Vancouver Island Health Authority (BC)

  • Marilyn Bater, Medical Director of Seniors Health & Department Head of Geriatrics, Vancouver Island Health Authority, Victoria, British Columbia
  • Eileen Goudy, Executive Director of Quality, Research & Safety, Vancouver Island Health Authority, Victoria, British Columbia
  • Mary Jackson, Director of Professional Practice, Vancouver Island Health Authority, Victoria, British Columbia
  • Rita den Otter, Program Director of Care Delivery Model Redesign, Vancouver Island Health Authority, Victoria, British Columbia

Engaging Patients in Care Decisions

Traditionally, the patient’s and family’s role in healthcare has been a passive one. Despite claims of patient-centered care, design and practice decisions often reflect the provider’s perspective. There are a number of reasons for this: healthcare systems are very complex; governments and other funders demand benchmarks, measurements, efficiency and accountability thereby encouraging standardized practices which, while enhancing predictability, may also decrease responsiveness to individual patient needs; and care providers seek significant degrees of influence, advancing the implicit, but false, conclusion that the system of care delivery reflects what is best for patients.

From 2008 to 2010, Vancouver Island Health Authority (VIHA) undertook a number of observational studies to understand how staff spent time in patient care. The results identified a significant gap in understanding who the patient was. Shortly after, a patient complaint corroborated the observational findings and became a focal point for VIHA (see anecdote). Our intervention project sought to understand the problem of meaningful patient engagement and determine readiness for change by engaging key participants. We focused on communication and engagement with patients and families, and looked for opportunities to bridge the gap between patient goals and expectations and provider concerns with task completion. Individualized care was the goal of our care model redesign.

Progress continues to be made at an organizational level. VIHA’s 2013/14 strategic plan is being refreshed to emphasize patient engagement: Where is the patient voice? A Strategic Advisory Coalition has been created to develop a vision for the new strategic plan. For the first time, patients will participate in this organizational initiative.