Citizen-Patient-Community in Health Care Planning, Decision Making and Delivery through Rural Health Councils
Research for the Rural Evidence Review project led by the Centre for Rural Health Research/
Rural Coordination Centre of BC assisted by the Expert Advisory Panel including
representatives from the BC Health Authorities, the BC Ministry of Health, and other key
The BC Royal Commission on Health Care and Costs (1991) highlighted the importance of citizen-patient-community (CPC) involvement in health care decision-making. While BC’s Patient-Centred Care Framework (2015) was written to support patient participation in their own care and acknowledges a role for patients, families and caregivers in how we improve the health care system, citizen-patient-community involvement remains a challenge.
The Rural Evidence Review was established to work together with rural citizens, patients and communities to better understand rural health care priorities across BC and to provide useful evidence for rural health care planning. Our team looked at the academic literature to answer the question, ‘How can rural health councils best include citizen-patient-communities in health care planning and decision-making?’
The research iden#fied different areas that are important, for example:
• motivations and justifications for citizen-patient-community participation,
• structures, roles, and functions of rural health councils, and
• ways of supporting citizen-patient-community participation and overcoming barriers.
The research is clear that well-structured citizen-patient-community involvement in health care planning and service delivery can lead to:
• better decision-making that reflects the needs of local communities;
• increased public understanding of those decisions, accountability, and trust;
• increased feelings of communities being included in health care planning decisions;
• increased support or “buy-in” for solutions reached collaboratively; and
• better health outcomes.
Challenges for successful citizen-patient-community participation include:
• a lack of a clear ‘job description’ (role and mission for participants);
• lack of Indigenous voices in health care decision-making;
• a shortage of committed volunteers and skilled facilitators;
• the complexity of health care issues and amount of information;
• conflicts of interest that stem from having multiple roles within the community; and
• a lack of diversity among participants.
There is an opportunity to invite citizen-patient-community voices into some of the new health care structures in BC including Primary Care Networks. Based on the findings of this review, we recommend:
(1) Rural health councils should be established within existing Primary Care Networks. (
2) Successful citizen-patient-community participation requires well-funded support. This
includes funding for orientation and training to help participants understand the objectives
of the rural health councils and the participation activities from the outset. Training is also
needed to help citizen-patient-communities feel prepared.
(3) Indigenous-specific and Indigenous-led rural health councils will be important to
represent the needs of those communities: many such communities may already have a
way of including citizen-patient-community voices.
(4) Responsibilities of health councils should be clear and that plans for evaluating success
be clearly stated.
(5) Long Term Care Regional Family Councils, recommended by the BC Seniors Advocate,
should be included to represent the family/resident voice. This will prevent the current
fragmentation of care and inadequate representa#on of the long term care sector in
regional health care planning.
(6) Include the voice of BC’s Community-Based Seniors’ Services (CBSS) sector and allied
agencies, who are hugely supportive of the health and well-being of rural seniors.
BC has committed to citizen-patient-community participation in health care planning through the ‘Patients as Partners’ initiative (BC Ministry of Health, 2007) and the Patient Centred Care Framework (BC Ministry of Health 2015). With the spread of Primary Care Networks and Community Health Centres, it is an ideal time for communities to work with Health Authorities to find ways that community voice can be heard. To access the full research report, please click here: Citizen Patient Community Participation in Health Care Planning, Decision Making and Delivery through Rural Health Councils