Let's be PALS: User‐Driven Organizational Change in Healthcare^*

Abstract

This paper explores user‐driven organizational change in the National Health Service (NHS). The NHS Plan (Department of Health, 2000) created Patient Advice and Liaison Services (PALS) to provide information, solve problems and drive user‐led change. Evidence is drawn from a study of PALS in London acute, primary care, mental health and specialist trusts, drawing on discussion forums, interviews with PALS officers and documentation. From context and role profiles, two conclusions are evident. First, organizational instability, boundary disputes, variable management support, resource limitations, financial insecurity and multi‐site working characterize the context in which PALS operate, and the officer role is characterized by problem diversity, overlap with complaints systems, monitoring problems, relationship building and ‘serial users’. Second, these context and role attributes restrict PALS to ‘repair and maintenance’, ensuring that established systems work correctly. While PALS sit on the bottom rung of a ‘participation ladder’, their contribution is more than tokenistic. However, a processual perspective demonstrates how a fluid, networked, and diversified context isolates PALS structures from management decision‐making, constraining their power base, and inhibiting the promotion of substantive change agendas.

Drug service user groups: Only a partial solution to the problem of developing user involvement

“…While organizations under pressure to meet mandated UI obligations, sought to convene groups specifically to enable formal user consultation, users were more inclined to self-organize around shared objectives (one of which may be service improvement) and to gain a sense of solidarity. It appears that, consistent with UI in other healthcare fields, agencies are more concerned with consumerism, accountability, and efficiency and users more concerned with service quality, and democratic rights to participation (Buchanan, Abbott, Bentley, Lanceley, & Meyer, 2005).…”

Community representation in hospital decision making: a literature review

“…8 Boards (and those responsible for budgets) held accountable for community engagement, for evaluating community engagement strategies, and for reflection on results and improving practices where needed; a clear policy on being a client-orientated service with user involvement recognised as a measure; and a well thought out and supported strategic plan for community engagement and an appropriate budget (planning, facilitators incorporated, approved budgets attached). 5,6,8,11,16,[20][21][22] Organisational issue: Poor support for and negative attitudes towards community engagement within the organisation; internal stakeholders feeling intimidated by the involvement of consumers in decision making and attempting to shift important discussions to outside committee meetings involving community; accountability gaps; disengagement from governance reform; and staff working within structures that reward different concerns (e.g. conditions for promotions, research publications etc.)…”

“…8,[14][15][16][17]19,20,23,24 Training and socialisation of professionals to participate in collaborations; a high level organisational champion; clear lines of accountability; and adequate time and resources for community engagement reflected in funding, job descriptions, rewards systems and workloads. 8,[11][12][13][14]16,18,22,25,26 Consumer issues: consumers feeling a tension between expert/ funded opinion and their lay knowledge; the consumer voice feeling isolated and intimidated; community apathy and poor participation levels; and community representatives with little opportunity to receive comments from or to feedback to others in the community. 8,24,27,28 Induction and preparation time, including information on the health service and how it is administered; appropriate training; good communication, including communication of clear and agreed roles to all involved and allowing participants to appreciate the process through reporting on inputs and outcomes; meeting environments which are nonintimidating and are open and inclusive; involvement of community workers that are independent of planners and policy makers; links to active user groups in the community; encouraging reflective behaviours through soliciting and encouraging feedback from clients; and incorporating strategies for community engagement, other than community representation, and developing linkages between these strategies.…”

Patient Advice and Liaison Services: results of an audit survey in England

“…The DH funded the NPDG to produce additional resources including training materials, a communications CD and a national PALS website ‘PALS Online’. In 2003 the DH funded a region‐wide evaluation of PALS in London 21–23 as well as commissioning a national survey of access to and use of PALS by children, young people and parents 24 …”