. In the consultation and citizen engagement stages, ideally citizens and their organizations are involved in helping to set agendas, time frames and the nature of the engagement process itself. In certain cases, governments will need to be prepared to step aside at times or to be the convenor of the process and primary carrier of results, but not to preside over and control the process. As Health Canada incorporates these kinds of collaborative approaches increasingly into its planning and operations, the department will be both working to meet the needs of Canadians and aligning itself with a key strategic priority of the federal government.

Bibliography

Internet Sites - Selected Organizations Working on Public Involvement

Public Involvement and Citizen Engagement Theory

Practical Guides to Public Involvement: General

Public Involvement for Specific Issues

Literature on Specific Methods

Evaluation of Methods

Documents for Citizens

Page details

2006-09-14