The Engagement Cycle

Introduction to The Engagement Cycle

Why work with patients and the public?

There are many reasons for engaging with patients, users, carers, communities and the public including those which are:

  • Moral – many believe that being engaged in decisions about planning, designing and delivering services is a fundamental right
  • Business – engaging people in planning, monitoring and improving health services can make sound business sense. See economic case for patient and public involvement in commissioning
  • Social and political – engaging people in planning, monitoring and improving health services can lead to more trusting and confident relationships between local stakeholders
  • Health – There is growing evidence that patient and public engagement (PPE) can deliver improvements, such as more responsive services, improve outcomes, patient experience, shared decision-making and self-care
  • Legal – There is a statutory duty for Clinical Commissioning Groups (CCGs) to engage patients and the public

Engaging with patients and the public can happen at two levels:

  • Individual level – ‘my say’ in decisions about my own care and treatment
  • Collective level – ‘my’ or ‘our say’ in decisions about planning, design and delivery of services

This Engagement Cycle focuses primarily on the collective level. However, it can also be used to think about the individual level (i.e. working with people at different stages of the cycle to improve different aspects of shared decision-making, provision of patient information, access to medical records, etc.).

What is The Engagement Cycle?

The Engagement Cycle is a strategic tool that helps commissioners (of health and social care) to understand who needs to do what, in order to engage patients, communities and the public at each stage of commissioning.

It identifies five purposes of engagement, represented as five different stageswhen people should be engaged in commissioning decisions:

  • Working with communities (of geography and of interest) to identify needs and aspirations.
  • Working with the public (as citizens and taxpayers) to plan and transform services
  • Working with patients and carers to design services and improve quality and safety
  • Working with patients and the public to procure and contract services
  • Working with patients and carers to monitor services and share learning.

For each of these five purposes, The Engagement Cycle provides simple advice on what to do in order to undertake high quality patient and public engagement (PPE) that will enhance and support the decisions that commissioners need to make.

Each stage of the cycle provides useful intelligence for the next (like a baton being passed on from one stage to another).

In order for the Cycle to work properly, the hub of The Engagement Cycle focuses on developing the engagement strategy, culture and systems that turns engagement into everyday practice.

Commissioners and their partners can use The Engagement Cycle as the basis for thinking through overall strategic direction, or focus on a particular stage to think through what needs to happen for a particular engagement purpose. But, for the Engagement Cycle to be effective, it should be viewed as a whole.

Who is it for?

The Engagement Cycle has been used successfully by all those involved in commissioning, such as:

  • Clinical Commissioning Group Leaders (Chairs, Vice-Chairs, Clinical Leads for Patient and Public Engagement, Lay Members and other Board Members)
  • Those responsible for corporate direction, engagement strategy and undertaking engagement activities. The Cycle works best when people at both strategic and operational levels work together
  • Programme leads and network partners responsible for particular client groups (NB. The cycle can be used to think about the five stages of engagement required for individual patient pathways, as well as for the organisation as a whole)
  • Engagement Leads and Practitioners working in, and with, CCGs
  • Patient and voluntary organisations seeking to work with, and influence, commissioners
  • Commissioning support agencies (Local Area Teams, Commissioning Support Units, Regional Offices of NHS England)
  • Local authority commissioners, Health and Wellbeing Boards and Public Health Teams
  • Health and social care providers, health professionals, staff and other partner agencies

The Engagement Cycle