The beginnings of health system transformation: How Ontario Health Teams are implementing change in the context of uncertainty.

ABSTRACT

PURPOSE/ SETTING: The launch of Ontario Health Teams (OHTs) by the Canadian province of Ontario in 2019 represented a milestone in the journey towards integrated care and population health management. However, early model development was riddled with uncertainty. We explore what makes transformation possible even in the context of uncertainty. METHODS: We conducted 125 interviews with administrators, clinicians, and patient and family advisors across 12 OHTs, representatively selected across geography and leadership sector, between January to September 2020. Interviews were transcribed and thematically coded, and a Foucauldian approach informed analysis. FINDINGS: A sense of uncertainty was identified at three levels (a) at a cross-organizational level, policymakers were perceived as providing inadequate direction; (b) at a sectoral level, certain sectors were uncertain about participating due to historic vulnerabilities; and (c) at a professional level, physicians were uncertain about the value of the new model and their place within it. These concerns were countered by a recognition of the need for change, inclusive decision-making, and developing empathy and awareness of each other's needs. This helped unsettle traditional hierarchies and facilitate new forms of certainty. CONCLUSION: Understanding the possibilities and challenges of this endeavour will be helpful to program implementers negotiating uncertain environments as well as to policymakers seeking to provide guidance without stymieing local innovation.