Build your OHT

For Ontario Health Teams (OHTs) to learn and improve rapidly, team members will need to have new ways of working together as system partners. They will need to do so both in using a population-health management approach to move the needle on quadruple-aim metrics (e.g., care experiences and specific health outcomes) for their priority populations and in putting in place the eight OHT building blocks. Collaborative decision-making and project plans will be essential for team members to work together as system partners.

Collaborative decision-making
The Ministry of Health has developed guidance for OHTs on collaborative decision-making arrangements as part of its support for OHT building block #6 (leadership, accountability and governance). The guidance emphasizes that collaborative decision-making arrangements are to be self-determined and fit for purpose. The guidance also includes a checklist to ensure that OHTs’ arrangements cover all key issues.

To complement the ministry’s guidance, RISE commissioned the law firm Borden Ladner Gervais (BLG) to prepare four templates (collaboration agreement, decision-making framework agreement, fund holder and indemnity agreement, and project agreement) that OHTs can adapt and use as they see fit when establishing their collaborative decision-making arrangements. RISE also prepared RISE brief 19 to describe the purpose of and key topics covered by the templates, as well as offer additional notes about their use. BLG also prepared their own guidance document to assist OHTs in adapting the templates for their own use. RISE encourages OHTs to start with RISE brief 19 and the BLG guidance document, and then to move on to the template(s) most relevant to their OHT.

While prepared in mid-2019 to support cohort 1 of OHTs, RISE’s other resources related to leadership infrastructure may still be relevant to later cohorts of OHTs. In reviewing the experiences of five teams that prepared readiness assessments to become OHTs (including some that had embarked on care integration well before the call for OHTs), a common observation that we make in RISE brief 2 about leadership infrastructure was that such infrastructure is needed to support new ways of working together as system partners. This leadership infrastructure can include, for example:

• an executive leadership group comprising CEOs and executive directors of partner organizations who can engage their respective boards of directors and commit their organizations accordingly (domain 46: collaborative governance)
• an integrated operational management group comprising (at least in part) vice-presidents of operations and directors of programs who can develop and execute workplans
• working groups focused on: 1) proactive primary-care provider leadership and engagement (domain 47); 2) proactive community engagement (as a component of domain 9: proactive patient and public engagement), 3) digital health (and specifically domain 40: data harmonization across organizations, sectors and systems, and domain 41: data modelling and analysis), and 4) communications

Such a leadership infrastructure, in this or other configurations, can address three of the biggest challenges in preparing to become an OHT: 1) moving from single organization governance to collaborative governance; 2) engaging the full diversity of primary-care providers; and 3) engaging the full diversity of community members.

Project plans
Project plans will be essential both in using a population-health management approach to move the needle on quadruple-aim metrics for priority populations and in putting in place the eight OHT building blocks.

One of the four BLG templates is a project agreement that OHTs can adapt and use as they see fit when designing and executing a year 1 priority population project (e.g., to improve quadruple-aim metrics for people with mental health and addictions issues or for those at risk of or affected by COVID-19) or putting in place an OHT building block (e.g., a new digital health solution). Over time such project agreements and accompanying work plans would ideally cover all priority populations and all OHT building blocks.

The work plans focused on priority populations can address one of the big challenges in becoming an OHT, namely transitioning from a focus on patients to populations (i.e., from caring for the patients who have ‘walked through the door’ of any given health organization to accountability for improving health in an entire population and for proactively serving all of those who can benefit from care). The work plan focused on the data analytics part of the digital health building block can address a second big challenge in becoming an OHT, namely harnessing a broad spectrum of data to understand who the OHT serves and how well it serves them, which includes transitioning from primarily analyzing hospital data to analyzing a broader spectrum of human-services data (including data from community-based organizations, primary-care practices, and housing and social-service providers, as well as data about the social determinants of health).

Other success factors
For OHTs working together as system partners:

1. OHT partner organizations will need to harness their staff’s:
   1. leadership capabilities (and support a transition from organizational leadership to distributed cross-sectoral leadership)
   2. change-management skills
   3. project-management skills
2. team members will also need to learn about parts of the health system that are new to them (e.g., team members from community-based organizations may have had limited opportunity to understand the many ways that primary-care physicians may be paid, and hospital leaders may have had limited exposure to innovative housing models)

For a ‘way in’ to descriptions how different parts of Ontario’s health system works, check out the RISE brief about Ontario’s health system.

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