For Ontario Health Teams (OHTs) to learn and improve rapidly, team members will need to have new ways of working together as system partners. They will need to do so both in the design of each of the eight OHT building blocks and in harnessing these building blocks to achieve specific targets related to the care experiences and health outcomes for a defined patient population.
In reviewing the experiences of five teams that prepared readiness assessments to become OHTs (including some that had embarked on care integration well before the call for OHTs), a common observation was that a leadership infrastructure is needed to support new ways of working together as system partners. This leadership infrastructure can include, for example:
- an executive leadership group comprising CEOs and executive directors of partner organizations who can engage their respective boards of directors and commit their organizations accordingly (domain 46: collaborative governance)
- an integrated operational management group comprising (at least in part) vice-presidents of operations and directors of programs who can develop and execute workplans
- working groups focused on: 1) proactive primary-care provider leadership and engagement (domain 47); 2) proactive community engagement (as a component of domain 9: proactive patient and public engagement), 3) digital health (and specifically domain 40: data harmonization across organizations, sectors and systems, and domain 41: data modelling and analysis), and 4) communications.
Such a leadership infrastructure, in this or other configurations, can address three of the biggest challenges in preparing to become an OHT: 1) moving from single organization governance to collaborative governance; 2) engaging the full diversity of primary-care providers; and 3) engaging the full diversity of community members.
The same review found that three types of work plans can assist leaders and their staff with harnessing the building blocks to achieve specific targets:
- understanding who the OHT serves (building blocks #1 and #5) and what matters to these people (building blocks #2 and #3)
- co-designing care that meets these needs (building blocks #3 and #4), which includes brokering discussions among partner organizations about meeting needs in a different way than they have in the past
- supporting learning and improvement in delivering this care (building blocks #5, #7 and #8).
However, there is also value in having a different configuration of work plans:
- one for each priority population, which will require harnessing each of the building blocks, to ensure year 1 targets are met
- one for each building block (or for each building block except for #6: leadership, accountability and governance) to ensure the OHT is well prepared for steadily expanding its priority populations and eventually meeting the needs of the entire population in its community
- a combination of both (i.e., a matrix structure).
These work plans can address two other big challenges in preparing to become an OHT: 1) transitioning from a focus on patients to populations (i.e., from caring for the patients who have ‘walked through the door’ of any given health organization to accountability for improving health in an entire population and for proactively serving all of those who can benefit from care); and 2) harnessing a broad spectrum of data to understand who the OHT serves and how well it serves them, which includes transitioning from primarily analyzing hospital data to analyzing a broader spectrum of human-services data (including data from community-based organizations, primary-care practices, and housing and social-service providers, as well as data about the social determinants of health).
Other success factors
For OHTs working together as system partners:
- OHT partner organizations will need to harness their staff’s:
- leadership capabilities (and support a transition from organizational leadership to distributed cross-sectoral leadership)
- change-management skills
- project-management skills
- team members will also need to learn about parts of the health system that are new to them (e.g., team members from community-based organizations may have had limited opportunity to understand the many ways that primary-care physicians may be paid, and hospital leaders may have had limited exposure to innovative housing models)
For a ‘way in’ to descriptions how different parts of Ontario’s health system works, check out the RISE brief about Ontario’s health system.
RISE can help. Start finding out how by clicking on ‘Access resources.’