The Stakeholder Process
At the heart of this process are 5 core values
Independence
Fairness
Professionalism
Empathy
Engagement
About the Process
After being appointed, our Facilitator, Monica, spoke with all the stakeholders who would be affected by this service. It became clear that significantly more stakeholder engagement would be needed than originally anticipated in order to support people in a way that would really help.
Monica began conversations with representatives from the 221+ Patient Support Group. A number of patient representatives shared their views. Their observations and concerns were carefully listened to. The needs of the 221+ members for any engagement to be empowering, meaningful, representative, realistic and inclusive was actively heard. After exploring options, this led to the co-design of a process. The framework that was agreed was a stakeholder restoration of trust process.
The process allowed for the parties to engage in effective communication methods and have the authority to determine the next stage. The 221+ patient support group identified the stakeholder organisations that would be invited to participate in the process. Each group that was invited consented to participate.
In line with restorative practice, the needs of the members were the foundation for creating this process. The RTM team worked in partnership with the 221+ patient support group to lay a foundation for a positive outcome. While this process emanated from a service set out in legislation, the stakeholder process was an opportunity for all parties to be open to the possibility that there may be a different need to be met at the end of their consultation.
You can read more below about the details of this process and its outcome.
The process has been based on the ideals of restorative practice but has also incorporated a considerable amount of flexibility. The main principles that applied in the stakeholder part of this process are outlined below:
Relationship Building
A core principle when embarking on this course was to facilitate relationship building between all parties. Part of that involved facilitating the understanding that there are people behind the issues and being able to foster an environment that helped to see people through multiple lenses and not only the lens of the problem.
Confidentiality
Confidentiality is a central principle to any process of this nature so that an open and honest dialogue can be had.
Neutrality and self-determination
The facilitator and moderators are independent in the performance of their functions and worked in a neutral, fair and impartial manner. Moderators do not make decisions or give a view on decisions, and this allows all participants to own any decisions reached together. The process was therefore self-determining for those who participated.
Creativity
The moderators wished to work beyond conventional problem solving and used creativity to achieve this. Symbolism was used at times to create momentum and movement and helped to draw together commonalities.
Informality and formality
During initial stages, and particularly during more creative sessions, the moderators endeavoured to keep things as informal as possible with participants working side by side. As the process progressed there came a time when things moved into a more formal space.
Flexibility
Flexibility was a core principle in this process. It was necessary for the facilitator and moderators to work with each group where they were at. The moderators were continuously adapting to the needs of participants. This often involved late-stage changes in approach and revision of plans.
Pace and readiness
An important aspect of the process was gauging the readiness of each party to engage and to move forward. This often required slowing the process down to meet the needs of those participating.
Voluntarism
Participation was through consent with discussion around all engagement being voluntary and based on informed choice.
While the facilitator had ongoing regularly scheduled meetings with stakeholders, a working group was established with representatives from four main organisations in order to coordinate planning. The working group has been invaluable for sharing information simultaneously and jointly planning sessions such as the Forum and Workshop, which are described further below.
Between September 2022 and January 2023, Moderators met individually with each stakeholder who had agreed to participate in this process. The purpose of those one-on-one meetings was for the moderators to establish their own connection with each party, explain the process and ascertain the priorities for each group. Three moderators worked together throughout this process and while they assigned a lead moderator for each meeting, it was intended that this would be seamless to those attending. Once this individual phase was concluded, the moderators brought together the representative group with a named stakeholder(s).
A flexible approach was taken to all meetings. There was an intention to work with emotion, imagination and creativity, which incorporated reflective thinking, in order to work beyond conventional problem solving. The first joint meeting took place on 1st February 2023.
1st February 2023
This meeting took place on St. Brigid’s Day and symbolism was used to encourage creative thinking. The meeting began with an informal discussion and transitioned to side by side creative work with the aim of reflecting on the legacy of women in Ireland, women who came before and women who would come after. Thought was given to their strength and ability to come together.
8th March 2023
This meeting consisted of a full creative day with a focus on relationship building and working together. The theme of International Women’s Day was used to encourage reflective thinking and exercises such as writing notes on legacy issues representing women before and after.
24th April 2023
This meeting moved into a more formal space to allow for a structured dialogue on substantive matters. Discussions with each party took place beforehand and an agenda was set from those discussions which formed the basis of the conversation. Breakout rooms were used as relief space from individual interaction in the main group and as a means of reflecting and gathering.
3rd May 2023 – Forum
This was a more structured and formal process to allow for an opportunity for everyone to come together and capture all the work done to date and look towards the future. It allowed all involved to stand back and look at what has happened and to examine “where we are and where are we going”. It was a reflection on achievements to date with a move to a future focus and planning of the next stage.
1st June 2023
This was an informal meeting without an agenda or structure and was held for the purpose of seeking clarity on certain points. The principle of flexibility was evident here as needs were responded to at each point.
14 June - Workshop
This session took a future focus view and involved drawing together the commonalities of those participating. In advance of the workshop participants were asked to prepare information under four main headings that they wished to share and contribute on the day. It was intended that the discussions would allow for an agreed shared view on the past, present and future. Flexibility was again used to respond to expressed needs and a structured approach was used as much as possible.
The outcome from the process described above is that all parties who participated up to that point agreed on their common goals. This has been captured in the statement that has come from the last workshop that they engaged in together and is as follows:
We, representatives from the 221+ Patient Support Group, Department of Health, National Screening Service and CervicalCheck have met on multiple occasions in the restoration of trust process. We are working through a future focused, sensitive and empathetic lens for the purpose of restoring the trust of those affected by the events of 2018 in the services provided by the National Screening Service. We have agreed the following based on our discussions:
“It is our wish that every woman and her family who find themselves impacted by cervical cancer will experience access to timely, high quality, evidence-based care. We hope that they will be treated with compassion, understanding and respect by the system and professionals involved in their care.
We recognise the painful past and share a vision of the future. We value the importance of screening for all women in Ireland now and into the future. Dr. Scally’s report captures the experience of women and their families. CervicalCheck is sorry for the harm that was caused to women and their families in the past.
Each and all of us accept this report in full. We acknowledge the measurable examples of all of the recommendations being implemented. We all recognise the importance and value of the patient’s voice in applying a person-centered lens to women’s healthcare. There has been a huge commitment to delivering on Dr. Scally’s recommendations and this has resulted in improvements in screening policy and an increased focus on women’s health.
We have reflected on and discussed the past through its multiple lenses and we are each committed to moving forward from a period of crisis to a stable future of collaboration.
As we move towards the future, we remain committed to engaging with each other in a respectful way under the principle that there is good intent from all involved. Creating pathways towards better communication will help us to talk openly and confidently about things that may arise in the future.
Each of us acknowledge all that has happened, all that has been achieved, all that we have done and we hope that our work together will lead others to follow. We recognise the effectiveness of screening in leading to a reduction in cervical cancer. We are all, as patients, public representatives and healthcare professionals, working towards the WHO strategy for the elimination of cervical cancer and we recognise that this is a collaborative effort between patients and professionals."
