Health System Change in the Midst of a Pandemic

Context: Health systems are in a state of constant change. In the province of Ontario, Canada, a new initiative called Ontario Health Teams (OHTs) was introduced in 2019 to create an integrated health care system, bringing together various sectors (e.g. primary care, community care, specialists, and hospitals). These OHTs were gradually rolled out across the province between 2019 to the present. Objective: This study presents the impact of the COVID-19 pandemic on the development of OHTs through the lens of primary care. Study Design: In accordance with Grounded Theory methodology, individual interviews were analyzed, including a constant comparative approach. Setting: Regional health care organizations in Ontario, Canada. Population Studied: A purposive sample of twenty primary care leaders engaged in health system change from across Ontario with extensive knowledge of OHTS. Results: The participants described, from the perspective of primary care, how the OHTs responded in three different ways to the pandemic. Some OHTs were forced to put further development on hold, as they pivoted to COVID concerns (e.g. long-term care facilities, PPE). Others described losing momentum temporarily, but then getting back on track and evolving more quickly. Still others explained how their OHT activities never faltered, and indeed, the pandemic rapidly accelerated their development, describing COVID-19 as a ‘silver lining’. A common experience articulated by participants was the breaking down of organizational silos as the pandemic necessitated all sectors to work together. The burgeoning collaborative relationships being established through OHT structures were viewed as facilitating this coming together, serving as a “proof of concept” of the “what and how” of OHTs. Conclusions: The COVID-19 pandemic has disrupted so many aspects of health care across the globe but for the OHT’s, an important health system innovation, it has served as an opportunity to examine what worked well and what could have been executed more effectively. Going forward the OHT’s can build on the “lessons learned”.