The document outlines the NHS Citizen research initiative, which involves action research and evaluation aimed at fostering citizen engagement in healthcare decision-making. It details the methodologies used, such as participant surveys and interviews, and explores the aims and questions regarding the development and impact of NHS Citizen on democratic engagement within the NHS. Additionally, it discusses future research opportunities and broader implications for health policy and culture change within the NHS.

1. Dr Dione Hills
Tavistock Institute of Human Relations
d.hills@tavinstitute.org
What is NHS Citizen Research?
Research workshop
7/4/15

2. Action research, evaluation and
research
• The NHS citizen design process is an action
research project.
• It is also being evaluated.
• It also potentially provides research opportunities,
over and above the action research and evaluation
activities.

3. Research
Evaluation
Action research

4. Use of terms:
• Action research: continuous cycles of planning, implementation, data
collection and reflection leading to revision and further planning
• Evaluation: A more ‘removed’ activity (i.e. the evaluators and the
actors are not the same people), and is generally constructed around a
clear set of evaluation questions (What works? For whom? Under what
circumstances?).
• Pure’ research: Has a primary aim of enhancing knowledge, with a
particular programme or policy providing a ‘test bed’ in which theories
and hypotheses can be explored.

5. Action research activities: data collection
Website
– Sign ups for newsletter
– Utilisation data
– Hits
– issues and comments posted
Other activities
– Evidence/research reviews
(citizenship)
– Participant interviews
(citizenship)
Team activities
– Team meetings and planning
documents
– Individual
discussions/interviews
– Team reflections
– Learning log
Events
– Participant ‘sign in’
– Feedback sheets (online)
– Gather test at expo and for first
assembly
– Discussions taking place

6. Evaluation aims
• To ensure that learning is surfaced and developed across the system
by gathering relevant information, reflection on the process as it
occurs, and any findings that are fed back into NHS citizen during
reflection events.
• To feedback learning into the system of developing NHS citizen
• For accountability (for funding received for this development process)
• To generate data to support its ongoing work
• To develop thoughts for longer term evaluation of NHS citizen itself.

7. Evaluation activities
• Theory of change mapping (provides evaluation framework)
• Survey of participants (on line)
• Interviews with team members
• Case studies of ‘issues’
• Collation of data and report writing (during April)
• Evaluation of citizen jury events (external researcher)

8. Citizens: self
selecting, act
as combatants,
lack trust and
confidence
Locations mapping
themselves
People signed up with NHS
citizen
Planning for assemblies and
citizens panel
Individual (board, staff,
directors) gain understand
of their role as NHS
citizens
NHS citizen enters
mainstream thinking
Citizen centred technical
architecture in place
Review process tested
New networks
developing
New patient groups
reached
Technical design of website
Board not
connected with
citizens
Planning for
‘front door’ and
space for conversations
Identify and talk with
individual (directors, their
PAs and champions
NHS staff: not
engaging
citizens as co-
producers
Connections/
Communicatio
ns:
fragmented,
poor quality,
not visible,
Lack results
Networks:
fragmented,
poorly
informed,
Change in board
behaviour
Prioritising of meetings by
board
PI orgs understand how
NHS citizen can help
Assembly meeting process
designed and implemented
Citizen’s panel process
and role designed
Growing audience of
NHS citizens
Leading PI orgs brought
together
Technical advisory group set up
Actions Outputs Outcomes Impacts
Clear route for people and
ideas established
Network mapping
Issues
Kings fund
symposium
Assemblies
take place
Citizen
panel tests
Processes for taking ideas to
action developed and tested
3 design
events
take
place
NHS citizen
prototype in
place
Connections built to networks
and organisations
Demonstrations of ideas
leading to action
Website
launched
More NHS staff use
social media
New expectations of
behaviour inside
system
Local
events

9. Process evaluation questions to date
• Are the actions to date ‘on target’ to deliver a prototype of NHS citizen by March 2015?
• What is being learned about democratic engagement, and how is this being translated
into changes within the programme as it evolves?
• Is the notion of ‘NHS citizen’ emerging as a useful concept?
• Is NHS citizen successfully engaging groups whose voices often go unheard?
• Is a process emerging through which ‘issues’ to be identified, researched, and presented
in a way that can be addressed?
• Is a structure, culture and environment (on and off line) being created in which all
participants feel included, and able to take part in deliberation and decision making
processes?
• What are some of the key elements of this structure, culture and environment?
• To what extent are the different ‘streams’ of the project working effectively together ?

10. Outcome and impact questions to date
• To what extent has an NHS citizen prototype been developed that is responsive, trusted,
inclusive and transparent
• Is there evidence that NHS citizen is on course to meet the aims set out on the website:
i.e. creating:
–a direct transparent route for citizens and organisations to the heart of the NHS
England decision making process
– a new source of evidence and opinion for the NHS England board
–a mechanism providing accountability for the work of NHS England
–a mechanism/system that leads to action, quickly
• Has NHS citizen begun to introduce changes in the culture of the NHS
• Has NHS citizen contributed to more active engagement and networking between
individuals, groups and organisations
• Is there evidence than any of the above is sustainable in the future and likely to lead to
further change?

11. Process questions going forward……
• Does the NHS Citizen model of citizenship work within the different spaces in the
system?
• What are the best ways of moving beyond the barriers that are preventing the
development of a more collaborative, open and participative culture within NHS England?
• Is there internal coherence between our different methods of filtering and prioritising
issues?
• Does the NHS Citizen model of democratic participation work in practice? Is it being
delivered in such a way that decisions are measurably more participative and effective?
• Do these methods address unconscious bias within the system and offer something new
in terms of decision-making?
• What measures need to be taken to support sustainable change?

12. Outcome and impact questions going
forward...
• Does NHS Citizen contribute to an effective culture of collaboration and accountability?
• To what extent does the NHS Citizen model of collaboration and accountability help to
unlock this culture change?
• How well does NHS Citizen enable people inside and outside the system to reach out to
hidden and excluded communities and facilitate the discussion of issues critical to them
within the system?
• What is the appropriate rate at which to scale different activities to ensure that the current
momentum is maintained while not over-reaching NHS England’s capacity to respond to
the issues that arise?
• How well do the prototypes being developed deliver against specification and intended
outcomes? There will be a particular focus on Gather over the first nine months.

13. Broader research questions raised
What is the role of deliberation, citizen engagement and democratic innovation in the area of
health policy development (Linked to wider theoretical development and research in this
area)
What is the link between democratic reform and existing structures of governance and
accountability (e.g. looking at whether this is different in relation to health policy compared
with local authority policy making?)
What does NHS citizen tell us about other ‘big’ issues facing the NHS in England:
–The challenge of translating core ‘values’ (like citizen involvement) into practical
structures and activities
–How does citizen involvement interface with the challenge of managing scarce
resources
–How to introduce ‘culture change’ in an old (67 years) organisation already subject to
numerous reorganisations and culture change interventions.
Plus many more…..

14. Research
Evaluation
Action
research
Learning exchange
via research hub
(and further
research
workshops)
External research
utilising
opportunities
provided by NHS
citizen
Supporting internal
action research
and evaluation
capacity

15. What kinds of research could be
undertaken?
Compatible with NHS Citizen values, i.e.
•Responsive, trusted, inclusive and transparent
•Participative research methods
•Respectful of ethical and legal (data protection) issues
•Seen as ‘valid’ in health service settings
?
?
?