Client involvement Seminar
EPR
Luc de Witte and Cristina Crisóstomo
welcome you all to
Mulhouse
17-18th June 2004
Client involvement Seminar
• The programme of this morning
– Introduction of speakers/trainers
– Introduction of participants
– Introduction to the seminar: approach, goals,
programme
– Introduction to client involvement
– Coffee
Client involvement Seminar
• Introduction of speakers/trainers
– Luc de Witte
• iRv, Heerlen professional university, Maastricht university
– Cristina Crisóstomo
• Centro de reabilitaticao profissional de Gaia
Client involvement Seminar
• Introduction of participants
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Name
Professional background
Organisation and work setting
Role in the organisation
Relevance of client involvement for own work
Client involvement Seminar
• Approach of the seminar
– Open / interactive / flexible  working group
– Please participate actively  discussion is more
effective than listening
– Interrupt, ask questions, ……
• Please help each other with language: perfect
English is not needed; understanding each other
is essential
Client involvement Seminar
• Goals
– Knowledge of different client involvement models
– Understanding of the concept of client involvement
at different levels (individual, facility/service, general
policy)
– Exchanged experiences and approaches in different
settings and countries
– Stimulate concrete plans to implement client
involvement in your own work setting
Client involvement Seminar
• Task for these two days
– Develop a plan for the implementation of (aspects of)
client involvement in your own work setting
– Present this during the last module tomorrow
Client involvement Seminar
• The programme
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8 modules
1 hour and a half each
Today 5 modules, tomorrow 3
Luc and Cristina work together, one has ‘the lead’ in
each module
Client involvement Seminar
• 1st module
• Introduction (now in progress)
• Lecture about “Client Involvement;
a major challenge for health care
organisations”
• What is client involvement
• Why client involvement
• A short exercise
Client involvement Seminar
• 2nd module
• Exchange and discussion of
experiences of the participants with
client involvement
• Work on the goals relating to the
implementation of client
involvement in the own work setting
Client involvement Seminar
• 3rd module
• Client involvement in the primary
care process
• Client-centred / demand-oriented care
• Examples of tools and instruments
• 4th module
• Practical exercises
• List the things the service user would
like to find in the organisation
• List the things the service provider
would expect to offer
Client involvement Seminar
• 5th module
• Client involvement at the level of the
facility or service
• Client driven organisation
• Profile of the enabling role of the
organisation
• 6th module
• Practical approaches
• Principle of Excellence Participation and
quickScan for the Principle
• Client role in setting a new service
Client involvement Seminar
• 7th module
• Client involvement on a general
policy level
• Role of client organisations
• 8th module
• Presentation and discussion of
individual plans of participants to
implement client involvement
strategies in their own settings
Client involvement Seminar
• Client involvement; a major challenge for health
care professionals
– Easily said, but not easily done  it is difficult and
has many consequences
– There is no ‘way out’  client involvement is
becoming a ‘must’
Client involvement Seminar
• What is client involvement?
– Making (informed) choices
– Being involved in building/designing programmes
(individual/collective)
– Dialogue/agreement
– Having decisive (financial) ‘power’
– ……..
Client involvement Seminar
• Different levels and different ‘intensities’
• Levels:
– Primary care process (micro)
– Facility of service level (meso)
– General policy level (macro)
• Intensities:
– From ‘hearing’ to ‘a say’ to ‘(co-)directing’
Client involvement Seminar
• Why client involvement?
– Fashion, ‘everyone does it (or better: talks about it)’
– Paradigm shift from medical to societal model
– Autonomy has become a central value in western
societies  independency, self-determination,
personal fulfillment etc.
– Clients have higher expectations
– Clients want care and services to support them in
their ambitions to participate in society
Client involvement Seminar
• Exercise: “what do you want most in life?”
End of module 1
Client involvement Seminar
2nd Module
• exchange and discussion of experiences:
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Experiences on micro, meso en macro level
Different approaches and methods
Positive and negative aspects
Influencing factors (enabling factors and barriers)
Client involvement Seminar
2nd Module
• Please formulate the goals of your individual
implementation plan: what would you like to
achieve with respect to client involvement and
why?
End of module 2
Client involvement Seminar
3rd Module
• Client involvement in the primary care process
 client-centered / demand-oriented care
Client involvement Seminar
4th Module
• What services and providers are relevant to the
rehabilitation?
• Which are in your current job the moments of
interaction with agencies for the rehabilitation?
• Current clients – focus in a target group and
focus in the reasons of exclusion and barriers to
their participation (identify needs)
Client involvement Seminar
4th Module
• List the things the service user would like to
find?
• List the things the service provider would like to
offer?
Client involvement Seminar
4th Module
• Specify the services to respond to the needs
• Classify the services offered in enabling and
empowering
• You are a service user
• Which services relevant to rehabilitation will you
choose?
Client involvement Seminar
4th Module
• Compare the offered services with the needed
services
• Select an unmet need as the basis for the
project and offered a new service
• List specifications of the new service!
End of module 4
Client involvement Seminar
• Why do organisations
need clients?
• To exist!
• Why do clients must be
involved?
• To tell the organisation
which are the right
things and how to do
them right!
Client involvement Seminar
• Is the organisation prepared to involve clients?
• Are the professionals prepared to listen to clients and
to use their feedback?
Client involvement Seminar
• Service organisations are organisations / enterprises
that provide services as products:
– Intangibles
– Service user participates in the production
– In simultaneous
• The front line providers:
– Must be listen to
– Must have all the information about the services
– Have passion for the service – make the client wish the
product by surprising him
– Be autonomous (service user behaviour and needs are not
predictable)
Client involvement Seminar
• A strong client orientation is one of the
characteristics of excellent organisations
Client involvement Seminar
• Becoming client-centric means:
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Knowledge of the clients
Commitment to improve client relations
Client service standards
Complaint-resolution process
On-going measurement of client satisfaction
Comparison of your own client satisfaction with that
of others organisations
Client involvement Seminar
• In addition, being client-centric requires that
client satisfaction information be:
– Disseminated throughout the organisation for
feedback and change
– Used to improve complaint resolution
– Used to set realistic goals for professionals,
services/programmes and the organisation as a
whole
Client involvement Seminar
Strategies to meet the committement of the organisation to
it are:
– Strive for 100% client satisfaction (that’s not mean that you are performing well!)
– Acknowledge that every individual perceive services in
his/her own terms
– Listen to clients and assess satisfaction regularly
– Use client feedback to drive the business
– Provide high-quality, reliable services
– Design products to meet client needs as simply,friendly and
inexpensvely as possible
– When there is a problem, response quickly and fully
Client involvement Seminar
Services might be
provided
prescribely,
or
collaboratively?
• The medical and
professionals systems tend to
encourage prescription and
recommendations based on
the professionals expertise (it is
important their experience, previous successes)
Client involvement Seminar
Services might be
provided
prescribely,
or
collaboratively?
• To achieve successful
outcomes the collaborative
approach: client who is
involved in the decision in a
meaningful way will be more
cooperative, more active and
independent in using the
services and more satisfied
with services overall (need to
discourage the impairment role)
Client involvement Seminar
Consider the relationship a partnership
Equality
Client know his/her goal, interests, dislikes, priorities and practical aspects
The organisation know thw systems, experience and matching services and
people, have access to a variety of resources
Shared responsability
In achieving the same outcome
Purpose
Both parts are trying to achieve the same thing, they are both focus on
solving the problem and reaching the goal
Client involvement Seminar
Organisation
client
N ... persons between, so it is difficult for the
organisation to see the value of what is doing to the
client
If the organisation doesn’t see probably is doing the
wrong thing!
Client involvement Seminar
$ 124,654,897
120 kilos
320/280
Blood pressure
650
cholesterol level
High risk!
Client involvement Seminar
He only look at one metric!!!!!
Balance the life of the organisation
Client involvement Seminar
To measure one thousand times and to cut once
(Turkish proverb)
Client involvement Seminar
SARAH
Surprise
Anger
Resentement
Acceptance
Helpful
(finally the information
must be helpful!!!)
Client involvement Seminar
“What matters, matters.
Ignorance of it doesn’t make it matter any
less.
Knowldege helps you make the right things
happen and stop the wrong things”
Client involvement Seminar
satisfied
Excitement needs
Performance needs
Not met
Met
Basic needs
dissatisfied
Client involvement Seminar
• Over time unexpected quality becomes a stated
requirement, as clients’ expectations and competitions
increases.
• Then that expectation becomes unstated but still
expected.
• Be sure the 3 client-focused quality are delivered within a
process
Client involvement Seminar
Driven/PLAN
Results/CHECK
User needs
review
Design input
Design process
Verification
ACT
validation
Design output
Service
Client involvement Seminar
• PLAN
– planning
• CHECK
– designing
• ACT
– evaluating
• General council (organisation
goals)
• ...
• Client council
• ...
• Satisfaction/quality measurement
(surveys, focus group, ...)
• ...
Client involvement Seminar
A long day ... A nice dinner
We deserve it!
End of module 5
Client involvement Seminar
6th Module
• Specify the role of the client:
– In the design
– In the development
– In the implementation of a new service
• Specify the enabling role of the organisation
Client involvement Seminar
EQRM Principle of Excellence
RIGHTS
The organisation has a Charter of Rights
The organisation has a policy to enhance and to promote equal opportunities and equal
Charter of Rights is known by the persons served and by staff.
The organisation ensures equal opportunities, equal participation, non-discrimination in service
Measures for protecting information about persons served are implemented in all parts of the
Results of achievement of persons served are administrated and benchmarked.
Procedures for getting access to information are implemented and known by staff and persons
Confidentiality of information in documentation is assured by procedures.
The organisation uses indicators for measuring confidentiality. Trends can be identified.
Satisfaction of services users concerning facilities and resources is measured systematically and
Responsibilities and duties of persons served are described and implemented in all part of the
Responsibilities and duties are evaluated with staff and person served. Trends can be identified.
All person served have an Individual Rehabilaition Plan based on the achievement of their full
The Individual Rehabilaition Plan is monitored and evaluated frequently and systematically.
The identified potential of persons served are known by staff.
Client involvement Seminar
EQRM Principle of Excellence
ETHICS
The organisation has a Code of Ethics reflecting the dignity of persons served.
Code of Ethics is known by staff and person served.
The organisation has procedures for confidentiality.
Staff and persons served know the procedures for confidentiality.
The organisation has procedures for getting access to information and documentation.
Procedures for getting access to information and documentation are known by staff, person served
Procedures for getting access to information and documentation are evaluated frequently and
The organisation has taken measures to ensure a safe environment based on a work related risk
The organisation has a health and safety plan for service users and staff.
The organisation has a procedure for complaints and appeal.
Staff and persons served know procedures for complaints and appeal.
Complaints are measured and tendencies can be identified.
The organisation has indicators for measuring the implementation of the principle of Ethics in staff
Satisfaction about confidentiality is measured and trends can be identified.
The organisation inform service users about its promotion activities
Client involvement Seminar
EQRM Principle of Excellence
PARTICIPATION
Organisation’s policy and strategy is discussed with persons served.
Persons served have the opportunity to influence the policy and strategy of the organisation
The organisation has procedures for involvement of persons served in planning, decision-making,
Persons served are involved in all levels of the organisation.
Persons served are involved in community-based activities.
The organisation actively promotes participation of persons served in the community.
The organisation monitored and administrates the participation of persons served in communityPersons served are involved in local, national and international partnerships and networks.
The organisation has a recruitment policy of inclusion for people with disability in the workforce.
Persons with a disability are included in the workforce.
Persons served are involved in programme development processes.
Staff knows procedures for participation of persons served.
Participation of person served in the organisation is evaluated frequently and systematically.
The organisation contributes to the participation of people with a disability in public systems.
The organisation facilitates accommodation of th workplace for employees with a disability.
Client involvement Seminar
CRPG own experience
Client involvement Seminar
Client Council / Club experience
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2002
Service users committee
Monthly meetings held with the top management
Informations, suggestions, claims
• Not a process
Client involvement Seminar
Client Council / Club experience
• Results
– a nice approach but there is less evidence!
• Idea of a Clients Club was born!
• The process of defining clients participation as
an organised system was created
• Support of the organisation
Client involvement Seminar
Client Council / Club experience
• Clients participation system
– fundamental pillars:
• Participation in the design, management and
evaluation of IRP, in a continuous way
• Participation in management of the organisation
• Participation in clients mobilization process
Client involvement Seminar
Client Council / Club experience
• Main strategies of participation:
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development and decision making of their own IRP
spontaneous presentation of both suggestions and claims
evaluation of both programmes and existent systems
satisfaction surveys – annually
Commission of Hygiene and Safety in Work (2 clients)
Clients Club
Client involvement Seminar
• Clients Club:
– the Service User Committee organise the electoral process –
2 lists applied
– structure of the Clients Club: Executive Commission, Club
Assembly, Activities Group, Activities Audit Commisison
– working in self-management
– organisation provided both resources and facilities to
implement its activities
– monthly meetings with the top management
Client involvement Seminar
• 2003
• New approach for the Clients Club
– Includes one representative per vocational training course
plus 3 representatives of clients on-job training
– President is elected among them
– Whenever a client goes to on-job training or leaves he
ensures his/her replacement
End of module 6
Client involvement Seminar
7th Module
• Client involvement on a general policy level
– Methods / possibilities
– Difficulties
Client involvement Seminar
• Methods / possibilities for client involvement at a
general policy level
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External reviews
Regular discussions about policy / needs
Client representative in board / council
Formal position of client council
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Client involvement Seminar
• The example of iRv
– Representative of national disability council in board
– Agreement with national disability council 
meeting every 3 mnths: projects, policy, etc.
– Internal procedure for involvement of clients in
projects  coordinator + committee / working group
– Regular interviews with major organisations
– Clients / client organisation are paid
Client involvement Seminar
• Difficulties
– Level of experience / expertise
– Which organisation do you need?  Who is
representing who?
– Helicopter view (see more than own problem)
– Continuity (energy, time, illness)
– Funding / payment
– ….
End of module 7
Client involvement Seminar
8th Module
• Presentation of indivual plans for implementing
(aspects of) client involvement in the own setting