Supporting the development of engagement capable environments for health system transformation in Ontario, Canada: Preliminary results from an implementation study

Background: Engaging and partnering with patients, families and caregivers (PFCs) is central to health system transformation. PFC engagement can support the development of more equitable health systems, yet many organizations face challenges doing this work effectively and sustainably.

 

Approach: In Ontario, health system transformation is centred around 58 local health care networks called Ontario Health Teams (OHTs). A core building block of OHTs is partnership with PFCs at all levels (e.g., planning, design and governance). Various implementation supports have been put in place to promote evidence-based practice in this area, with mixed results. A framework focused on building engagement capable environments (ECEs) within OHTs was developed in collaboration with OHT PFC partners, engagement and executive leads. The Framework includes a set of core competencies, structures and enablers, and maturity milestones.

Since 2024, OHTs have been required to adopt and implement the framework, supported by new and revamped capacity-building supports. This mandate presented a rare opportunity to study and learn from the implementation of this engagement capability framework on a province-wide scale. Study aims include assessing the elements of a multi-faceted implementation strategy to support the uptake of this framework across OHTs, identify the key facilitators and barriers to implementation, and assess its early impacts. Guided by the methods of implementation research, a multi-method, observational design study is underway to assess both the implementation strategy and its impacts over time. The study is being conducted in partnership with OHT leadership, staff and PFC partners to ensure all project phases and elements, from conceptualization through knowledge dissemination, meet the needs of knowledge users.

 

To assess the first year of framework implementation, baseline surveys and interviews were conducted with up to four individuals per OHT (patient partner co-chairs, engagement leads and executive leads). Interviews explored current implementation status, use of and perspectives on implementation supports, challenges and facilitators for implementation and initial impacts. Surveys were completed by interview participants along with a broader group of OHT staff, PFC partners and governance partners to understand broader perspectives on the Framework implementation and impacts.

 

Results: Most respondents report that their OHT is making some progress towards the implementation of the ECE OHTs Framework with broad agreement that it has been an effective tool to guide OHTs’ PFC engagement and partnering activities. Participants identified several tangible benefits of framework implementation including providing a collective understanding of the value of PFC engagement, identifying the need for formalized processes, procedures and policies, and creating greater accountability. Challenges identified included insufficient funding and capacity for the work, PFC recruitment challenges, and lack of clarity around the Framework.

 

Implications: Creating the conditions for effective, sustainable PFC engagement and partnering is a priority for health systems, organizations and teams, yet challenges persist in this achieving this goal. The lessons learned from this unique and robust implementation study are positioned to guide ongoing and future efforts to build the capabilities needed to promote and sustain these efforts both in Canada and internationally.