Act I: The challenge – when mandatory becomes meaningful
Every NHS board knows the requirement. Patient and public involvement isn’t optional. It’s mandatory. But Norfolk and Waveney Integrated Care Board recognised a cruel irony: mandatory doesn’t mean meaningful, especially when lived experience in healthcare gets silenced by systemic power imbalances.
“We’ve always wanted to develop our approach to patient and public involvement,” reflects Maggie Tween, senior cancer programme manager. “Like all care boards and clinical networks, we aspire to co-production but don’t necessarily fully achieve it.”
The pandemic had intensified existing dynamics. Healthcare professionals, under unprecedented pressure, focused on targets and timelines. Patient representatives, invited to contribute, found themselves silenced by systemic power imbalances. The risk wasn’t just ineffective meetings. It was virtue signalling by tickbox, a practice that could damage organisational culture more than doing nothing at all.
Norfolk and Waveney’s Cancer Transformation Programme made a strategic decision. Rather than simply inviting patient voices to the table, they would invest in empowering those voices to reshape the conversation entirely.
The objectives were clear and courageous:
- Build patient representatives’ confidence to speak up, question, and challenge
- Shift established power dynamics in favour of lived experience
- Create truly representative care strategies for their community
Act II: The transformation- lived experience takes centre stage
Working alongside our specialist DEIB training consultants, Norfolk and Waveney embarked on a programme that put patient representatives at its heart. In spring 2023, the design began where all meaningful change must, with deep listening.
The Communication Practice’s expert lived experience interviewers conducted confidential conversations with patient representatives across the region about their meeting experiences. The insights were sobering. Representatives reported feeling intimidated by clinical environments. Consultants arriving late with brusque efficiency. Professional jargon creating barriers. Power dynamics that silenced the very voices meant to guide care.
“Although they’d agreed to attend meetings to represent patients and carers,” Maggie explains, “all our patient representatives found themselves constantly having to deal with all the behaviours of people ‘being busy’ in the NHS.”
The Communication Practice knew exactly how to help.
Innovative NHS patient engagement training
The innovation lay in the response. Rather than traditional training, the programme deployed forum theatre, live performance bringing meeting dynamics viscerally to life. Three professional actors portrayed a patient representative, a clinician, and a manager in a scripted performance. The script didn’t imagine these dynamics. It represented them, drawn directly from patient representatives’ lived experiences.
In one pivotal moment, a participant watching a clinician dismiss a patient’s concern about appointment timing called “Stop!” She suggested the clinician instead ask: “Help me understand what makes that timing difficult for patients.” The room watched the dynamic shift from dismissal to discovery. The clinician character learned that early morning appointments meant rural patients couldn’t use public transport. A simple question had uncovered a systemic barrier.
Participants watched the performance unfold. Then came the transformation. Guided by expert facilitators, they discussed what worked and what didn’t. The scene replayed. This time, participants could shout “Stop!” and redirect the action.
They weren’t just observing power dynamics. They were rewriting them.
Following the forum theatre, participants received practical communication strategies tailored to healthcare settings. Then, our actor-coaches created safe spaces for brave conversation in breakout rooms, where patient representatives got to practise their new skills.
Our actor-coaches worked with each participant to ensure they left the session with:
- Confidence to navigate professional healthcare settings
- Skills to articulate lived experience effectively
- Techniques to manage emotions during challenging discussions
Act III: The impact – confidence becomes contribution
The transformation was immediate and measurable. Patient representatives didn’t just attend meetings. They shaped them.
“This workshop really helped,” confirms Maggie. “Patient/carer representatives are more confident to speak up and share their views. We’re already seeing the difference in our board meetings.”
The programme’s impact extends beyond individual confidence. It’s reshaping Norfolk and Waveney’s entire approach to co-production. Healthcare professionals are witnessing the value of truly inclusive dialogue. Meeting cultures are evolving. Power dynamics are shifting.
Six months post-intervention, patient representatives report they now regularly use the intervention techniques learned. One representative shared: “Before, I’d sit silent when I didn’t understand the medical terms. Now I say, ‘Could you explain that in layman’s terms?’ And you know what? The clinicians thank me because it helps everyone understand better.”
“While this is something we need to and will address internally by working on our meeting culture,” Maggie acknowledges, “supporting our patient reps to develop the skills they had told us they needed made a hugely positive impact.”
The board isn’t stopping there. They’ve learned that inclusive communication isn’t about inviting people to speak. It’s about creating conditions where they can be heard. And so, they’re examining their meeting structures, their communication norms, their fundamental assumptions about whose voice carries weight.
“Like all care boards, the need to redress the patient-provider power balance so impacted by the pandemic is pressing,” Maggie notes. “This workshop really helped set us on that path.”
The business case: why patient voice drives better outcomes
Norfolk and Waveney’s investment in patient voice directly impacts care quality and system efficiency:
- Co-designed services better meet community needs, reducing costly redesigns
- Engaged patient representatives improve service uptake and adherence
- Diverse perspectives identify risks and opportunities clinical teams might miss
- Authentic co-production strengthens public trust in healthcare systems
- Empowered representatives become ambassadors for service transformation
NHS patient engagement training through forum theatre methodology addresses healthcare’s unique challenge: bridging the gap between clinical expertise and lived experience. By practising intervention in simulated meetings, representatives develop the confidence to navigate real power dynamics.
Your next chapter: from tick-box to transformation
Norfolk and Waveney’s journey demonstrates that meaningful patient involvement isn’t about compliance. It’s about courage. The courage to acknowledge power imbalances. The courage to invest in change. The courage to let patient voices lead.
The question for healthcare organisations isn’t whether patient involvement matters. It’s whether you’re ready to move from tick-box representation to genuine co-production. Because in healthcare transformation, the most powerful expertise isn’t always clinical. Sometimes it’s experiential.
Ready to transform patient consultation into genuine co-production? Contact us to explore how forum theatre and communication practice can shift your organisation from hearing patient voices to acting on them. Why? Because meaningful change happens when lived experience shapes strategy, not just informs it.
Discover how forum theatre, practice conversations, and experiential learning can empower patient representatives and transform healthcare co-production. Contact us to explore strategic DEIB solutions built to fit your culture.