The Perils of Patient Government: Professionals and Patients in a Chronic-Care Hospital

Leslie McGrath was a librarian with the Toronto Public Library.

In The Perils of Patient Government Joseph Lella describes the efforts that he and his colleagues made to provide greater decision-making power to a group of chronic-care patients in a Canadian Veterans’ hospital. The aim of this “patient-government” project was to allow patients greater opportunities for personal independence and social integration.

In part one, Lella portrays a physically colourless ward and a highly structured and inflexible ward routine. The majority of patients were said to feel powerless and were struggling for a sense of individuality in their lives. In one informative chapter, Lella focuses on four veterans and their attitudes towards living in the hospital.

The second section discusses the establishment of a patients’ committee intended to have input in matters affecting hospital residents. Patients represented by this committee were part of an “experimental” ward; other patients generally similar in characteristics were part of a “control” ward; and the “experimental” and “control” wards were compared in terms of independence and social involvement at the end of the project. A chapter in the second part of the book was written by a social worker attached to the project who recounts some of its early successes.

Part three cites some of the reasons the project did not achieve a greater degree of success. These included the personal characteristics and career plans of the professionals involved in the project, as well as organizational pressures in the hospital. Lella also raises an ethical question of whether chronic-care patients should be relocated in a hospital simply for research purposes.

The book concludes with three appendices which place Lella’s findings in a theoretical context and which elaborate on his research design and methodology.

For the most part, The Perils of Patient Government is a very readable book. The possible exceptions to this are the appendices which arc written in a more scholarly fashion and may be more difficult to understand without some background in sociological theory. The book provides a detailed description of the establishment and operation of a self-government project. The project is evaluated and its shortcomings are presented clearly and candidly. There are few suggestions, however, as to what strategies could be employed by future change agents to ensure a greater possibility of success. Lella does provide a good analytic framework for studying “negotiated organizational change.” This, however, does not appear until the latter part of Appendix A. Notwithstanding these limitations, The Perils of Patient Government illustrates how individuals and a larger hospital organization interact with each other, and the qualitative nature of the book should appeal to both academic and general audiences.