November 26, 2020
By Alisa Kim
American president John F. Kennedy once said, “change is the law of life,” but adapting to change is seldom easy. This is especially true in health care. As the province launches Ontario Health Teams, significant challenges lie ahead. The goal of the initiative, announced in the fall of 2019, is to bring together health care providers and organizations to deliver coordinated services to people in a defined region. Ontario Health Teams are comprised of primary care providers, medical and surgical services, mental health and addictions services, rehabilitation and complex care, palliative care, and other community-based agencies. Ontario Health Teams will be responsible for integrating these services and coordinating delivery to optimize care and recovery—all at a reasonable cost to the health care system.
This model of integrated care is widely recognized as a better way of meeting people’s needs. Research has shown it can enhance communication and improve handoffs between providers, and, when implemented well, can produce better outcomes and cost savings. All of this sounds ideal, but, as Dr. Ross Baker, professor at the Institute of Health Policy, Management and Evaluation (IHPME), notes, the devil is in the proverbial details.
“Everyone agrees that better integrated care is needed”, says Baker, “but there are many challenges because staff have to coordinate their work and communicate more effectively, and changing established practices is hard. Moreover, information and communication systems that support front-line staff are not easily connected. Just as important are the relationships between leaders. While some agencies have a history of working together, which enables further integration, many don’t have strong prior relationships, and OHT leaders need to develop shared goals and learn to trust each other.”
Recognizing the need to help leaders from different agencies work cooperatively, the Ministry of Health enlisted Baker and colleagues to work with Ontario Health Teams Leadership Councils. Baker, Paula Blackstien-Hirsch, a faculty member of IHPME and consultant, and Heather Graham, a consultant and graduate of IHPME, have developed a program to support Ontario Health Teams.
Since September 2020, the team has delivered interactive learning modules for Ontario Health Team leaders from a broad range of agencies across the province. Each module includes overviews of materials on shared leadership, collaborative governance and accountability. Baker, Blackstien-Hirsch and Graham also facilitate breakout sessions in which participants discuss how their Ontario Health Teams are addressing these issues. The sessions allow OHT leaders to exchange information on local strategies and experiences within and across OHTs. The goal is to help leaders work together more effectively and support leaders’ oversight as front line teams design new models of care that serve specific populations like people with mental health and addictions issues, and older adults with multiple chronic conditions.
“This is about building trust among leaders from a large number of organizations from different sectors, many of whom do not have a history of working together,” says Blackstien-Hirsch. “Their ability to address complex issues to achieve shared population health outcomes will, in part, be reliant on making effective consensus-oriented decisions, sharing and distributing leadership, committing to shared accountability for shared goals and outcomes, and investing collaboratively in necessary backbone supports.”
The feedback on the training has been positive. Graham says participants have appreciated the opportunity to share learning and insights across Ontario Health Teams, and access evidence-informed tools and frameworks that help them navigate issues like unacknowledged power dynamics, which can erode trust and undermine authentic collaboration. In some settings, there have been differences in views between community-based providers and hospitals, and, often a lack of trust—factors that can impede work to redesign care, says Baker.
Other important questions have been raised, notes Graham. “Why is it important that key stakeholders—including clients or users—have a voice in framing the problems and informing shared decisions? How do we balance the pressure of timelines and expectations with the need to slow down to build trust, and negotiate consensus and shared ownership? While Ontario Health Teams are at different stages of maturity or development, the level of engagement makes it clear that OHT partners are committed to doing the work that is required to achieve and sustain success,” she says.
The next phase of the project is to identify and develop coaching resources for Ontario Health Team Leadership Councils. This work is being led by Dr. Michelle Nelson, a faculty member at IHPME and scientist in the Sinai Health System, and Lynne Sinclair, a consultant on interprofessional practice. They have recruited people already employed in Ontario Health Team partner agencies and are designing an interactive program to develop further their skills in supporting leaders.
Another element of the program is to create webinars and podcasts to provide information on leadership, governance issues and emerging strategies. All these efforts will be evaluated to assess their impact. Dr. Andrew Pinto, a faculty member of IHPME and a physician and researcher at the Upstream Lab, is coordinating the evaluation.
The team hopes to equip Ontario Health Team leaders with effective strategies and tools to manage relationships among partner agencies so that they can redesign services that meet the needs of their local population. Baker says the work has been challenging, but fruitful. “It’s been very intense getting this work off the ground, but we’re hitting our stride and the positive feedback has been rewarding.”