Using participation to create resilience: how to involve citizens in designing a hospital system?

Decisions on health-related risks affect many people personally. The public debate on hospital planning is therefore especially emotional and conflict-ridden. Due to the aging population and the high costs of constantly improving medical care, the question arises in many German rural areas as to which hospitals can be kept and developed further and which ones should be closed. The new approach of the present state government of Baden-Württemberg in Germany, in collaboration with the University of Stuttgart and the State Health Office Baden-Württemberg, is to apply citizen participation to prepare this type of decision. The design of this type of public participation process is based on the criteria of mediation (including open decision-making scope, opportunity for discussion in the protected context of the working group, as well as disclosure of all information and transparency of the results toward the public). This approach has proven useful for conducting dialogs in areas with potential conflict. Based on the experiences from this hospital participation process, further recommendations for an effective, efficient and fair participation processes could be derived. The case demonstrates that adequate and structured involvement processes are capable of delivering sustainably acceptable results even in difficult decision-making processes.