What are the proposed governance and leadership structures for your team? Please describe the governance and operational leadership structures for your team in Year 1 and, if known, longer-term.

Core Partner Board of Directors/Trustees are very engaged and supportive of the formation of a Guelph and Area OHT that will create an integrated system of care.  At September Board meetings, our Core partners passed two joint motions

 To approve, in principle, the Guelph and Area OHT Submission

  • To direct leadership of each Guelph and Area OHT core partner to jointly develop a proposal for a joint strategic planning process to be completed in Year 1 (2020).

 A governance engagement session was held on September 26, 2019 with all our Core Partner group and representatives from each of their Boards. Relationship and trust building had already started before the meeting as some of the Board members had met previously to start the discussion about integrated governance. In addition, Board member cross-appointments have already started – one member of the GGH board is also a Guelph FHT board member and vice versa.

The goal of the governance session was to create a space where Board members would agree upon a common purpose, and understand and define functions of an OHT Board both in Year 1 and at maturity. The governors were tasked to design a structure that supported the required Year 1 functions of an OHT (following the “form follows function” principle). The session also included the governors envisioning a future state of a governance structure for the G&A OHT.

The session was very well received and the following meeting objectives were met:

  1. Provide an update on the mandate for OHTs, and the status of the G&A OHT submission to date
  2. Provide input to establish the Joint Purpose and Guiding Principles for governing the G&A OHT
  3. Discuss Interim Governance Structure options for the Guelph and Area OHT

Our work was grounded in advice from governance experts through pre-reading including agreement that the Ontario Health Team (OHT) model will evolve over time.  We agreed that in Year 1, our focus will be on service integration and we discussed how our boards could support this focus.  We agreed that service integration does not require governance integration and there was confirmation that a joint strategic planning exercise should be completed in Year 1 to help inform the longer term governance structure of the G&A OHT.

There was agreement that the joint/common purpose was to oversee the development of a health system that was grounded in equity (rather than equality), that would address the needs of the whole person and that would support a seamless patient experience.  They described a desire for our residents to be proud and trusting of their OHT and refer to the G&A OHT as “My OHT” that included “My Care Team” and “My Key Contact Person”.  Finally, they envisioned a mature Guelph and Area OHT to be one in which providers had fun and found joy in their work.

 The group then identified guiding principles for governance to assist in the development of a governance model for the OHT. Collated responses included that the G&A OHT Board should:

  • be committed to educating itself about the community that it serves
  • include broad community representation, including clinicians and patients/caregivers
  • be representative the broad community and be skills-based
  • invest time and money in the development of strong, transparent and trusting relationships between partner organizations and of a strong culture of trust and collaboration across all areas of the OHT
  • leverage governance strengths and successes of partner organizations and best/leading governance practices from other jurisdictions – develop formal conflict resolution and shared decision making framework/processes
  • embrace and demand diversity of thought, perspective and expertise

The next exercise during the session was to review the Year 1 governance functions of the G&A OHT including:

  1. Oversight of joint strategic planning process,
  2. Formalize working relationships among team partners including: decision-making, conflict resolution, performance management, information sharing, resource allocation, integrating new partners, and engagement; and
  3. Develop and recommend a long term structure based on a joint strategic plan. 

It was agreed that an interim Year 1 ‘Strategic Steering Council’ will be created to act as a strategic planning structure that will include core partner organizational representation and will incorporate the voice of patient/caregiver and physicians. This Council will:

  1. Oversee the joint strategic planning process.
  2. Develop formal conflict resolution and shared decision making framework/processes.
  3. Develop and recommend a long term structure based on a joint strategic plan. 

Advisory Groups may be developed to support achievement of these two Year 1 priorities.

New partners will be invited to join with endorsement as recommended from the existing Core Partner.  Once developed in the first 30 days, the group’s decision making process/framework will help to guide such decisions. 

Our current operational leadership structure has evolved this year and will continue to lead the OHT work. The group includes Executive Leads from the 12 core partners who will continue to meet biweekly as the Guelph and Area OHT Core Partners Executive Committee. This group will be supported by a Transformation/Implementation Lead who will also provide leadership direction to nine groups that include staff, physicians and patients/families from the core organizations. These ‘Enabling Infrastructure Working Groups’ include: ‘Patient Partnership and Community Engagement’, ‘Quality Improvement and Continuous Learning’, ‘Funding and Incentive Structure’, ‘Human Resources’, ‘Communications’, ‘Digital Health’, ‘Caregiver Support’, ‘Data & Performance Measurement’ and ‘Care Delivery’. The ‘Care Delivery Working Group’ will include three work streams, each representing one of our three priority populations and will lead the development and execution of a work plan to achieve our Year 1 key change activities. See Figure VII.

 On September 18th, the Core Partners envisioned a mature state operational leadership structure for the G&A OHT (See Figure VIII). Features includes operational leadership/accountability close to the patient i.e. at the IPCT level with accountabilities for health of rostered population including: clinical service delivery, performance/health outcomes, funding, planning. Managers of each specialty/secondary service would oversee delivery of service, build primary capability, link with provincial programs, and be accountable for health specific outcomes. Of note, secondary services are invited into the IPCT, rather than the patient being referred out.

 We met with the patients, families and caregivers at our September 18th engagement session to hear about their ideas about leadership and governance of the OHT. The recommendations will be shared with the Year 1 “Strategic Steering Council’ and will be considered as the governance model evolves. The recommendations include:

  • To allow the patient centred model to be realized throughout the whole system, two patient/family advocates be full voting members of the board of directors of the Guelph and Area OHT.
  • A patient and family advisory council of the G&A OHT should be created and have accountabilities related to; providing feedback to organizations, projects and programs; be a critical component when approving new initiatives/operations; and increasing patient engagement across the system.
  • This council should report directly in to the board representing broader patient voice from all sectors of the health system.

G&A OHT has engaged physicians and other front-line clinicians in all co-design engagement sessions and working groups in support of OHT planning and design. Physicians from Guelph General Hospital, including specialists, and the Guelph Family Health Team attended our governance session on September 26th.  As we evolve our OHT governance, we will continue to engage our physicians in meaningful discussion about how our physicians and other primary care groups would like to be involved both at the clinical and leadership level. We have strong support from physician leaders across our system.  For example, the Physician Lead from CMHAWW is a shared position with Grand River Hospital, and is in an excellent position to provide system level input from a physician’s (psychiatry) perspective.  The other Psychiatrists at CMHAWW have also expressed a strong desire to be involved in co-designing and implemented Year 1 deliverables related to mental health and addictions care. 

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