To fix the health-care system in Ontario, turn it on its head.
That’s the idea behind the Ontario Health Team (OHT) model, where health-care providers compare notes and share resources so patients get better care without having to rehash their medical history at each appointment.
“It brings the players together and requires that they start to communicate a little bit better,” said Dr. Scott Elliott, a Brantford physician who chairs the Brantford Brant Norfolk Ontario Health Team.
“The whole point is to bring the patient into the centre of the process so that all the services feed into the patient’s needs.”
The province introduced OHTs in 2019 as a reimagining of health-care delivery in Ontario. Gone would be the Local Health Integration Networks and large agencies like Cancer Care Ontario. They would be replaced by dozens of regional teams like the one approved in November 2020 for Brant and Norfolk.
Each OHT is comprised of hospitals, long-term-care homes, family doctors, the local health unit, paramedics, municipalities, community agencies, home- and institutional-care providers, and front-line staff.
“We’re now all sitting at the same table on a monthly basis, having regular conversations about how we can move forward with primary care in more innovative ways. That’s never happened before,” Elliott said.
A Spectator investigation in July 2019 found the province’s plan for OHTs was short on specifics, such as how the groups would be funded and kept accountable. The COVID-19 pandemic further slowed the transition to OHTs, but Elliott said the challenge of mobilizing against the virus served to underscore just how much the system needs to change.
“Health care is at a tipping point right now. We know that. The pandemic caused us to realize the frailties that we have inherent in the system,” he said.
Among the planks of the Brantford Brant Norfolk OHT’s recently released strategic plan are improving residents’ access to primary care, using technology to book appointments online and share patient records between providers, and addressing health-care worker burnout.
Elliott said despite health-care organizations traditionally operating in silos, OHT participants “very quickly bought into the idea.”
Creating a streamlined system that puts patients first sounds great to Sarah Cannon, former executive director of Parents for Children’s Mental Health.
“As a patient, care is not very connected,” she said.
“Patients should be feeling like they are receiving services (from providers) that talk to each other. They should not be feeling like they have to retell their story over and over again.”
As a parent of children with mental-health challenges, Cannon can confirm the health ministry’s own assessment that patients and providers alike find the current system “confusing, inconvenient, and challenging to navigate,” resulting in delayed or “fragmented” care as patients move from one provider to the next.
“And you begin to not trust the system,” Cannon said. “‘Are you guys not talking to each other? Why am I always starting from scratch?’”
While co-ordinating community surveys and focus groups for the new Brantford Brant Norfolk OHT, Cannon heard the same feedback again and again from local patients and their families.
“They want to feel heard and respected, and they don’t always want to be chasing the symptoms,” Cannon said.
“Help me prepare for my entire journey so I’m going to know what to expect. Give me the resources and the information I need instead of always being reactive.”
The OHT leadership group has identified dementia, mental health and addictions, and homelessness as priority areas, recognizing those services need to be better integrated between hospitals and local agencies so people don’t age out of care or fall through the cracks.
That integration will mean changing how doctors are paid to account for time spent co-ordinating patient care away from the examination room, Cannon noted. Visits may take longer as patients are given the time to address several issues rather than rush through one ailment per appointment.
But the payoff will be worth it in terms of better outcomes for patients, she said.
Cannon admits OHTs are taking an ambitious swing at a complicated problem, but she sees potential for this model to make a difference in patients’ lives by putting existing resources to more efficient use.
“For this to work, it has to be transformative,” she said.
“It can’t just be, well, we’ll tweak this area and this area. It has to be that we actually think of a new way of communicating and working and collaborating together.”
J.P. Antonacci, Local Journalism Initiative Reporter, The Hamilton Spectator