Abstract
Introduction: In 2019, The Ministry of Health in Ontario, Canada’s most populous province, created Ontario Health Teams (OHTs) through the Connected Care Act 2019. OHTs are intended to be regional integrated health systems designed around attributed populations engaging collaborations between providers of hospital services, primary care, and community health service. Currently, OHTs remain “non-legal entities”. There are currently 50 established OHTs across the province with others in development, displaying various levels of maturity, organizational forms and delivery systems. An emerging challenge for OHTs is thus to establish shared governance, leadership and accountability, and create new rules of collective clinical and fiscal accountability towards community-driven population health. However, to date, little research has been done on current governance challenges, enablers and opportunities within the OHTs. We believe this creates a unique and timely research opportunity to explore emerging patterns of governance in the context of newly created integrated health systems, and implications for practice.
Methods: Our study compares current governance across three OHTs, using a qualitative cross-case comparative design across three OHTs, we will explore the following empirical questions:
1.What are the current governance structures in the OHT?
2.To what extent is the Leadership Council acting in a governance role?
3.To what extent are partner boards engaged in the OHT strategy and planning?
4.What are the challenges in engaging partner boards in strategy and oversight for integrated care?
Cases (N=3) were selected based on intentional sampling and case variations (e.g., ranging from 100,000 to 900,000 covered populations; a mix of urban and rural; various attributed populations).
Data will be collected through semi-structured individual interviews with key stakeholders (e.g., governance council members, clinical leaders, patient partners), document review and non-participatory observations of governance meetings and leadership councils. Data will be analyzed according to a narrative process approach and guided by the FSG Collective Impact Framework.
Results: We will interview 7-10 leadership council members across each OHT (N=30 in total) and study their governance structures and strategies for partner engagement. Exploring and comparing the governance structure across three OHTs, we aim to focus on the quality of leadership councils (people engaged and their collective impact), roles (areas in which councils exercise governance roles) and structures and processes of the council (how they enact decisions and work). We will also highlight how the component of partner engagement is enacted in practice, drawing learnings for the partner engagement strategies of OHTs.
Conclusion: Our study maps the various governance trajectories taken by emerging integrated health systems (OHTs), highlighting the associated challenges, enablers and opportunities. With the evolving highly interdependent governance structure among OHT partners, we provide different accounts of policy in action and practice. Lessons from cross-comparison can further refine governance pathways and evolve strategies that promote effective and efficient partner engagement.
Implications: Strong governance will contribute to the maturation of OHTs. Our study identifies various governance practices and decision-making rules adopted and reports stakeholder views on their effectiveness, highlighting how and to what extent current governance frameworks promote integrated care delivery.