Abstract
Background: East Toronto Ontario Health Team (ETHP) has adopted equity-based approach to engagement as part of its strategy to achieve improvements in population health by focusing on East Toronto's priority neighbourhoods and improving equity in access to healthcare.We are focusing on mobilizing integrated care researchers, provincial and municipal policymakers, OHT partner organizations, service providers, patients, caregivers, and other community members, around the importance of local context, and the refinement of integrated care models (like the OHTs) at local levels with health-equity in mind.
Approach: Over 50 community members were engaged in focus groups and interviews. Fifteen residents joined the Taylor Massey Residents Wellness Council (TMRWC) to inform East Toronto OHT (ETHP) work in the Taylor Massey neighbourhood. They were involved in the co-design of social and healthcare solutions that address issues of access to services, and improving health outcomes.The creation of the TMRWC was critical in identifying the urgent need for improved access to primary care and service navigation support for the residents of Taylor Massey. As a result, ETHP launched Health Access Taylor Massey (HATM), a healthcare, community and social services hub, co-designed with TMRWC. HATM diverse team of healthcare providers includes family doctors, nurses, mental health counsellors, resource navigators, and others, and offers a range of services from preventative cancer screening and diabetes care to prenatal care. TMRWC members together with the Community Health Ambassadors are continually involved in health promotion and outreach activities in the Taylor Massey neighbourhood. The TMRWC was also behind several community-led initiatives such as the Council annual Taylor-Massey Wellness Day which draws crowds of over 300 people from the neighbourhood.
Results: Beyond directly supporting the operation of HATM, TMRWC members are also active participants in ETHP's broader advisory network which is comprised of over 60 patient and caregiver advisors from all East Toronto's neighbourhoods. Their input has helped ETHP service providers better understand the importance of culturally competent care in improving health outcomes, which is especially relevant in East Toronto's diverse neighbourhoods. For example, TMRWC members helped identify a health-equity issue related to access to Halal food in the hospital for patients who are practicing Muslims. Their experiences of accessing the healthcare system has helped ETHP better understand the importance of culturally competent care in improving health outcomes in diverse neighbourhoods, addressing issues of health inequity stemming from the social determinants of health as well as the importance of community-centered partnerships in population health management.
Implications: In a healthcare system with limited resources, dealing with increasingly complex healthcare needs of a diverse and aging population, service providers are well advised to look to mobilizing the communities they serve as partners in care. Empowered individuals and communities become partners in solving their health problems and improving their health outcomes. Approaches that involve long-term partnership with community members and are focused on local health issue(s), involve co-learning, capacity building, co-design, shared decision making, balancing power, mutual ownership of the problems and the solutions - can help OHTs achieve better results in reducing disparities and address health equity issues.The Council has grown to be an invaluable resource not only for HATM but also for the OHT and its partner organizations. As ETHP partner organizations learn how to work together, it is the community members that hold them accountable for the delivery of integrated care services and shifting towards a culture of co-design. ETHP is one of 2 OHTs on an accelerated path to maturity and the TMRWC will be involved in co-designing solutions for OHT governance and Integrated Care Pathways for chronic illnesses, and home care delivery.