InfoGuide: Systemic Advocacy

November 2006

Disclaimer: This Infoguide is intended for use as general information and is prepared for purposes of convenience only. It is not to be relied upon as legal advice or legal authority. If you have inquiries as to legal proceedings, or if you would like more detailed information regarding legislation, you should consult a lawyer.

Who is this InfoGuide intended for? 

• This InfoGuide is intended to assist anyone who wants to be a catalyst for change and have an impact on issues at the "systems level," including clients, families, health practitioners, service providers, advocates and consumer-survivors. Systemic advocacy work can result in positive change for both individuals and the system. This type of advocacy can result in positive changes to service delivery, remove access barriers and result in changes to legislation, which can enhance the legal and civil rights of all Ontarians.

What is "systemic advocacy"? 

• Systemic advocacy means identifying and addressing systemic problems by analyzing their root causes and recommending corrective action. Systemic advocacy is aimed at promoting positive change to the mental health system in Ontario and the people it is intended to benefit. Systemic advocacy can have an impact at any level of an organization or any level of government and often relates to quality of care, quality of life and rights issues that affect a large number of individuals (as opposed to one person). It often leads to broad "systems level" change through the development of laws or policies and procedures at the provincial level. In other cases it can lead to changes in hospital policies or a changes in practices at the local level.

Why is systemic advocacy important? 

• Systemic advocacy is important because it gives you an opportunity to make "systems level" changes that will help a large number of individuals. Systemic advocacy also provides an opportunity to proactively address issues related to the promotion and protection of patients' rights.

How do you identify a systemic issue? 

• Systemic advocacy issues can be brought to your attention in a number of ways, including through individual problems or group complaints where you notice a pattern to the complaints and the inequities experienced by those who want assistance.
• When you identify a possible systemic advocacy issue, you may want to spend some time collecting background information, researching the issue, determining the nature of the rights that have been violated and writing a clear and concise issue statement. It is also important to assess the impact of the issue on both the individual and a larger group of people. Always be sure to put a "human face" on the problem as it is easier for people to identify with the issue. Whatever the issue is that you are pursuing, always give it the "family test." In other words, is this situation adequate for my family member or loved one, is this how I want them to be treated, or should systemic change be made to improve circumstances for the individual or a group of individuals?
• Part of your assessment should also include an understanding of why it is an issue at this particular time, the availability of options for resolution and the identification of the other parties involved. Identifying possible allies is also recommended: depending on the issue, there may be natural partners whose participation in bringing the issue forward may lend a greater weight to your argument.

How will I know if there are any legal issues? 

• Usually people know when their rights have been violated or at least they have a sense that something is unfair or unjust. If you are not a lawyer or an expert on the issue in question, much of the work that you will do as an advocate will be "non-legal" in nature. If you are not sure if a legal right has been breached, you can contact a legal clinic, lawyer or any other organization that deals with human rights or legal issues for guidance. You should also suggest to the individual or group that they seek their own legal opinion.

How do I develop an action plan? 

• An action plan is a detailed work plan that includes the steps you will take to implement the plan, who you will consult with and how you plan to involve others in addressing the issue. Give some thought to your advocacy style.
• It is often easier to resolve a systemic issue if you are able to form a coalition or work collaboratively with others. Remember, however, that one person will need to provide leadership to co-ordinating your efforts to ensure that your systemic advocacy work proceeds without losing momentum.

Is it important to document your systemic advocacy work? 

• You should always document the date, the time, the names of the people you spoke to and their contact information. You should also record any actions you have taken and any promises you have made to others. Be sure to keep copies of ingoing and outgoing correspondence and communications. Such information might be important at a later time if the issue is not resolved satisfactorily. By following these steps, you are creating a "paper trail" in the event the other party fails to keep their commitment or does not honour their agreement.
• Sometimes, it may be necessary to send follow-up letters confirming conversations or decisions to ensure everyone has a common understanding of the key decisions and commitments made by each party. These follow-up letters can be crucial to resolving future disagreements with respect to implementation and resolution. In addition to accountability, maintaining accurate records is an excellent method of tracking your progress on an issue.

Is it important to have a "Plan B"? 

• Always begin your systemic advocacy with a back-up plan or "Plan B" in the event your preferred approach does not work. You will likely find that as you begin working to resolve your issue, new information will become available. It may be wise to incorporate this information into your strategy as it could have an impact on the approach you have chosen or the resolution you are seeking.
• In assessing your first action plan, ask yourself the following questions. Is the plan working? Is it an effective approach to issue resolution? Are people listening and understanding the issue? Do you need to include other individuals or perspectives in your strategy? Never be afraid to ask these tough questions, even if you are afraid of the potential answers. It will only strengthen your work and make you a better advocate.
• Before you go to "Plan B," be sure to talk to everyone involved about the change and strategy development. It is important to communicate and to seek input from others before implementing the change, confirm that everyone understands the rationale for the change and clarify the new approach. You do not want to send mixed messages that will undermine the new strategy and your credibility.

When should I escalate the issue? 

• Escalation is perhaps one of the most powerful tools in systemic advocacy work as it allows you to involve decision makers at a higher level. It is critical to develop an escalation plan at the outset because if you are not able to resolve the issue closest to the person who made the original decision, you will need to go to a person with more authority.
• Some people believe that the first step of an action plan is to go to the top person in an organization - for example, the Executive Director or Chief Executive Officer. It is our experience that this is not effective because there is nowhere else to go if you are unsuccessful with the person in charge. By starting with the person who made the original decision and escalating the issue upwards, you have more opportunities for discussion, review and possibly resolution. There will also be more opportunities to educate others about the issue and to obtain their support and hopefully their commitment to addressing and resolving the issue.
• Keep in mind that you should not escalate the issue too high or too soon as it could lose its impact. Effective escalation is all about timing - knowing when to escalate, how and to whom.

Do I need a communication plan? 

• A communication plan may be helpful to frame your issue in clear and concise terms and to think about your strategy and the desired outcome. Your communication plan should define the main messages, the mode of communication of these messages and their delivery. Each element is important because it can influence the perception of the issue and who listens to the message. It is also effective to repeat your message numerous times so that it will be remembered by those who need to hear it.
• As with your action plan, you need to have a "Plan B" as part of your communication plan. For example, what happens if your message is unclear or it simply is not being heard by the key decision-makers? A change in strategy and approach would be appropriate. Perhaps you need to rethink the delivery of the issue, describe it in a different way or repackage it with a new message and delivery style. Never be afraid to re-assess your communication plan because that is how you will get your message out to others and get their support.

What if I do not achieve the outcome I wanted? 

• There may be times when you will not achieve the outcome you wanted or you may have to settle for less than you hoped. Do not view such an outcome as a failure, but celebrate incremental change as a success. You will have other opportunities in the future to address the issue. Learn from your experiences to think of new approaches, partnerships and strategies to approach the issue in the future. Recognize the factors that contributed to the outcome so that they are addressed in your next systemic advocacy effort. Above all, remember that over time a series of incremental changes may result in a very meaningful change.

Should I evaluate the outcome? 

• Yes. You should analyze what did and did not work, recognize successful strategies and approaches and understand what you would do differently next time. This will help you incorporate new skills and ideas into your systemic advocacy issue.
• Celebrate your success and do not be discouraged if you did not achieve all of your goals as there will be other opportunities.

Is follow-up important? 

• Yes, it is important to follow-up on an issue to ensure that the decision or resolution was actually implemented. This will also give you an opportunity to evaluate the outcome and assess how it has improved the situation of either the individual or the group that made the original complaint. If the resolution has not been implemented, you can then assess your next steps and the process for re-activating the issue.

Questions? 
If you have questions contact your local Patient Advocate or Rights Adviser or call the central Psychiatric Patient Advocate Office at 1-800-578-2343.

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