See Appendix E for a Deliberative Process checklist and Appendix F for guiding questions for an After Action Review (AAR)
Year 1 – Identification of regional access priorities and population focus
The first objective of deliberation is to make a collective decision about the targeted vulnerable population (i.e., the focus of the innovative intervention). Deliberative processes will serve to gain common ground relating to access goals, unmet needs and principal perceived barriers to access for vulnerable communities in each region.
LIP Core Team and Management Team analyse the results of the first deliberations to assist in developing design options for the local organisational innovation to address access-to-care for the vulnerable population. This is used to generate background material for the second series of deliberations.
Year 2 – Selection and design of local organisational innovations
The objective of the second series of deliberative processes is to develop consensus on core design elements of the local organisational innovation to address access-to-care for the targeted vulnerable population. This forum helps each LIP decide on an organisational innovation that will address the needs of the vulnerable population while reflecting the resource realities within the local context.
groups whose demographic, geographic, economic and/or cultural characteristics impede or compromise their access to community-based primary health care services
the consequence of the interface between the five dimensions of consumer ability and five dimensions of service accessibility (Levesque, Harris & Russell, 2013)
Access is a consequence of a dynamic process. See proposed primary health care model (Levesque et al., 2013 & Obrist et al., 2007).
Contextual and demographic factors are assumed to influence the service and consumer dimensions and need to be measured/monitored in each partnership.
The 5 dimensions of accessibility of services:
1) Approachability;
2) Acceptability;
3) Availability and accommodation;
4) Affordability;
5) Appropriateness.
The 5 dimensions of ability of consumers:
1) Ability to perceive;
2) Ability to seek;
3) Ability to reach;
4) Ability to pay;
5) Ability to engage.
Access to community-based primary health care is indicated by first-contact accessibility (primary indicator of access): The ease with which a person can obtain needed community-based primary health care (including advice and support) within a time frame appropriate to the urgency of the problem (Haggerty et al., 2007).
At a population level, access to community-based primary health care is indicated by assumed outcomes of poor access (secondary indicator of access): high rates of emergency department visits, avoidable hospitalizations and emergency department presentations for Ambulatory Care Sensitive Conditions.
a novel set of behaviours or routines implemented through planned and coordinated actions (based on Greenhalgh, 2004)
Excludes innovation aimed at individual practitioner behaviour changes (e.g., clinical practice, treatment innovation) if they are not intended to address one of the dimensions of service accessibility
Excludes innovations aimed at community members (e.g., general health literacy strategies)
Requires action to be planned and coordinated
May include behaviours or routines provided off-site or externally that improves accessibility of the community-based primary health care organisation (e.g., routine access to telephone translation services).
