Abstract
Background: Seven Ontario Health Teams (OHTs), each a group of cross-sectoral health service organizations, were chosen by the Canadian province of Ontario to lead the modernization of home and community care. We explore how stakeholders across sectors experienced and negotiated the task of balancing standardization and local needs, required by this work.
Approach: As part of a qualitative evaluation of OHTs’ implementation plans, we conducted semi-structured interviews (26) and focus groups (4) with cross-sectoral participants, monthly interviews with team leads, and monthly observations of key team meetings with a subsection of three teams, from November 2023 to October 2024. Participants included senior managers from hospitals, home care and community organizations, physicians, care coordinators, patients, caregivers and OHT staff members. We also conducted a document review of relevant system-level guidance and OHT-level program proposals. We aimed to understand the key elements of each home care model and what helped and hindered its development. Results were shared with each OHT, allowing stakeholders the opportunity to provide input into and learn from our findings.
Results: We focus here on a key theme that emerged from our data – the tension between the need to standardize while simultaneously catering to local needs. This tension manifested at system, sectoral, managerial, provider and patient levels. OHT stakeholders found that while system stakeholders had tasked them with testing new homegrown models of homecare delivery, their transformational ideas for how the care coordinator might work within the new models, for instance, were circumscribed by homecare accountability agreements, contracts and union regulations. The home care sector’s attempts to standardize its policies to ensure uniformity of patient experience was interpreted as a lack of understanding of local context by other OHT members. OHT managers’ attempts to test innovations at different sites to enable local adaptations was sometimes met with push back from providers working on the ground. Finally, patients and family members were concerned that the initiative did not account for what truly mattered to them. We found that the tension between localization and standardization could be mediated by experienced organizational leaders able to creatively navigate between both impulses, managers able to centre the voices of patients and family members, and patients and family members able to remind people of what mattered to them.
Implications: We identified the importance of communication a) across sectors, so that all stakeholders were aware of the pressures that a specific sector may be facing and the rationale for it, to mitigate the apportioning of blame, and b) with on-the-ground providers so that they understood the rationale for change and the value of them guiding it. We are in the process of sharing these findings with system and policy stakeholders as well, to build awareness of some of the challenges to innovation that are beyond the control of OHTs themselves. The audience for these findings includes other jurisdictions navigating the task of striking a balance between localization and standardization.