Over the last 25 years and more many schemes have been hatched to transform Canada’s health/healthcare “system”. All have had one basic aim – to connect the dots; to co-ordinate the work of the ‘players’, hospitals through primary and home care to mental health and other community-based providers, getting them working together to make it easier for patients and their families to navigate care transitions from one to another. Reform’s imperative has also been governments’ concern about healthcare’s growing cost, measured both in terms of its share of total spending and also the opportunity cost over the longer term of constrained funding for the social determinants of health, education, housing, financial security, et cetera. That concern also reflects people’s growing unease about sustainability, possibly combined with increased awareness that the outcomes achieved here in Canada are middling at best when compared to those achieved in other developed countries.
Ontario’s government appears to have recognized that:
- Fundamental transformation of how health and healthcare services are organized and provided remains undone. What is referred to as a system is an illusion that needs to be made real.
- Transformation is now urgently required to avoid jeopardy to the province’s less than robust economic status.
- Connecting the dots and achieving greater cost-effective productivity can only be accomplished by health service providers themselves, working together in teams with patients and other community representatives to make the changes most appropriate for the particular community, district, or region each team serves.
Some fundamental policy requirements are needed to enable those teams to create real health/healthcare systems and run them so they meet the needs of the people they serve.
It is essential to have people willing to take on the challenge. At the head of the list, the government, supported by its Ministry of Health and Long-term Care and the Premier’s Council on Improving Healthcare and Ending Hallway Medicine, seems both game and well aware that new approaches are required to engage the ‘players’ who actually provide health and healthcare services. It appears now to have realized that top-down direction in accordance with a central design won’t cut it in the big, diverse of Province of Ontario. Those players, individual health service providers and their organizations and institutions, organized into teams, will have to do the heavy lifting and do so in accordance with the needs and priorities determined by the people of their communities, districts, or regions. Although it remains early days, it is already apparent in the very short time since expressions of interest in the formation of Ontario Health Teams were invited that a substantial number of those players are also keen to take on the challenge of change. They range from individual health service providers, public health units, through a variety of community agencies, and extend to the most sophisticated of referral hospitals. That augurs well for system-building.
Many factors are essential to support the success of Ontario Health Teams but none more so than having in place comprehensive, standardized health information systems, ones in which their contents are shareable by patient-owners and health service providers alike while securing the privacy of both. This central resource-in-common is especially important in these early days of the digital revolution to support not only electronic communication between patients and their service providers but also the application of wearable health parameter recording devices and the utilization of so-called artificial intelligence algorithms in the future of healthcare practices. It is also vital to facilitate easier transitions of patient care from one provider to another. Also essential is the development of new and better measures of not only the processes of providing care but of their outcomes, assessments of the health and wellness both of individuals and of the populations from which they are drawn. Such measures of accountability are vital not only to ensure that patients, their families, taxpayers, and elected governments are all getting their money’s worth but also so OHTs can quickly and reliably assess the impact of the changes they make, how well they are meeting the needs of patients and their families, and especially the degree to which their system’s services impact positively on the overall well-being of the populations they serve. The development of such measures and imbedding them in an information management system in common is something that can only be done centrally by government, working with the Province’s OHTs, the Privacy Commissioner, and others. Its development and application soon is vital to the success of systemizing the current ‘field of silos’.
Four other imperatives apply.
One is consistency of the goals, objectives, and degrees of freedom provided to Ontario Health Teams in the policy directions of government. Again, it remains early days but the locus of relevant decision making is unclear among the Minister of Health and Long-Term Care, the Premier’s Council on Improving Healthcare and Ending Hallway Medicine, contract agreements between the government and unionized public sector healthcare workers (including the Ontario Medical Association), and healthcare’s new ‘super-agency’, Ontario Health. Government’s expectations of OHTs must be made clear to their ‘worker bees’ and served populations and so also must be the tools, including funding, the Teams will have available to meet them.
Another is time. Healthcare and the interactions among its providers have remained more-or-less the same for a very long time. Decade in and decade out the same dependencies and methods of communication have become habitual as have the hierarchies that will have to change as people who previously considered themselves essentially free-lance performers learn how to play on a team. To succeed, OHTs will need both consistency in the policies that affect them and time to develop and implement the various strategies they will adopt within their communities, districts, and regions to replace those old habits with those transformational change requires.
Of the two final imperatives, one is the freedom to innovate, to do things differently, even to fail – to risk finding that a new way of proceeding will not work as well in practice as theory promised.
And the other is incentive. To be successful, Ontario Health Teams have to be able to identify reward for doing the heavy lifting of system-building. They, their willing participating health service providers together with the people of their communities, districts, or regions have to be able to see clearly in the larder the carrots on which they will be able to feed if and when the changes they make come to fruition. Change must be motivated. If there is nothing to be gained, nothing will be ventured and transformation of health and healthcare services in Ontario will not happen.
 Where else would one find fax machines in use?
Queen’s Health Policy Council members