Figure 1
The Context and Capabilities for Integrating Care (CCIC) Framework [18].
Table 1
Context and Capabilities for Integrated (CCIC) Framework Domains Captured in the OICLS survey.
| OICLS SURVEY DOMAIN | CCIC CAPABILITIES | DESCRIPTION OF CCIC CAPABILITY [18] |
|---|---|---|
| 1. Leadership Approach (5 items) | Leadership | Methods and behaviours used by formal leaders (vision, respect, trust); strategies to empower members. |
| 2. Shared Vision* (7 items) | Partnering; Network Culture | Development and management of formal/informal connections between organizations (e.g., building common understanding and vision). Widely shared values and habits in the organization. |
| 3. Team Climate (6 items) | Commitment to Learning; Delivering Care; Network Culture | The existence of a set values and practices that support development of new knowledge and insights. Widely shared values and habits in the organization. Methods used by providers in caring for patients. |
| 4. Commitment to Improvement (3 items) | Partnering; Improving Quality; Measuring Performance | Development and management of formal/informal connections between organizations (e.g., building common understanding and vision. Use of practices that continuously improve patient care. The systematic collection of data to measure goal achievement. |
| 5. Readiness for Change – Suitability (6 items) | Readiness for Change | The extent to which organizations and individuals are willing and able to implement change (e.g., attitudes toward change, fit between current strategy and the change) |
| 6. Clinical Functional Integration (2 items) | Delivering Care; Information Technology | Methods used by providers in caring for patients (e.g., use of standardized clinical tools). The availability and ease of use of technology-based communication and information storage mechanisms |
| 7. Roles and Responsibilities* (2 items) | Partnering; Network Culture | Development and management of formal/informal connections between organizations (e.g., implementing referral and discharge/transfer agreements). Widely shared values and habits in the organization. |
| 8. Administration and Management (2 items) | Network Design; Resources | The arrangement of units and roles how they interact; communication and decision-making channels. |
| 9. Financial and Other Material Resources (2 items) | Resources; Information Technology | Availability of tangible and intangible assets for network activities. The availability and ease of use of technology-based communication and information storage mechanisms. |
| 10. Non-financial Resources (4 items) | Resources; Measuring Performance; Improving Quality | Availability of tangible and intangible assets for network activities. Use of practices that continuously improve patient care. The systematic collection of data to measure goal achievement. |
[i] *Items in the OICLS Shared Vision and Roles and Responsibilities domains capture both People and Values and Key Processes CCIC categories.
Table 2
OHT Survey Respondent Characteristics (N = 480).
| CHARACTERISTIC | N | % |
|---|---|---|
| OHT location | ||
| Urban/Suburban | 408 | 85% |
| Small Community/Rural* | 72 | 15% |
| Current Role [select one] | ||
| Chief Executive Officer, President or Executive Director | 257 | 53.5 |
| Other Senior Management (COO, CFO, Vice President, Chief of Staff) | 68 | 14.2 |
| Administrator, General Manager, Director of Care | 58 | 12.1 |
| Physician or Other Clinical Role | 71 | 14.8 |
| Patient/Caregiver | 15 | 3.1 |
| Other | 11 | 2.3 |
| Type of Organization Represented [select all applicable] | ||
| Community Support Services (Including Community Mental Health & Addictions) | 176 | 36.7 |
| Primary Health Care Practice | 149 | 31.0 |
| Hospital | ||
| - Acute Care Inpatient Hospital | 39 | 8.1 |
| - Mental Health Inpatient Hospital | 6 | 1.3 |
| - Rehabilitation or Complex Continuing Care Hospital | 14 | 2.9 |
| Long-Term Care | 54 | 11.3 |
| Home Care | 72 | 15.0 |
| Public Health | 13 | 2.7 |
| Patient and Family Advisory Council | 16 | 3.3 |
| Other§ | 77 | 16.0 |
[i] * A Small community/rural OHT was defined as populations <150,000.
§ Examples of other types of organizations represented include municipalities, paramedic services, hospices, shared (digital) services organizations.
Table 3
Ontario Integrated Care Leadership Survey (OICLS) questions and response characteristics (N = 480).
| OICLS QUESTIONS INCLUDED IN THE 10 DOMAINS** | RESPONSE OPTIONS | ||||
|---|---|---|---|---|---|
| n (%) | MEAN (SD) | OPTION 1 (%) | OPTION 5 (%) | OVERALL CRONBACH ALPHA | |
| Shared Vision* By working together, how well, at present, are the members in your [program name] able to | 0.893 | ||||
| 3. Develop goals that are widely understood and supported among members | 479 (99.8) | 3.873 (0.807) | 0.6 | 21.5 | |
| 4. Identify how different organizations/programs in the community could help | 478 (99.6) | 3.688 (0.812) | 0.6 | 14.6 | |
| 5. Respond to the needs and problems of the community | 477 (99.4) | 3.669 (0.783) | 0.2 | 12.8 | |
| 6. Include the views and priorities of the people affected by the OHT’s work | 478 (99.6) | 3.692 (0.880) | 1 | 16.3 | |
| 7. Obtain support from individuals and organizations in the community | 477 (99.4) | 3.692 (0.837) | 0.8 | 14.9 | |
| Leadership Approach§ Please rate the total effectiveness of your [program name] leadership in each of the following areas | 0.945 | ||||
| 18. Empowering people/members involved in the OHT. | 479 (99.8) | 3.793 (1.007) | 2.3 | 26.7 | |
| 19. Communicating the vision of the OHT. | 479 (99.8) | 3.754 (1.068) | 2.3 | 29 | |
| 20. Creating an environment where differences of opinion can be voiced | 479 (99.8) | 3.814 (1.102) | 3.3 | 33.6 | |
| 21. Helping the OHT to be creative and look at things differently. | 479 (99.8) | 3.668 (1.077) | 2.7 | 25.3 | |
| 22. Fostering respect, trust and inclusiveness amongst OHT members. | 479 (99.8) | 3.889 (1.118) | 3.5 | 37.6 | |
| Team Climate* At present in this [program name] | 0.902 | ||||
| 15. We are prepared to question the basis of what the team is doing | 477 (99.4) | 3.964 (0.979) | 1.9 | 35 | |
| 16. We critically appraise potential weaknesses in what our OHT is planning | 478 (99.6) | 3.785 (0.987) | 1.7 | 26.2 | |
| 17. The members of the OHT build on each other’s ideas | 479 (99.8) | 4.127 (0.939) | 1 | 43.8 | |
| 39. We have a ‘we are in it together’ attitude | 479 (99.8) | 4.267 (0.948) | 1.7 | 53.2 | |
| 40. We take the time needed to develop new ideas | 479 (99.8) | 3.954 (0.947) | 1.7 | 32.8 | |
| 41. To what extent do you think your OHT’s objectives can actually be achieved | 479 (99.8) | 3.887 (0.795) | 0 | 22.1 | |
| Clinical Functional Integration* At present in this [program name] | 0.805 | ||||
| 12. We share tools for clinical coordination | 477 (99.4) | 3.264 (0.999) | 3.4 | 10.9 | |
| 13. We share clinical information across partners | 477 (99.4) | 3.195 (1.001) | 3.8 | 9.6 | |
| Readiness for Change – Suitability* To what extent do you agree with the following statements? | 0.758 | ||||
| 34. I think that my organization/practice setting will benefit from this change | 464 (96.7) | 4.218 (0.940) | 1.7 | 48.1 | |
| 35. This change will make my role easier | 450 (93.8) | 3.049 (1.124) | 4.4 | 11.8 | |
| 36. I feel it is worthwhile for me that the organization adopted this change | 465 (96.9) | 4.353 (0.876) | 1.5 | 55.5 | |
| Commitment to Improvement* At present in this [program name] | 0.764 | ||||
| 8. We have a common vision of how to improve the integration of care | 479 (99.8) | 4.163 (0.862) | 0.6 | 40.9 | |
| 11. We have agreed to share responsibility for achieving improved patient outcomes | 479 (99.8) | 4.161 (0.911) | 1.3 | 43.4 | |
| 14. We have used data to identify the improvements for our target populations | 479 (99.8) | 3.825 (0.965) | 1.3 | 26.9 | |
| Roles and Responsibilities* At present in this [program name] | 0.881 | ||||
| 9. We understand the role we will play in taking responsibility for the local population | 479 (99.8) | 3.942 (0.915) | 0.8 | 29.6 | |
| 10. We understand the role we will play in coordinating care | 479 (99.8) | 3.764 (0.933) | 0.6 | 23.4 | |
| Administration and Management§ Please rate the effectiveness of your [program name] in carrying out the following activities | 0.898 | ||||
| 23. Communicating among members | 480 (100) | 3.823 (1.036) | 1.9 | 30.2 | |
| 24. Organizing OHT member activities, including meetings and projects | 480 (100) | 4.044 (1.012) | 1.9 | 40.4 | |
| Financial and Other Material Resources¥ For each of the following types of resources, to what extent does your OHT have what it needs to work effectively | 0.683 | ||||
| 29. Money | 427 (89) | 2.440 (0.871) | 16.4 | 0.7 | |
| 30. Tools and technologies | 457 (95.2) | 2.823 (0.823) | 5.5 | 2.4 | |
| Non-financial Resources¥ For each of the following types of resources, to what extent does your OHT have what it needs to work effectively | 0.803 | ||||
| 25. Skills and expertise | 468 (97.5) | 3.703 (0.692) | 0.6 | 9.4 | |
| 26. Data and information | 462 (96.3) | 3.381 (0.726) | 0.9 | 5.8 | |
| 27. Ability to identify target population criteria and deliver interventions | 456 (95) | 3.697 (0.768) | 0.7 | 13.6 | |
| 28. Connections to political decision-makers, government agencies | 436 (90.8) | 3.612 (0.873) | 1.4 | 16.1 | |
[i] * A 5-point Likert response scale where Strongly Disagree = 1, Disagree = 2, Neither Disagree or Agree = 3, Agree = 4, and Strongly Agree = 5.
§ A 5-point Likert response scale where Poor = 1, Fair = 2, Good = 3, Very Good = 4, Excellent = 5.
¥ A 5-point Likert response scale where None of what it needs = 1, Almost none of what it needs = 2, Some of what it needs = 3, Most of what it needs = 4, All of what it needs = 5.
£ A 5-point Likert response scale where Not at all = 1, Minimally = 2, Somewhat = 3, Mostly = 4, Completely = 5.
** There were five items that were not included into the domains. These items were as follows:
31) Organization or practice setting’s attitude toward change: [Resistant to change | Cautious toward change | Open to change | Innovative]
To what extent do you agree with the following statements:*
37) I have the skills that are needed to make this change work
38) This change will disrupt many of the working relationships I have developed
32) Your organization’s shared values are compatible with those of other OHT members
33) Your organization’s staff have a strong sense of belonging to your OHT
Figure 2
OHT Summary Results on 10 Domains of the Ontario Integrated Care Leadership Survey by Leadership Organization.