Influence of health organization structure and process on citizen participation in community health centre decision-making

Abstract

The move toward primary health care renewal in Canada and in industrialized nations around the world is resulting in a fundamental change in the way health care is delivered. Citizen participation is one of the five pillars of primary health care-not just participation in decisions related to an individuals’ health care treatment, but also from the larger perspective of decision-making that affects policy and structure within an organization. Health care organizations want to be responsive to the needs of their communities, and consumer-savvy citizens increasingly expect to play a part in the decision-making process of organizations. The relationship between health care administrators, providers and citizens is sculpted by fundamental philosophies, values and processes. These include organizational culture, change process, social capital, citizen role definition and shared power or citizen empowerment. This research seeks to link the concepts and create an understanding of the dynamic and complex relationships which result in effective or ineffective citizen participation in decision-making within organizations. A theoretical framework was used which addresses these fundamental philosophies. The object of this research is to explore the processes and structures of organizations that facilitate or hinder meaningful citizen participation. Community health centres (CHCs) have long been recognized in Canada and around the world as leaders in the facilitation of citizen participation, and this research reviews pertinent documents from fourteen CHCs across Canada. Some of the data collected from a national research project on community health centres is used. Through secondary analysis, the original results of the document audit are compared to the original results of a quantitative survey administered to volunteers, clients, health care professionals and board members at each site that collected information about community capacity, organizational capacity and outcomes. Results of this thesis research are presented in a framework of community and organizational characteristics influencing the degree of public participation supported in the literature. The research presented in this thesis shows some relationship between supportive factors identified in the organization’s documents and the degree of participation and satisfaction identified in the quantitative survey results. Possible reasons for this relationship are explored and recommendations are made based on a hierarchical model of participation, with greater citizen participation as the goal.