The Brant County Health Goals Project was initiated and sponsored by the Grand River District Health Council (GRDHC) and the Brant County Health Unit (BCHU). Its purpose was to identify community-level health goals for Brant County. The Brant Community Healthcare System (BCHS) was also an important collaborator throughout the project. The project ran from June 2001 to November 2002.
The focus of this article is on the role of the project task force.
The Brant County Health Goals Task Force was assembled by the executive directors of the GRDHC and BCHU to make recommendations about suitable health goals. It was made up of eight men and women with diverse backgrounds, skill sets and experiences. They collectively brought perspectives from the health, education, municipal politics and business sectors.
The Task Force adopted an evidence-based approach, which involved considering both qualitative and quantitative evidence in their selection of health goals. A guide was developed by the Task Force to support their decision-making process (please see related resources). All decisions were reached by consensus.
Major activities of the task force were
* an analysis of the 2001 Brant Community Health Status Report (another collaborative project of the GRDHC and BCHU);
* a review of the 1996 Brant County Health Goals;
* a public consultation process (Citizen's Panel Study), completed in conjunction with the Centre for Health Economics and Policy Analysis (CHEPA) from McMaster University;
* a review of recent external community health reports;
* an environmental scan;
* a comprehensive communication plan;
* development of draft health goals; and,
* a second consultation process with the public and key community stakeholders, which included a community survey, open houses, focus groups and consultation with the Rural Well-being Teams and former Citizen's Panel members.
Although participation in the consultation processes was not as high as desired, the results indicated that a broad range of community members found the proposed health goals clear and felt that their comprehensiveness and inclusiveness were important strengths. The final report was completed in November 2002. It received sponsors' endorsement in March 2003 and was then widely distributed to community stakeholders.
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III Lessons Learned
* Think big picture. A population-based approach is more inclusive than a disease-specific approach.
* Keep it local. The made-in-Brant design increased flexibility.
* Strike a balance. Ensure time for a thorough process is balanced with the desire and pressure for tangible outcomes. There are inevitable tensions between short- and long-term outcomes and between vision and action.
* Do not avoid conflict. The diverse Task Force represented many different points of view, which at times led to conflict. However, this resulted in increased collective knowledge and better teamwork.
* Foster consensus. Although consensus decision making took more time, it resulted in solid decisions, which helped tie the group and process together.
* Ensure that everyone's voice is heard. The two community consultations included innovative methods and groups that are not traditionally approached. This resulted in a more comprehensive and inclusive framework.
* Get the word out. Internal and external communication was critical to this project. The Task Force members' willingness to deliberate via email between meetings maintained momentum. Keeping other stakeholders informed with plain-language updates developed in conjunction with the local literacy council was also important.
* Document and report. Write reports even if no one is asking for them to ensure the project has a past and a future.
* Know when to conclude. The initial phase of the project was concluded when the final of three executive directors who spearheaded the project moved on to other positions.
* Increase the amount of up-front time spent defining the project and securing resources. The Task Force accomplished the tasks laid out in the Terms of Reference. However, the process was unexpectedly long. Involving the Task Force as early as possible in the process may have helped to ensure that work estimates were more closely matched to the Task Force's expectations, interests and needs.
* Co-chairmanship is beneficial. The rotating chairmanship was an asset as it allowed senior managers to balance the work of the task force with the interests of their organizations. However, changing leadership increased the complexity of decision-making and communications procedures. Community members should also be considered for chair.
* In addition to senior management, program managers and directors from sponsoring organizations should be fully informed about the project to reduce the negative impact when inevitable staff departures occur. All of the three executive directors from the sponsoring organizations eventually left the task force due to job changes.
* Foster active participation from consumers on the task force. One way to do this is to include more consumer representatives (than representatives from other sectors).
* Public consultation methods should be as diverse as possible, appropriate to the needs of different target groups and contain a deliberative component. Public consultation is a continual challenge but a responsibility. Some individuals or groups may participate at different stages of the process.
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The Task Force developed the Brant County Health Goals Framework to focus on, and organize around, areas where community-level action could contribute to health improvements. The Framework includes a vision, values, guiding principles, health goals, core strategies and an action planning template. Each goal has a set of sub-goals and objectives that further explain how it will be realized. The final report contains the details about the Framework (see http://www.grdhc.on.ca, under Reports). Next steps will be considered in 2003-2004. It is premature to assess long-term outcomes but tracking and evaluation will remain important aspects of next steps.
Other important process outcomes have included
* ongoing coverage and proactive follow up by the local radio station (CKPC);
* the Child and Youth Services Council of Brant incorporated action planning for the health goals into their own planning process;
* collaboration in a downtown needs assessment;
* improved linkages with the Brant Healthy Living Coalition and other programs and organizations;
* contribution to research in the area of public-consultation methods; and
* a presentation at the 6th Health Promotion Conference in Victoria, B.C., in 2002.
Abelson J, Eyles J, McLeod C, Collins P, Forest P-G. Does Deliberation Make a Difference? A Citizens' Panel Study of Health Goals Priority Setting. Health Policy, 2003; 66(1): 95-106.