Case 7: Our health. Our perspectives. Our solutions: Establishing a common health vision

Citizen Engagement in Health Casebook

New Brunswick Health Council
Nicole Pollack and Mary Pat Mackinnon, Ascentum

Methods of dissemination

The final report was sent to the above recipients either as a hard copy in the mail or as an electronic link in an email. The final report was also posted on the NBHC website.

Lessons learned

Lessons learned include recruitment challenges (getting a representative mix of the general population and high attrition rates); the importance of having clear objectives and managing expectations; and, ongoing communications strategies/staying in contact with past participants is critical to sustaining impact.


The New Brunswick Health Council (NBHC), an independent organization created by the New Brunswick Government in 2008, is mandated to measure, monitor and evaluate population health and health service delivery in the province, and to ultimately formulate recommendations on those topics for the Minister of Health. The creation of the NBHC was driven by the recognition that citizens are the health system's most important stakeholders.

Why citizen engagement?

In February 2010, the NBHC undertook a province-wide citizen engagement initiative entitled Our Health. Our Perspectives. Our Solutions to help inform its recommendations to health care partners on what citizens believe is required to achieve a citizen-centred health system. The three-phased approach was designed to involve New Brunswick citizens and health care stakeholders in a dialogue about the provincial health system, particularly on topics such as what people value most about the system, how it can be strengthened, and what can be done to improve provincial health outcomes (see Table 1).

Table 1: Topics of Discussion
Phase I Perspectives
  • Values of an "ideal" health system
  • Priority issues to improve the health system in New Brunswick
  • Strengths and opportunities to create the kind of health system you want
Phase II Solutions
  • "Image-ing" a citizen-centred health system
  • Where and from whom health care, services and supports should be delivered
  • What the health system should do more — and less
  • Encouraging healthier choices and behaviours
Phase iii Common ground
  • Making tough choices: primary care priorities
  • Making tough choices: acute/supportive care priorities
  • Making tough choices: system-wide priorities
  • Health care sustainability and funding models


Our Health. Our Perspectives. Our Solutions was the NBHC's first large-scale public engagement initiative. The NBHC contracted Ascentum, an Ottawa-based public engagement firm that specializes in public participation and stakeholder engagement, to provide strategic advice, collaborate on the engagement design and process, and provide documentation, analysis and reporting services.

The locations for Phase I and II (Moncton, Bathurst, Edmundston and Saint John) were chosen to ensure that New Brunswickers could attend a dialogue session without having to travel more than 200 kilometres. Phase III, the final phase of the approach, featured a provincial dialogue session in Fredericton, the provincial capital. In total, nine dialogue sessions took place across all three phases.

The initiative brought together a diverse mix of participants: half of them were randomly recruited citizens, while the remainder were targeted stakeholders, including representatives of various community and public interest groups, health and wellness managers, academics, health professionals, provincial government decision makers and elected municipal officials. At the outset, a target of 125 participants was set for each of the four Phase I dialogues (for 500 participants in total), but due to challenges randomly recruiting public participants, the final tally was 310.

For Phase II, all participants were invited to reconvene in the same locations for a second day of dialogue in order to continue their work together. More than two-thirds (223 participants total) returned for this phase. Phase III then brought together a random selection of participants — roughly one third (111) of the original Phase I participants — drawn from each of the four locations for a final dialogue. Inviting the same individuals to attend multiple dialogue sessions allowed them to deepen their understanding of the issues by reflecting on what they heard between phases, thus offering richer and more informed perspectives throughout the phases.

In Phase I, the NBHC provided participants with information to help them form a clear and accurate picture of New Brunswick's health care system challenges (see Table 2). The process encouraged participants to explore what they valued about the system. Phase II asked them to envision the kind of health care system desired by New Brunswickers and to identify solutions that would address the challenges faced by the system.

In Phase III, the NBHC validated the findings from the first two phases and helped participants to link their ideas to actual sectors in the health system and to prioritize potential action plans. This phase took a more deliberative approach; exercises such as "Imagine that You are the Health Minister" enabled participants to weigh distinct options that reflected different value propositions and to consider the difficult decisions with which policy makers must wrestle in allocating resources.

During each phase, participants were well supported with detailed Conversation Guides, which provided a wealth of accessible information on the New Brunswick health system (such as its structure, costs and services), as well as key findings from the previous phase.

Table 2: Sample of Phase I Agenda (8:30 AM – 4:00 PM)

Participants were assigned to tables based on language and perspective. Tables worked in either French or English, and they were composed of a balanced mix of citizens and stakeholders whenever possible. Simultaneous interpretation for the plenary presentations and discussions was available at all sites. The dialogue design for each of the phases featured a mix of learning sessions, facilitated small group work, the sharing of perspectives in plenary, and validation through keypad voting for critical questions. Trained table facilitators, assigned to each table, were responsible for both facilitating and recording the table conversations on template worksheets.

The NBHC stressed the importance of good dialogue practice throughout the initiative. The message that dialogue is all about people working together to explore and understand different points of view was reinforced across all three Phases. To that end, participants were frequently reminded that there are no "right" and "wrong" answers — only individual experiences and points of view, each of which would carry equal weight and legitimacy in the eyes of the NBHC. Participants' written evaluations indicate a very positive reaction to the dialogue process.

Participants provided rich feedback to the New Brunswick Health Council (see Table 3). While diverse perspectives were heard, the degree of consistency in participants' comments across dialogue sites and across all three phases highlights a powerful province-wide consensus on key elements that, taken together, established the foundation for a common vision for health care in New Brunswick.

Table 3: Key Findings

Outcomes and impact

The three-phased engagement initiative was designed to iteratively "build up to establish a common health vision" for a citizen-centred health system. This was done strategically to be in alignment with the Provincial Health Plan (2008-2012), which affirms that the province's health system needs to become citizen-centred in all aspects. The rationale for aligning with the Provincial Health Plan was to increase the relevance of the results to health system planners in order to increase the potential impact.

The results of Our Health. Our Perspectives. Our Solutions became the cornerstone for the NBHC's 2011 recommendations to the Minister of Health for improving the system. Participants' primary health care priorities were extrapolated from the final report and highlighted in an accessible one-page document. Prior to the Minister's Primary Health Care Summit (October 20-21, 2011), the NBHC used the one-page document to brief the Minister and ensure that she was well prepared to incorporate key messages about citizens' primary health care priorities in the Summit proceedings. The Assistant Deputy Minister of Health has stated that the engagement report has been positively referenced around the board table of the Department of Health on several occasions.

The key findings of the initiative have been presented to various decision makers, including the health system senior management teams (from organizations such as the Department of Health, Horizon Health Network, Vitalité Health Network, Ambulance New Brunswick, and FacilicorpNB) and the associations of municipalities in New Brunswick (Union of Municipalities of NB and the Association francophone des municipalités du N.-B.). Furthermore, the key findings were so well received by the associations of municipalities that the NBHC was invited to make a presentation to the municipal zones. These dissemination activities have brought the key findings of the engagement initiative and the resulting recommendations to the attention of important government decision makers. Senior government officials, including the Minister of Health, refer to the Our Health. Our Perspectives. Our Solutions report in their day-to-day work and their public addresses.

Lessons learned

Important lessons emerged from the challenges of recruitment. The NBHC hired a third party recruitment firm who made over 39,000 calls to New Brunswickers with a goal of recruiting 500 participants for Phases I and II. In total, 479 participants confirmed their participation for the Phase I dialogues, with 310 actually attending. Attendance dropped to 223 in Phase II. The high attrition rate may have been partially a result of not offering a stipend or honorarium to participants. The sessions were held on Saturdays to accommodate those working regular business hours, but both stakeholders and the younger population reported that this was a deterrent to participation. The NBHC learned that more intensive advance networking is critical to ensuring good stakeholder turn out. Involving marginalized groups was also a challenge, as was designing a process to suit varying literacy levels. The NBHC realized that a single process may not be effective for all target audiences, and as a result, it undertook a secondary stream of engagement with younger adults.

Another lesson learned relates to the importance of having not only clear and measurable objectives at the outset, but also careful, transparent management of participant expectations about how the results of the engagement will be used. The credibility of the process was heightened by the presence of the NBHC CEO, who moderated all of the sessions and conveyed a strong message at every dialogue that the outcome of the work would be the cornerstone of the NBHC's recommendations to the Minister of Health. Articulating how participants' contributions would be used was critical for participant buy-in and commitment. Senior decision makers in attendance benefited from hearing citizens' perspectives, and in turn, participants were reassured that their voices were being heard. The process also demonstrated that citizens were able and willing to have tough discussions on cost-effective health care strategies when provided with credible health system information, well-framed questions and a process that allowed for meaningful engagement.

Finally, the NBHC learned the importance of ongoing communication strategies with its various audiences (the public, stakeholders, media, and government), and maintaining contact with past participants. The link to the NBHC 2011 "Recommendations to the Minister of Health" document was sent to all dialogue participants, and stakeholders were invited to the press conference at which the Minister of Health was officially presented with the NBHC's recommendations.

Date modified: