CE Handbook - Chapter 4: Enhancing Citizen Representation on CIHR's Boards and Committees (Focus Area 1)

[ Table of Contents ]

As noted in Chapter 1, CIHR has already developed a foundation for citizen engagement (CE) naturally through a number of activities. This chapter provides an overview of the ways in which CIHR has included citizens on a variety of boards and committees (Focus Area 1 from the CE Framework) and outlines some of the challenges in and opportunities for supporting this type of involvement.

The guidance offered in this chapter is grounded in the lessons drawn from Institute Advisory Board members and the tools developed for the Community Reviewers in Peer Review program. Over the years, CIHR has engaged a number of Canadians who represent diverse backgrounds and who share a common interest in health and science. The examples highlighted in this chapter are derived from the experiences of those "engaged citizens" in their governance roles. They are designed to outline best practices for providing the information and support that are necessary to integrate citizens into settings that are predominantly composed of health researchers.

"The little research available suggests that citizens can learn to navigate the complexities of integrating expertise and experience and come to sound public judgment. At the same time, we are seeing evidence that, when applied correctly to the right situation, deliberative citizen engagement can save time and money when it comes to implementation."

Public Deliberation: A Manager's Guide to Citizen Engagement (IBM Center for The Business of Government,2006)

4.1 Citizens in Governance Roles at CIHR

Some of CIHR's governance committees (including Institute Advisory Boards, community-based research peer and merit review committees, institute task forces, and working groups) already have the inclusion of citizen representatives as a core component of their composition. For example, the Stem Cell Oversight Committee specifies in its terms of reference that "representatives from the general public will represent the views and values of Canadians potentially affected by the new technologies."17 Members of such governance committees reflect a wide range of expertise; a few committees also include patients and voluntary sector representatives in addition to those Canadians with an interest in health research.

The lay public members of the Institute Advisory Boards (IABs) come from diverse backgrounds. The wide range of perspectives they bring is derived from their experience with voluntary health organizations and private business, or as health care practitioners, health care users, and policy-makers. Nonetheless, members are asked to serve in a personal capacity—not as representatives of their primary affiliations (if they are academics, policy-makers, or health care professionals). Lay public representatives are full members of the IABs; in fact, some IABs have extended their inclusion of lay public representation by developing sub-committees and working groups with members from the voluntary sector, patient groups, and advocacy groups to develop approaches for knowledge translation and to inform research priorities.

4.2 Challenges to Integration

It is not always easy to bring public representation into a governance setting. Apprehension about the impact that such representation may have on the committee's goals and procedures can surface among the other committee members. Proper training and orientation—for both the public representatives and the other members of a given committee—are essential to dispel such fears.

The CE Framework introduced an article that was recently published (2008) in the Canadian Medical Association Journal (see Section 2 of the Framework). The authors of the article address the common arguments against public involvement in health care settings. For example, it is often said that members of the public will not be objective (that is, they have a personal bias that will prevent them from representing diverse interests). The authors explain that "this concern is applicable to al participants currently sitting at the priority-setting table, including health care professionals, administrators and researchers. There is no reason to believe that members of the public are less objective than any other type of participant."Furthermore, the authors suggest that most members of the public can bring their real-life experience, insights into societal values, and beliefs as users of the health care system to the table. Their contribution is their perspective(s). In order to compensate for barriers such as the power imbalance between these public representatives and the clinicians and policy-making experts, an appropriate tone should be set during deliberations and a sufficient number of representatives from the public should be included on decision-making bodies to avoid tokenism. One or two public members are not enough for a critical mass on a particular committee or board to develop, as it reduces the probability of reflecting the broad views of the public.

To enhance citizen representation on CIHR's boards and committees, staff will need to embrace proactive mechanisms or tools to promote recruitment, and examine ways to increase public knowledge about the existence of such opportunities.

4.3 Success Factors for Engagement on Committees and Boards

Orientation

Good orientation is critical to the success of all members serving on a committee or an IAB, regardless of background, credentials, or experience. Both members and staff require some orientation to reinforce the purpose of the committee or board, expectations, roles, agenda development, meeting management, and how decisions are achieved. If this information is provided to members as part of an orientation process, then they will be able to contribute fully and comfortably at the start of their membership.

Recommendations for successful and positive orientation practices have been developed by the "lay representatives" from CIHR's IABs (who come from voluntary health organizations, non-governmental organizations, and patient communities). To engage any new member of a committee or board effectively, they suggest the following:

  • In-person orientation: Whether this orientation takes place during the evening before the first meeting or at an early breakfast that day, it is best to include the committee/board chair in this introduction to membership. In addition, a couple of other veteran members can provide different voices, and they also give the new member some people to connect with or sit beside at the first meeting.
  • Introductory material (sent in advance): Written material (electronic or paper) about the committee, roles, responsibilities, and expectations of each member should be sent to the new recruit well in advance of the first meeting. This gives the new person time to digest the material and develop questions. To complement the written material, a pre-arranged follow-up phone call should also be scheduled between the new member, the committee/board chair (or other member), and a CIHR staff person who can provide a long-distance welcome and answers to questions.
  • Introduction to the context of a committee—not just the process: Set the stage for meaningful discussion by
    • describing the rationale and goal for developing these multi-sector, multi-disciplinary committees/boards;
    • fostering an environment that values asking questions; and
    • describing how meetings are managed, how decisions are made, and what information or advice they are based on (i.e., how priority-setting decisions are achieved at the Institute level and at the corporate level).19

Training

Training is just as important as orientation when it comes to welcoming new members to a committee or board setting. While orientation provides a new recruit with the background information and context to participate fully in committee discussions, training provides committee members with specific skills—simple or complex. For example, while orientation may be used to provide new members with information about the financial context of a program, training could be used to illustrate how to read complex financial tables or generate new reports.

The case study presented in this chapter provides a comprehensive overview of the tools developed to train community reviewers, staff, and committee members who interact with them in the course of the review process. Both teleconferences and face-to-face presentations are used (with accompanying materials) to train all those involved in the inclusion of community reviewers. These presentations are listed in Appendix 1 and are available in full by contacting the Partnerships and Citizen Engagement (PCE) Branch at pce.pec@cihr-irsc.gc.ca.

Evaluation

Few examples of formal evaluations exist for committees and boards whose members represent a range of expertise, sectors, and lay people. So how can CIHR measure the success of these bodies and the satisfaction of members? Enthusiastic and committed participants are considered to be one measure of success.

The CE Framework established that enhancing representation of citizens on its decision-making bodies will help to develop greater mutual learning and understanding; it is also hoped that it will improve trust, transparency, and collaborative decision making. Evaluation criteria, then, should examine the perception(s) citizens have about their own impact or contribution to the committee/board, and about whether or not they feel that increased learning, trust, transparency, and collaboration have been achieved.

The literature on the evaluation of CE programs is very limited. The Health Canada Evaluation Menu Template (found in Chapter 8) provides relevant measures that can be adapted for use in the evaluation of our own committees and boards. Any relevant evaluations of CIHR committees will be included in the Citizen Engagement shared drive of resource materials.

Case Study 1: CIHR Community Reviewers Program

Case Study #1

What: Citizen Engagement through the CIHR Community Reviewers Program

Why: Involving citizens in the peer review process ensures transparency and accountability in CIHR's investments.

Who: Citizens who have knowledge of (or experience with) a health issue and/or have an interest in scientific research.

How: Volunteers submit an application to become a community reviewer. The ones chosen for the position receive extensive orientation and are then assigned to one of CIHR's peer review committees. They are non-voting members, but they do comment on the overall process, the structure and objectivity of the discussions, and the quality of the lay abstracts.

In the fall of 2004, CIHR started the Community Reviewers Program as a pilot project to involve the public in the CIHR peer review system. This project reflected CIHR's commitment to enhancing public and stakeholder engagement in health research in Canada, and also increased the transparency and accountability of our peer review processes. It began as a pilot project in order to establish the feasibility of including the public in peer review committees. Throughout its evolution from pilot project to full program, the Community Reviewers Program has enjoyed continuous endorsement and support. The pilot project officially became a full program in the summer of 2007. Initially, four peer review committees were involved in the program; but, as of the spring of 2009, the program has grown to include 25 committees. Essentially, one community reviewer is assigned to one of CIHR's Open Operating Grants peer review committees. While community reviewers are non-voting members of these committees, they do have a number of responsibilities. Part of their role is to provide written feedback to applicants on all lay abstracts submitted to the committee and pick projects of public interest for CIHR to highlight through communication activities. They may also work with CIHR to enhance external communication and public engagement. In addition, the community reviewer provides written feedback on the proceedings of the committee (such as the quality, quantity, and variety of science reviewed) and the structure and objectivity of the discussions.

Since its initial implementation, refinements have been made to the program's tools for the volunteer selection process, orientation and training, roles and responsibilities, and feedback loops. In the beginning, there was a lack of clarity in defining the program's objectives and the recruitment/orientation processes were conducted in a relatively informal manner. It was difficult to determine the best way to ensure meaningful and appropriate involvement of non-scientists in a peer review environment. Initially, there was also some apprehension from stakeholders who were concerned about the level of involvement from these individuals and how they would impact the peer review discussions. Today, through orientation and training, these apprehensions have been reduced significantly. This orientation and training for the Community Reviewers in Peer Review Program is very comprehensive and includes training for the community reviewers themselves, but also for CIHR staff members and committee chairs, as well. Various sessions have been designed for each target audience; they include PowerPoint presentations and written documentation. (Please see Appendix 1 for more information.)

Recruitment of the community reviewers involves specific selection criteria. A community reviewer must be impartial and must value and support the mission of CIHR. This reviewer cannot be currently involved in academia or health research but must have experience working on a committee. The goal is to get broad representation on the committees, but the reality is that those who volunteer to be a community reviewer usually have a vested interest in health or scientific research.

The program uses a self-nomination process through CIHR's online volunteer application form. The opportunity to become a reviewer is "advertised" through existing committee members and community reviewers, CIHR staff, the Canadian Association of University Research Administrators, CIHR's university delegates, CIHR e-news alerts, CIHR's Institute Advisory Boards, and CIHR's website. The selection process for new volunteers begins with an initial screening of the current online applications. Once an applicant is deemed to meet the selection criteria, the process proceeds to a screening interview via telephone and a reference check. During the phone interview, the Community Reviewer Program Officer explains clearly (and realistically) what becoming a community reviewer entails. This allows the volunteers to develop an informed opinion about whether or not the position is something of interest to them—and something that they can commit to in their schedule. The selection process is finalized by the CIHR Deputy Director and the chair of each peer review committee. Once the process is complete, the new community reviewer is sent a confirmation letter and asked to serve a three-year term.

Feedback mechanisms are crucial to the program's success. A Community Reviewers Feedback Form was created to solicit input from the community reviewers on the value and quality of their orientation, the ease of use of ResearchNet, CIHR staff's level of service, their experience at the committee meeting, recruitment, and general feedback. Similarly, an Evaluation Questionnaire is given to the committee Chairs and Deputy Directors to gather their comments about the role, involvement, and performance of the community reviewer on their committee. This system allows CIHR to stay in touch with both sides of the program and constantly evaluate the alignment of the program with its objectives.

Overall, the program provides valuable lessons in effective volunteer management: it involves in-depth orientation and training, selection, placement, and evaluation. Above all, CIHR staff members must remember that the community reviewers are volunteers (i.e., they are giving their time because they are interested and want to give back). While peer reviewers are also volunteers, they are volunteers of a different sort; researchers who are funded by CIHR are expected to volunteer their time to contribute to the peer review system and they also benefit from the career development that such experience brings. Community reviewers, in contrast, are members of the public who approach CIHR on their own to contribute to the health research enterprise on their own time. The organization needs to be realistic in what it asks these volunteers to do and needs to appreciate whatever contributions they can make to CIHR.

This program has tremendous value for CIHR. Not only does it demystify CIHR and the peer review process for members of the public, but it also helps us to develop spokespeople for CIHR and for health research in general. Community reviewers can also help health researchers to understand the importance of engaging the public and to write for a lay audience. Researchers often say that writing the lay abstract is the most difficult part of an application, so feedback from a lay reviewer can be extremely beneficial. The success of the program has led to buy-in from key stakeholders and the program expansion (noted above). CIHR has received positive feedback from the Tri-Council, universities, and the public. Through the program, CIHR has also been able to identify activities to help communicate the merits of investment in health research.

4.4 Conclusion

With the lessons learned from the Community Reviewers Program and the tips for orientation from the IAB members, CIHR is poised to enhance citizen representation on its boards and committees. Staff members can ensure that current committee and board representatives are provided with appropriate information, and orientation plans can be developed early to encourage full participation from future volunteers—or to create new committees altogether.

Endnotes

  1. Terms of Reference, CIHR Stem Cell Oversight Committee June 2008.
  2. R.A. Bruni, A. Laupacis, D.K. Martin, Priority Setting in Health Care Research Group, "Public engagement in setting priorities in health care" Canadian Medical Association Journal (2008). Emphasis added.
  3. Meeting Minutes, CIHR Meeting of the Voluntary Health Sector and NGO IAB members (April 14-15, 2009).
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