Proposed Governance for a Health Co-op

Governance for a health co-op or community health centre is arguably trickier than for many other social activities. A good representation of patient and provider interests in the governance of the centre is necessary, but at the same time it's complicated by the patient-provider dynamic. Put another way, imagine if you as a board member have to tell your doctor that she can't have a raise this year.

Without knowing much about it, the model created by Carole Christensen and used by the Multi-Cultural Family Centre (MFC) at the REACH Community Health Centre is interesting. In their case, the goal was to ensure that the needs of non-European residents of Canada were being provided for by the MFC.

We propose a "Patient Advisory Council" and a "Provider Advisory Council" as the primary governing bodies of the centre. The Patient Advisory Council would represent the interests of the patients or clients of the centre. If the centre was truly meeting its objective of being patient-centred, then this council would be the primary direction-setting body in the centre. Many of its decisions would likely be strategic or broad in scope, like what programs should the centre provide and where should the centre provide them.

The Provider Advisory Council would represent the interests of the providers in the centre, and would therefore be the place where the details are worked out, in a sense. This council would define medical protocols, care guidelines, and procedures, as well as the day-to-day management of the centre. If the centre is to function well, this council has to have processes in place to resolve conflict and otherwise ensure that the workplace is healthy.

Legally the centre is required to have a board. Given the above governance, the board should actually be minimal. While the board would have final responsibility in the eyes of the legal system, by the statues of the centre the board would be subservient to the advisory councils. Paradoxically, this could work well. While the board members might feel that they have no control, they can always resign, which would put the advisory councils in an awkward position of having to explain to the membership why the board had resigned. This creative tension would be beneficial to the organization.

Many sources of funding require that the recipient organization have charitable status. Ideally, there would be a separate organization with charitable status, that elects its board members at the same time as the centre. By having the same people on both boards, the organizations work to a common goal while maintaining the required legal independence.