Finally, Ontario’s Ministry of Health has begun recruitment for the position of patient ombudsman, which has been vacant for over 18 months since our current health minister, Christine Elliott, resigned to run for the leadership of the Ontario PC Party. While the office of the ombudsman has continued its work efficiently, it’s a bureaucratic operation lacking a soul and a vision.
A lot has changed in the healthcare landscape in the interim and certainly since the office was created in 2016. Patients and families are much more involved in the delivery and design of care. The integrated care model being adopted for Ontario’s health system transformation has, as its bedrock, a principled commitment to engaging with patients and families as partners. While the Ontario Health Team model is still a work in progress in figuring out how to do this properly, the office of the patient ombudsman can rely on established guidance of how an organization can adapt to a state of partnership.
While the ombudsman role is ostensibly to resolve patient/customer complaints, let me be clear that health care complaints are unlike any other industry. If the stitches in the seat of my new trousers split open when I bend over, it may result in a momentarily embarrassing moment. But if the stitches in my abdomen holding me together after bowel surgery bust open, I’m faced with a life threatening situation. Just re-stitching isn’t going to erase the trauma of that event.
Years ago, the patient relations office in hospitals was a moniker for “complaints department.” The best patient relations people I met held two degrees – social work and law. It seemed to me to be compassion with a baseball bat. But over time there’s been an interesting transition in many institutions from patient relations into an office of patient experience or folding into same. This recognition that complaints are an outcome of the continuum of patient experience is a sea change in how organizations are developing a deeper appreciation of patient experience.
On an organizational level, there are three actions progressive organizations are taking to address patient experience. First, make improving patient experience the strategic priority as opposed to solely resolving patient complaints. Second, have a definition of patient experience so that everyone in the organization shares a common understanding of what they’re committed to. Third, create a dedicated role at the executive level.
Supporting this strategy is increased transparency and accountability of organizations to the public they serve. We see this from examples in the UK, Australia, and Ireland where there is public disclosure of complaints, tracking of their progress and the outcomes of the process. This methodology is a direct response to the increased patient and public involvement in design and delivery of care.
Patients around the globe are participating in quality committees, standards committees, research projects, curriculum design, hiring panels, etc. This activity is more profound than a survey response or a focus group. Patients are co-designing change and influencing the strategic direction of organizations, whether they be in care delivery, research, policy, or education. Patients are even advising professional associations such as the Canadian Medical Association.
While the patient ombudsman is not an advocate for patients, given the critical nature of the work, the restriction of engagement to feedback to a generic email address or comments on communications material misses the point of relationship inherent in partnership.
For good reasons, patient experience now demands more. In her 2019 annual report, Ontario’s auditor general stated that approximately 67,000 people were harmed during their hospital stay. While this number sounds alarming, the important lesson is that there was harm. These people might be in pain and suffering to one degree or another. While pain may be managed and resolved, the emotional, social and financial suffering may not be.
Harm underlies every dispute. Just as my trousers need to be repaired after splitting, so too the harm in healthcare needs to be repaired and we need to seek out compassionate methods that are going to get us to a place that honours the full spectrum of patient experience.
We can do better resolving harm to patients than just hammering out a mediation agreement. D’Anna Holmes, a colleague at The Beryl Institute, said, “this is a human business. None of us are a bar chart or a percentile rank.”
The focus on the need for repair as a component of resolution is illustrated by a report to New Zealand’s Ministry of Health by Victoria University’s Diana Unwin Chair in Restorative Justice – where over six hundred women and men injured and harmed by surgical mesh shared their stories. The report highlights the severity of the harm and the impact on their lives.
The Patient Ombudsman was a welcome addition to the Ontario administrative landscape. But they can’t sit on the sidelines while the rest of the system is transforming. To be faithful to the principle of partnership driving this change requires an unwavering commitment to the human experience. Patients are capable, resourceful, innovative and resilient despite their pain and suffering. To fulfill this commitment, the next patient ombudsman must be someone who understands how to bring people together in shared purpose by virtue of the expertise derived from their own lived experience.