Patient advisers a prescription for health-care power shift

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When candidates for a phlebotomist's job came to Kingston General Hospital for interviews recently, they faced a hiring panel comprised of three people: A human resources official, a manager from the lab and immunology department and a 77-year-old retired innkeeper whose primary experience in health care was on the receiving end of a needle.

The innkeeper was Patrick Dickey, one of the 55 patient advisers who now have a say in every decision the hospital makes, right down to hiring those phlebotomists – the people trained to draw patients' blood.

Mr. Dickey asked questions that the professionals might not have considered. What, for instance, would the interviewee say to patients who balked at having their blood taken?

"I'm looking for empathy," Mr. Dickey said. "I'm looking [to see] that they will take the time to explain why the procedure is being done, why it's important."

KGH is one of at least three Canadian hospitals that have taken the philosophy of patient-and-family-centred care to heart to the degree that it puts patients on its hiring panels, a practice that KGH started almost two years ago. The Thunder Bay Regional Health Sciences Centre began tapping patients to hire managers in 2010; North York General Hospital in Toronto followed suit in 2012.

In an era of drum-tight health-care budgets, hospitals are casting about for creative, low-cost ways to improve their services. Some have hit on deeply engaging patient volunteers as a partial solution, spawning the rise of "patient-and-family-centred care" programs at hospitals across the country.

Proponents of the approach say it could be a radical break from the past, when hospital bosses concentrated on what was best for doctors and nurses and not the people they treated. Even though the philosophy encompasses much more than staff recruitment – KGH has a whopping 256 initiatives in which it seeks patient advice – inviting patients to sit on hiring panels is perhaps the clearest demonstration of a hospital administration's willingness to shift that balance.

"It's very cutting edge. There aren't many places at all that do it," said Daryl Bell, KGH's chaplain and its lead for patient-centred care. "We just talked to a group of HR people and they were agog that we were having [patient] advisers sitting in on interviews. They couldn't see how it could possibly work. They were threatened by it."

KGH was dealing with threats of its own when it began recruiting patient advisers.

In 2008, money and management woes prompted the province to put the hospital under the control of a supervisor. When the hospital emerged from the process a year later, it faced a $30-million deficit and a deeply suspicious community.

Chief executive officer Leslee Thompson, recruited in 2009, recalled someone at a public forum declaring: "I'm scared to come to your hospital."

"We had really let them down. So we asked for their help," she said.

Since they began participating in hiring panels, KGH patients have helped pick more than 350 staff members, ranging from nurses to IT professionals to senior managers. Their say carries as much weight as that of hospital staff.

If treated as window dressing, "our patients would smell that out as tokenism in a moment's flash and they would have nothing to do with it," Mr. Bell, the KGH chaplain, said.

The co-chair of the patient and family advisory council at Thunder Bay Regional Health Sciences Centre was also concerned when he started volunteering to help select the institution's senior staff that the patient engagement efforts would be little more than a PR stunt.

"The hiring panels were a real test for me," said Keith Taylor, 54, a retired sales manager at a car dealership who had two hips replaced at the Thunder Bay hospital. "I always said right from the get-go, 'If this a token gesture to prove to the community that you've engaged your patients, I want no part of it.' "

Mr. Taylor, one of about 100 patient advisers at the hospital, was surprised to find he wielded real power at the hiring table. In one case, he broke away from the consensus position, blocking a doctor's move to a high-level director's position.

"I was the deciding vote," Mr. Taylor recalled. "There was a very skilled physician, his CV was impressive, his clinical skills were some of the best, but he didn't really have the philosophy ... didn't seem to care."

The Thunder Bay Health Sciences Centre was recently invited by Accreditation Canada, the agency that enforces quality standards at health-care facilities, to be part of an advisory group that will draft guidelines to evaluate how other organizations perform on patient-and-family-centred care.

That suggests the idea could spread to more hospitals, as it already has to North York General Hospital in Toronto.

It started recruiting patient and family advisers in August of 2012 and now has 28 who have pitched in on picking senior staff, including the hospital's chief of surgery. However, at North York General, hiring managers still have the final say.

At Kingston General hospital, patients advisers don't just help with hiring paid staff. They help select other patient volunteers to join their ranks.

"This is not about creating a group of cheerleaders for the hospital," Ms. Thompson, the KGH CEO, said. "None of this would be helping us move forward if everyone was just saying how great we were."