It’s a conversation that is difficult at the best of times: what one’s health-care wishes are, around the end of life. How do you know what someone’s wishes are, if they can’t speak for themselves any longer?
CEAN – the Community Engagement Advisory Network at the Vancouver Coastal Health Authority – tackled the problem with a unique, peer-led approach, bringing the patients themselves into the conversation. For that, CEAN won the 2016 IAP2 Canada Core Values Award for P2 for the Greater Good.
CEAN is a group of community volunteers that advises VCH on planning and delivering health-care services, coming from the perspective of the patient or family member. The idea of Advance Care Planning started over a decade ago, and in 2010, members of the VCH Senior Leadership Team, Board and CEAN held a public forum on ACP. Two major themes emerged: the importance of the public talking to the public, and the importance of conversation.
According to Pat Porterfield of CEAN, the number of legal forms that have to be filled out can cause one to get bogged down in that aspect and miss the importance of talking to one’s family and friends about those wishes. It was equally important to have people talking to people, because some of the members of the forum noted that there could be skepticism of the role or motives of the Health Authority leading the discussion.
Some were concerned that the Authority could be seen as having an ulterior motive – like controlling health-care costs. Forum participants also noted that it would be important for members of the public to hear “testimonies”, as it were, from others who had had those conversations with their families and friends. It was necessary, then, for VCH to be seen to be supporting the initiative, but that it be driven by members of the public: it’s the conversation that’s important.
The main requirement for volunteers taking part in this project is passion for helping people have this conversation and often, the facilitators have personal experiences: they may have had an advance-care conversation in their own lives, or there hadn’t been such a conversation and they wished that there had.
Each facilitator develops their own workshop, but the team works together very collaboratively; supporting one another emotionally, and when developing and reviewing materials for the public.
Each workshop ends with an evaluation, and feedback has been very positive: whether workshop attendees are looking for help in making their own plans or to have the conversation with a loved one, they feel they understand the process better and are more capable of making decisions as a result.
Van Ness Avenue is the “spine” of San Francisco – a part of Highway 101 – but it’s fallen into disrepair in recent decades. It runs past City Hall and cultural organizations like the ballet and the opera. It’s one of the densest transportation corridors in the city. As a piece of the city’s history, it was used as a fire-break in the Great Fire of 1906 – most of the east side of Van Ness burned up, and what was on the west side was more or less protected.
When it came time to upgrade the thoroughfare – sidewalk-to-sidewalk, from fifteen feet below the surface to 30 feet above — the city brought together various agencies – including the San Francisco Municipal Transportation Agency (SFMTA) – to put the Van Ness Improvement Project together. Lulu Feliciano, SFMTA’s Outreach Manager, says that may be the more efficient way of doing things, but it also meant major inconvenience for the people living and working along that stretch.
SFMTA had already recognized the key principle of IAP2: that people affected by a decision have a right to a voice in that decision, and with such a wide range of interests to cover, the agency had to go beyond more traditional methods to reach them.
SFMTA took pre-construction surveys, using hard copies, online surveys and door-to-door visits, asking people about their conceptions of the noise, parking issues and other inconveniences regarding construction in their area. This direct consultation helped cultivate relationships with the neighbours.
These data – collected from 85 percent of businesses and residential properties – were shared with the contractors in developing a construction strategy and sequence that addressed residents’ concerns such as traffic circulation and parking. SFMTA also learned about specific business needs that had not been considered before, and a Business Advisory Committee was set up to deal with those specific needs. That committee has had direct access to project staff and has helped develop strategies to help businesses through the impactful construction of the project. Some of the tools developed with the committee include a Construction Survival Guide packed with information for businesses, as well as a campaign to discourage double parking on the corridor.
A series of walking tours helped show the public what the existing conditions were and what would be improved through the project.
A key challenge SFMTA faced was one many practitioners face: getting past “the usual suspects”. They found they had been hearing from the same people they heard in other projects, and they knew they needed to find other ways of reaching out. They learned, for example, from the City of Chicago’s experience, that setting up a text messaging system to create a two-way conversation was vital. This tool was especially helpful in engaging younger audiences. Among other things, these updates involved keeping people informed on when they could give input on specific aspects of the project.
The text surveys were not just in English, but also in Spanish, Chinese and Filipino. So far almost a thousand have responded; SFMTA is reaching the goal of including new voices as 60 percent indicated they were unfamiliar with the Van Ness Improvement Project and 79 percent opted into the text messaging conversation.
SFMTA made extensive use of texting through the GovDelivery platform. They also learned a lot about the limitations of the system – such as, the fact that it did not allow for people who indicated they did not know about the Van Ness Improvement Project to automatically receive updates on the project. SFMTA Public Relations Assistant Sean Cronin says that makes it important to continue pushing information out to people who responded and cultivate relationships that way.
Here are some of the resources SFMTA used:
Construction of the Van Ness Improvement Project began late last year and is expected to continue through 2019. As construction progresses, the team will expand on its pre-construction efforts to foster relationships with the public and continue to be good stewards of the neighborhood.
IAP2 members can hear the entire webinar here.