A 28-member Citizens' Reference Panel commissioned by St. Michael's to provide recommended improvements to the health services they provide to Toronto's inner city. The panel met 8 times over the course of the year before issuing a final set of principles and priorities.
Problems and Purpose
St. Michael’s Hospital has been working with local partners to improve health care services in central-east Toronto. St. Michael’s recruited local area residents to help identify the most important gaps in local health services, and recommend ways we can address them. The Residents’ Health Services Panel is an important part of St. Michael’s public engagement plan to ensure that the priorities of local residents are heard.
Background History and Context
St. Michael’s has served central-east Toronto since 1892 and from the outset has focused on providing quality care to some of the city’s sickest patients, including those who experienced poverty, were marginalized, or otherwise disadvantaged. St. Michael’s is a Catholic teaching and research hospital founded by the Sisters of St. Joseph in 1892 to care for the sick and poor of Toronto's inner city. As downtown Toronto’s adult trauma centre, the hospital is a hub for neurosurgery, complex cardiac and cardiovascular care, diabetes and osteoporosis care, minimally invasive surgery and care of the homeless and disadvantaged. St. Michael’s is also one of the province’s major sites of care for critically ill patients.
In its newest strategic plan, published in 2015, St. Michael’s renewed its longstanding commitment to the critically ill and to disadvantaged populations. St. Michael’s also adopted a new strategic priority: comprehensive care for its entire urban community — a diverse area experiencing unprecedented growth and change. The St. Michael’s Residents’ Health Service Panel was created in partnership with the Toronto Central Local Health Integration Network to give residents of central-east Toronto the opportunity to provide representative and informed advice to St. Michael’s about how it could best achieve this strategic priority.
Although this engagement of local residents is a new endeavour for St. Michael’s, it complements other mechanisms of patient, family, and public engagement: three well-established community advisory panels that each focus on a specific marginalized population, and the newly established Patient and Family Advisory Committee, which focuses on recent recipients of hospital care. Members of the Residents’ Health Services Panel have been asked to learn about the local health-care system, the hospital, the demographics of the local community, and then to work on behalf of the entire community to shape the hospital’s efforts to improve local health services.
Organizing, Supporting, and Funding Entities
Funding for this Panel was provided by St. Michael’s Hospital.
The Civic Lottery process and each Panel meeting was organised and facilitated by MASS LBP.
Participant Recruitment and Selection
In February 2016, 14,500 randomly chosen central-east Toronto households were sent a letter from St. Michael’s Hospital’s CEO inviting them to volunteer for the panel. Letters and invitations were also distributed through service agencies throughout the local geography. More than 300 residents of central-east Toronto put their name forward, and the panel’s 28 members were selected randomly from amongst those volunteers. Members were selected using a civic lottery, a process developed in Toronto that has now been used more than 25 times to convene citizen panels across the country. The selection process achieves broad representation by ensuring a proportionate number of the panel members are appointed to the panel based on their age, gender, household tenure, patient status, visible minority and indigenous status.
The 28 members of the St. Michael’s Residents’ Health Services Panel are Toronto residents without any special training in medicine, healthcare, administration or public policy. While some residents were frequent users of health services at St. Michael’s, others had never been through the hospital’s doors. All panelists were committed to helping improve the health-care system and each offers an important perspective concerning the needs of local communities. Collectively, they bring a wealth of knowledge about the health system experience of local residents, and a commitment to helping health-care organizations focus their attention where it is needed most.
Methods and Tools Used
MASS LBP was commissioned to run the recruitment process and deliberative events using its signature Civic Lottery and Citizens' Reference Panel methodologies. Each Panel meeting has a speaker, or sets of speakers, to inform Panelists on the day's topics. After presentations and the opportunity for Panelists to pose questions to the experts, the Panel begins table discussions and deliberations. Each table contains approximately 7 Panelists and a facilitator. Panelists work towards consensus recommendations where appropriate. Panel sessions are often set up for the panel to cover one topic in the morning, and one in the afternoon.
What Went On: Process, Interaction, and Participation
Panel members heard from some of Toronto’s foremost health system experts about the way Ontario’s health system is structured, the operations of St. Michael’s Hospital, and the current demographics and health needs of central-east Toronto; they hosted a public roundtable meeting to learn from other local residents about the needs and priorities of their community; and they have engaged in a series of facilitated discussions to identify six guiding principles and 15 priorities that they believe should guide St. Michael’s efforts to improve comprehensive care for our entire urban community.
Each Panel meeting resulted in consensus recommendations on the following topics:
- How the Academic Family Health Team at St. Michael's could begin offering interprofessional services to local residents who receive primary care from other providers (e.g. chiropody, physiotherapy, mental health care, and tax clinics)
- Creating an information service (accessible in a variety of ways, including in person, phone, and web-based options) where patients can find out about all health services in central-east Toronto, outlining the issues that a local health service information service should prioritize, examining the perceived shortcomings of existing information services, and determining a set of essential features that any new service should offer
- Changes to ambulatory care services provided by St. Michael’s Hospital, including what priorities should be kept in mind when reviewing the ambulatory care services that exist at the hospital
- Effective ways for St. Michael’s to continue to engage patients, family members and residents
Influence, Outcomes, and Effects
In the seventh of its eight meetings, the Panel discussed the impact the Panel’s work had so far on the activities of St. Michael’s Hospital. Hospital staff presented the ways in which the Panel was having an influence already, as well as some of the reasons that action on priority items sometimes take more time than panelists expected. After the presentation, panelists discussed their thoughts on the Panel so far, and noted that:
- They were eager to see their recommendations implemented as soon as possible;
- Progress on the issues the panel highlighted are necessary and urgent, and the hospital should seek to be leading on these changes whenever possible;
- The panelists were invested in hearing back from the hospital about how the hospital has acted on their recommendations, and felt the hospital should be accountable for explaining prolonged lack of progress if it were to occur;
- Panelists will eagerly look to the 2017 Corporate Objectives for evidence of alignment with their recommendations.
Analysis and Lessons Learned
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