Leading through Uncertainty: Supporting Bold Leadership in Uncertain Times

Approach: ALIGN supports the development of leadership and governance in Ontario Health Teams (OHTs) – collaborative partnerships meant to shift Ontario’s health system towards more integrated care.

To better understand their needs, the ALIGN team conducted semi-structured interviews with 12 OHTs. We asked about their current state and aspirations, challenges and enablers, and learning priorities with respect to leadership and governance. Uncertainty emerged as a major theme with which many OHT leaders were grappling.

Building on this, we developed an interactive workshop to further explore this theme. Through sensemaking exercises, participants identified uncertainties they were facing, causes of uncertainties, and how these were impacting their OHT. This led to a rich discussion of challenges, enablers, and strategies for leading in the face of uncertainty, which we captured for analysis.

Results: Uncertainty emerged as a major theme in the interview data. OHT leaders spoke of multiple uncertainties, ranging from local issues such as strengths of partnerships to system-level issues such as funding, policy, and long-term vision. Uncertainties about internal factors (e.g., people and relationships) were seen as more manageable than external factors (e.g., resources and policy). There was a sense that system uncertainty is particularly high at the moment, owing to shifting policy directions and election cycles.

These responses were validated during the workshop. Further probing revealed four kinds of uncertainty that spanned the discussion:

•Vision: unclear vision is seen as a major challenge for leaders (e.g., changing directions);

•Commitment: a lack of commitment is seen as another major challenge (e.g., lack of sustained funding);

•Capability: doubts about system capabilities are a third type of uncertainty (e.g., readiness for change/disruption);

•Steps: a fourth type of uncertainty is practical: what are the steps for implementing integrated care? (e.g., governance models)

Overall, the picture that emerges is one of leaders doing their best to advance integrated care locally but feeling adrift due to system-level uncertainties. Participants spoke of wanting to “move faster” but having to instead “wait for the system to catch up.” While a few leaders see the current state of uncertainty as an opportunity to focus on local priorities, many see it as problematic and creating a state of limbo. Finding ways to lead in the face uncertainty is therefore a key learning priority for these leaders.

Implications: Our experiences suggest the following learnings:

(1)Leading through uncertainty is an important skill for integrated care leaders;

(2)Uncertainties around vision and commitment are seen as particularly challenging to effective leadership and governance;

(3)Activities that help explore, analyze, or reduce uncertainties are valuable for integrated care leaders;

(4)Integrated care initiatives in Ontario would best be supported at the system-level by aligning and reducing uncertainties for vision and commitment (e.g., clear long-term vision, public championing of OHTs).

Next steps for this work include further validation of learnings using focus groups and co-designing strategies with OHTs for leading through uncertainty.