The launch in 2017 of the Irish 10-year reform programme Sláintecare represents a key commitment in the future of the health system. An important component of the programme was the development of a health system performance assessment (HSPA) framework. In 2019, the Department of Health of Ireland (DoH) and Health Service Executive (HSE) commissioned the technical support of researchers to develop an outcome-oriented HSPA framework, which should reflect the shared priorities of multiple stakeholders, including citizens. This study describes the method applied in the Irish context and reflects on the added value of using a citizen panel in the co-production of an HSPA framework.
A panel of 15 citizens was convened, recruited by a third-party company using a sampling strategy to achieve a balanced mix representing the Irish society. Panelists received lay-language preparatory materials prior to the meeting. Panelists used a three-color scheme to signal the inclusion and importance of performance measures. An exit questionnaire was administered to understand how participants experienced being part of the panel. The citizen panel was the first in a series of three panels towards the development of the HSPA framework, followed by panels including representatives of the DoH and HSE, and representatives from professional associations and special interest groups.
The citizen panel generated 249 health performance measures ranging across 13 domains. Domains assessed as the most important included people-centeredness, coordination of care, and coverage. Prioritization of domains differed between panels. Citizen panelists shared a similar understanding of what a citizen panel involves and described their experience at the panel as enjoyable, interesting, and informative.
The engagement of citizens early on in the co-production process of the HSPA framework shaped the processes that followed, with the restating of priorities of the citizen panel informing decision-making throughout. Citizen engagement in HSPA development is essential for realizing value-based people-centered health systems and assuring an inclusive process that helps to generate trust and ownership of performance intelligence. Future research could expand on how citizen panels could be further engaged in co-creating mechanisms to assess, monitor, and report on the performance of health care systems.