Fostering public engagement
===========================

* Graham Sher, MD PhD

*   © 2008 Canadian Medical Association or its licensors

I read with interest the article on public engagement in setting health care priorities.1 As the chief executive officer of Canadian Blood Services, an organization that emerged from the tainted blood tragedy of the 1980s, I can attest to the value of engaging the public in decision-making.

The Commission of Inquiry on the Blood System in Canada set the stage for engagement;2 however, owing to a history of mistrust, stakeholders and the public were reluctant to participate in decision-making about the blood system. Canadian Blood Services met this challenge by establishing 1 national and several regional standing committees, for which the founding members participated in defining the terms of reference. Initially the national committee was to report to the chief executive officer, but the committee members were not confident that their input would receive genuine consideration by decision-makers. Once the reporting structure was modified so that the committee reported to the board of directors, the committee members' trust increased exponentially.

Experience has taught us that several critical success factors must be present within an organization to ensure effective public engagement: integration of public engagement into the business, establishment of formalized principles for engagement, commitment to building and maintaining trusting relationships with the public and stakeholders, and willingness to consider and act on their input. There must also be direct access of the public and stakeholders to the decision-makers, transparency with regard to the process and goals of engagement, openness to sharing all information relevant to the issue, an inclusive approach to identifying and involving the public and stakeholders, timely engagement at a point in the decision- making process when input can genuinely influence outcomes, and meaningful ways of recognizing stakeholders and the public for their contributions. 

As a recent example, Canadian Blood Services has accepted the mandate to develop an integrated national system for organ donation and transplantation in Canada. In September, about 130 stakeholders contributed to setting priorities for the new system. These stakeholders will continue to be at the table as the system evolves because we firmly believe that operating in an open and collaborative manner is essential to ensuring a safe health care system and maintaining trust in that system. 

## Footnotes

*   **Competing interests:** None declared.

## REFERENCES

1.  1. Bruni RA, Laupacis A, Martin DK, for the University of Toronto Priority Setting in Health Care Research Group. Public engagement in setting priorities in health care. CMAJ 2008;179:15-8.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo4OiIxNzkvMS8xNSI7czo0OiJhdG9tIjtzOjI0OiIvY21hai8xNzkvMTEvMTE3NC4yLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

2.  2. Krever H. *Final report: Commission of Inquiry on the Blood System in Canada*. Ottawa (ON): The Commission; 1997.