Obtaining public input for health‐systems decision‐making: Past experiences and future prospects

Abstract: Interest in finding more effective methods for public involvement in decision‐making about health systems is more widespread than ever in Canada since significant aspects of health‐care decision‐making were devolved from provincial governments to regional health authorities. Involving the public can be risky business, however, as the accountability and legitimacy of decisions made by governing authorities are often assessed against the nature and degree of interaction that occurs with the public. Consequently, decision‐makers in a variety of policy domains routinely struggle with questions about when it is appropriate to involve the public, what the most effective means are for doing this, and how to measure their success. The authors analysed these issues by documenting the experiences of health‐systems decision‐makers in two Canadian provinces (Ontario and Quebec) with public consultation and participation over the past decade. Their findings illustrate that despite the different roles and responsibilities held by Ontario and Quebec decision‐makers, decisions to consult with their communities are driven by the same basic set of objectives: to obtain information from and to provide information to the community; to ensure fair, transparent and legitimate decision‐making processes; and to garner support for their outcomes. Decision‐makers also acknowledged the need to rethink approaches for involving the public in decision‐making processes in response to the perceived failure of past public participation and consultation processes. While these experiences have clearly left some participation practitioners feeling beleaguered, many are approaching future community consultation processes optimistically with plans for more focused, purposeful consultations that have clear objectives and more formal evaluation tinged with a healthy dose of pragmatism. Sommaire: L'intérêt que I'on porte à trouver des méthodes plus efficaces pour inciter le public à participer à la prise de décisions au sujet des systèmes de santé ne cesse de grandir au Canada depuis que les gouvemements provinciaux ont transféré aux autorités régionales la responsabilité d'importants aspects de la prise de décisions dans ce domaine. Cependant, faire intervenir le public peut être une affaire délicate, car la transparence et la légitimité des décisions prises par les autorités existantes sont souvent évaluées par rapport à la nature et au degré d'interaction qui se produit avec le public. C'est pourquoi, les décideurs dans divers domaines de politiques ont généralement de la difficultéà déterminer quand il convient de demander I'avis du public, quels sont les moyens les plus efficaces pour le faire et comment mesurer leur succès. Nous avons analysé ces questions en documentant les expériences que les décideurs des systèmes de santé de deux provinces canadiennes (l'Ontario et le Québec) avaient eues en ce qui concerne les efforts de participation et de consultation publique au cours de la derniére décennie. Nos conclusions démontrent qu'en dépit des divers rôles tenus et diverses responsabilités assumées par les décideurs de I'Ontario et du Québec, leur déision de consulter leurs communautés est guidée par les mêmes principaux objectifs: obtenir de I'information de la communauté et lui en foumir; assurer des processus de prise de déisions justes, transparents et légitimes et obtenir I'aval de leur décision. Les décideurs ont également reconnu le besoin de repenser les approches visant à faire participer le public aux processus de prise de décisions suite à I'échec perçu des expériences antérieures de participation et de consultation du public. Alors que certains partisans de la participation ont été clairement découragés par ces expériences, un grand nombre envisagent avec optimisme les processus de consultation communautaire. Ils croient que les consultations pourraient être plus focalisées et plus déterminées visant des objectifs clairs et une évaluation plus formelle et empreinte d'une bonne dose de pragmatisme.     

Reviews

R. W. Davies, The Industrialisation of Soviet Russia 1. The Soviet Offensive: The Collectivisation of Soviet Agriculture, 1929–1930. London: The Macmillan Press Ltd., 1980, xxi+491 pp., twenty tables. £20.00.

The Industrialisation of Soviet Russia 2. The Soviet Collective Farm, 1929–1930. London: The Macmillan Press Ltd., 1980. x + 216 pp., nine tables. £20.00.

Zdeně'k Mlynár, Night Frost in Prague. The End of Humane Socialism. London: C. Hurst & Co., 1980. 300 pp. £9.50.

Alistair McAuley, Economic Welfare in the Soviet Union: Poverty, Living Standards and Inequality. Hemel Hempstead: George Allen & Unwin Ltd., 1979 and Wisconsin: University of Wisconsin Press, 1979. xix + 389pp. £15.00.

Nicolas Spulber, Organizational Alternatives in Soviet‐type Economies. London: C.U.P., 1979, x + 290 pp, index. £15.00.

J. H. Moore, Growth with Self‐Management: Yugoslav Industrialization 1952–1975. Stanford, California: Hoover Institution Press, 1980. xvi + 334 pp. $17.95.

Richard K. Ashley, The Political Economy of War and Peace. The Sino‐Soviet‐American Triangle and the Modern Security Problematique. London: Frances Pinter (Publishers) Ltd., New York: Nichols Publishing Company, 1980. xv + 384 pp. £15.

Boris Komarov (pseud.), The Destruction of Nature in the Soviet Union. Foreword by Marshall I. Goldman. White Plains, New York: M. E. Sharpe,* 1980. x+150pp. $15.00.

George Katkov, The Kornilov Affair: Kerensky and the Break‐up of the Russian Army. London and New York: Longman, 1980. xiv + 210 pp. £4.95 paper.     

Building metropolitan governance capacity: The case of the Communauté métropolitaine de Montréal

Abstract: This article is about building metropolitan governance capacity. Based on the case study of the Communauté métropolitaine de Montréal (the Montreal Metropolitan Community), the authors seek to understand how this new metropolitan institution develops its capacity to manage metropolitan issues. What factors influence metropolitan governance capacity? What are the impacts of actor behaviour, incentive structures, and political leadership on that capacity? Specifically, results focus on two of the CMM's areas of responsibility: land‐use planning, and social and affordable housing. Based on the analysis of official documents of the CMM (its act of incorporation, activity reports, budget, etc.) and thirteen interviews with elected municipal officials and public servants, the authors show that the building of metropolitan governance capacity is influenced by the interactions between those three factors, as well as by other elements specific to each context.