Ontario Health Teams, which bring healthcare providers like hospitals, primary care and community health services together, are expected to resolve many of the concerns around how healthcare gets delivered in Ontario. OHTs will be able to address some of the major concerns currently dogging the healthcare system in Ontario, especially given the government’s plan to create a ‘low-rules environment’ with little governance.
The members of an OHT share a single funding envelope, co-ordinate care and provide 24/7 access to navigation services and take responsibility for outcomes. Here we look at some of the biggest challenges which OHTs might face, in meeting their vision and goals.
1. Hospital boards hold all the power
OHTs can plan and decide on service delivery, without the involvement of community or patient/family engagement in planning the service or allocation of resources. OHTs will also be, in most cases, led by the hospitals which have the largest budgets, however constrained, among the partners. On the positive side, given that most of the hospitals are well governed, this would help to improve the processes for other providers. But questions still remain. Who will ensure that the funding envelope is split up equally among these health care providers? Will the hospitals be able to resist the temptation to consolidate regional budgets to ensure better funding to hospitals first? How far will they be willing or able to meet the public demand for better community or mental health care? How transformative with their leadership prove
2. Collaboration and conflict resolution
The need to set a cleat locus for decision-making and to decide the degrees of freedom awarded to an OHT seems apparent at this time. There may arise a need for a conflict resolution mechanism to ensure the smooth and collaborative functioning of the OHTs with different opinions in the Ministry of Health as well other public sector unions like the Ontario Medical Association and Ontario Nurses Association.
3. Managing home care Services
Currently, 85% of home care visits are provided to patients directly by the community, without the involvement of any hospital or healthcare provider. Who will now manage the home care services worth over $4 billion, organized and standardized well at the provincial level? Will it now be decentralized and managed separately and independently by each OHT?
4. Consolidation of care provider compensations
The compensation paid to the providers in the care teams will be determined by the OHT’s budgets and governance process. However, physicians’ compensation would have to be negotiated with the Ontario Medical Association and may have to be kept out of the OHT, even though the physicians will be playing leadership roles in the OHT.
5. Meeting demands for accountability
The legislation behind the formation of OHTs has written in specific powers to coerce, to order, to direct mergers, amalgamations, service transfers and entire closures of health-service providers, at various points. Health care providers are just expected to step out of their silos and start working collaboratively in teams, and to ensure that a patient doesn’t get lost through the system. As a wide variety of different health-care organizations come together for patients within a geographic region for the first time in the province, issues of accountability are bound to crop up and could create legal snafus on an unprecedented scale.
6. Standardized health information systems
Nothing can be more important than establishing a comprehensive, standardized health information system, which can be securely accessed by both patients and health service providers. Adoption of technology is fundamental to such virtual access to health information, which is being collected as we speak by various care providers along with the information being collected by the innumerable wearable devices, which people are voluntarily adopting to track and record their own health. The information must be available for the assessment and analysis of the performance of the health services as well as the efficacy of the various population health measures being undertaken in the province.
The aim is to plan the health services of over 14 million people in Ontario and many aren’t sure if it may need more guidance than what is currently put in place. What would help to ensure that the participants who maybe hospitals, community care providers, public health units and even sophisticated referral hospitals will be able to work in harmony? We can’t afford to have the OHTs be thrown into a chaotic disarray after the existing order, however inefficient, gets dissolved. Which means, we will need to seek the answers to some of these questions, right now.