Section 4: Stakeholder Engagement in Resource Allocation Decision-Making

Section Overview

In this section, you will be introduced to stakeholder engagement and how decisions affect patients, care providers, and policy makers at different levels in health care.

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Engaging Stakeholders in Resource Allocation Decisions

Resource allocation decision-making occurs at multiple levels and requires stakeholders from both health and non-health settings. There are three important levels of decision-making: micro, meso, and macro levels (Guindo, et al., 2012).

Traditionally, decisions in LTC are made from a macro-level perspective where processes and policies have been directed from higher authorities (e.g., Ministry of LTC) and are expected to be followed by those on the ground (Kapiriri et al., 2007). Resource allocation in this environment can pertain to health care resources and human resources. In contrast, the LTC home management or administrative staff, which are at the meso-level, are responsible for developing need-driven criteria to make resource allocation decisions. One problem that has been brought to the forefront during the COVID-19 pandemic is that residents in LTC and/or their family/substitute decision-makers should have been more involved in some of the decision-making processes (micro-level), such as requirements for visiting (understanding that many decisions were made based on safety and were time-sensitive in nature), as these stakeholders were most affected by illness and death, as well as the pandemic restrictions that were put into place. Meso-level decision-making in LTC during the pandemic was mainly utilized while interpreting and implementing the directives from the Ministry of LTC as homes were directed what to do, not necessarily how to do it.

Focusing on the most affected stakeholder (i.e., the resident) is referred to as resident-centred care and should drive decision-making in LTC (Scott et al., 2001). The Ontario Association of Residents’ Councils (OARC) recently took this resident-centred care approach to seek input into vaccination requirements for visitors entering LTC homes (Fleming, 2018). The OARC promotes the vision that every long-term care resident in Ontario shapes the place they call home. This is achieved through ongoing communication, meaningful engagement, and collaboration between residents, their Residents’ Councils, and their LTC teams (OARC, 2022).

Knowing that mandatory vaccination policies have now been implemented for all staff working in LTC in Ontario, the OARC posed questions via an online survey as to whether residents wished for all visitors to be fully vaccinated to be granted access into LTC homes. Involving residents in this discussion and decision-making process considered the intangible costs experienced in LTC and included these very important stakeholders in the dialogue. Results from the survey were not released, but the directive released from the Ministry of LTC a few weeks after the survey was launched stated that all visitors coming into LTC homes required full vaccination (i.e., a minimum of two doses of an approved COVID-19 vaccine) to be granted entry. Seeking residents’ input was a novel process implemented by the OARC, as it provided residents with an opportunity to be heard and included in decisions that directly affect them while also highlighting the importance of keeping the lines of communication open from the top down.

All stakeholders and decision-makers need to understand the working environment of LTC – LTC settings are home to a variety of residents (18 years of age and older but mostly elderly residents) where they live, eat, socialize, and receive immediate care 24-hours a day. This needs to be considered and respected at all times, as residents in LTC homes are valued members of the community with voices that deserve to be heard and consulted. LTC homes are required to have Residents’ Councils where residents have the opportunity to bring forward any questions or concerns that they may have, to be informed of changes that are taking place in the home (including discussions about costs associated with LTC), and to be involved in the decision-making process. Moving forward, all LTC homes should prioritize seeking input from these stakeholders for all decision-making processes. Whether decisions are sought regarding food items on the menu, how often to have Residents’ Council meetings, what safety measures need to be put in place, or where Ministry funding should be directed, residents’ opinions and insight should be included without exception. The motto used in the Niagara Region LTC homes is “nothing about me, without me”, which is a great example of resident-centred care and supports the vision of the OARC.

Summary

Resource allocation is a process that requires thorough consideration of various levels of stakeholders in both health care and non-health care settings. It is imperative to understand that each level has its own perspective of the decision-making process and its function. For example, during the COVID-19 pandemic, special consideration was given to the residents of the LTC homes by involving them in important discussions. While LTC homes were already required to have Residents’ Councils and hold regular meetings, this was even more necessary during the pandemic so that information regarding restrictions and regulations could be communicated to those who wished to participate and have a greater understanding of the changes as they occurred. This allowed them to partake in meetings related to decisions about their livelihoods, which empowered them and their sense of control, thus contributing to more satisfied stakeholders. Moving forward, it is imperative that all stakeholders are included in the decision-making process, particularly those that are most affected by the decisions being made.

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