Family physicians partnering for system change: a multiple-case study of Ontario Health Teams in development

Colleen Grady; Sophy Chan-Nguyen; David Mathies; Nadia Alam

doi:10.1186/s12913-023-10070-0

Family physicians partnering for system change: a multiple-case study of Ontario Health Teams in development

BMC Health Serv Res. 2023 Oct 17;23(1):1113. doi: 10.1186/s12913-023-10070-0.

Authors

Colleen Grady¹, Sophy Chan-Nguyen², David Mathies³, Nadia Alam⁴

Affiliations

¹ Centre for Studies in Primary Care, Department of Medicine, Queen's University, 220 Bagot Street, Kingston, ON, K7L 3G2, Canada. colleen.grady@queensu.ca.
² Centre for Studies in Primary Care, Department of Medicine, Queen's University, 220 Bagot Street, Kingston, ON, K7L 3G2, Canada.
³ Muskoka and Area Ontario Health Team, Muskoka, ON, Canada.
⁴ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.

Abstract

Background: The Ontario Health Team (OHT) model is a form of integrated care that seeks to provide coordinated delivery of care to communities across Ontario, Canada. Primary care is positioned at the heart of the OHT model, yet physician participation and representation has been severely challenged at planning and governance tables. The purpose of this multiple case study is to examine (1) processes and structures to enable family physician participation in OHTs and (2) describe challenges to family physician participation.

Methods: We chose a qualitative, exploratory multiple-case study approach following Yin's design and methods. The study took place between June and December 2021.We conducted semi-structured interviews with OHT stakeholders in four communities and carried out an analysis of internal and external documents to contextualize interview findings. Thematic analysis was applied within case and between cases.

Results: Four OHTs participated in this study with thirty-nine participants (17 family physicians; 22 other stakeholders). Over 60 documents were analyzed. Within-case analysis found that structures and processes should be formalized and established to facilitate physician participation. Skepticism, burnout, heavy workload, and the COVID-19 pandemic were challenges to participation. Between-case analysis found that participation varied. Face-to-face communication processes were favoured in all cases and history of collaboration facilitated relationship-building. All cases faced similar challenges to physician participation despite regional differences.

Conclusions: The implementation of OHTs demonstrates that integrated care models can address critical health system issues through a collective approach. Physician participation is vital to the development of an OHT, however, recognition of their challenges (skepticism, burnout, COVID-19 pandemic) to participating must be acknowledged first. To ensure that models like OHTs thrive, physicians must be meaningfully engaged in various aspects and levels of governance and delivery.

Keywords: Family physicians; Integrated care; Ontario Health Teams; Primary care.

MeSH terms

COVID-19* / epidemiology
Humans
Ontario
Pandemics
Physicians, Family*
Qualitative Research