Collaborative Governance in Action: Co-designing a Shared Performance Measurement System to Strengthen Accountability within the Burlington Ontario Health Team

Background: Integrated care systems rely on collaboration across organizations that traditionally function in silos. The Burlington Ontario Health Team (OHT) offers a compelling example of how formal collaborative governance can be operationalized to co-design meaningful performance measurement tools that foster shared accountability among diverse partners. This presentation reflects on Burlington OHT’s journey to develop a performance dashboard through an inclusive and iterative co-design process that strengthened alignment, transparency, and collective ownership of outcomes.

 

Approach: At its foundation, the Burlington OHT’s formal collaborative governance structure was designed to ensure that decision-making authority, resource stewardship, and strategic direction were equitably distributed among partner organizations. The governance framework draws on Ostrom’s Institutional Analysis and Development (IAD) principles, emphasizing collective action, mutual trust, and clearly defined rules of engagement. Within this framework, all partners from primary care and acute care to community agencies and patients have a formal role in setting priorities and monitoring progress.

 

This governance approach provided the foundation for a co-design process that guided the creation of a shared performance measurement dashboard. Burlington OHT convened representatives from each partner organization, as well as patient and caregiver partners, to collaboratively identify what “collective performance” meant in the context of integrated, person-centered care.

This iterative process surfaced diverse perspectives, aligned priorities across sectors, and ensured that selected indicators were both meaningful and actionable for all members of the OHT. The co-design approach transformed the dashboard from a reporting tool into a shared learning instrument that reflects the lived realities of providers and patients alike.

 

Results:The resulting performance measurement dashboard combines population health indicators, process metrics, and patient & provider experience measures. More importantly, it functions as a shared accountability mechanism that reinforces collective responsibility for outcomes. The dashboard’s development process fostered mutual understanding among partners—bridging organizational languages, data cultures, and accountability frameworks. By engaging in transparent dialogue about what success looks like, Burlington OHT partners built a common narrative of performance grounded in shared values rather than individual institutional mandates.

 

Implications: The experience of the Burlington OHT demonstrates that formal governance mechanisms, when combined with authentic co-design and joint performance measurement, can generate both technical and relational value. Technically, the dashboard provides a practical tool for monitoring progress and informing improvement efforts. Relationally, it has cultivated a culture of trust, psychological safety, and shared purpose among partners—critical ingredients for sustaining integrated care transformation.

 

In conclusion, Burlington OHT’s experience underscores that performance measurement in integrated care is not merely a technical exercise but a governance practice that reflects how partners choose to work together.

By embedding co-design within a formal collaborative governance structure, the OHT translated abstract principles of shared accountability into tangible practice. This case contributes to the growing body of evidence that inclusive governance and co-designed measurement tools are central to achieving meaningful, sustainable, and person-centered integration