We have embraced that change management is key to creating a successful OHT. As we continue our transformational journey we will need to evolve our change management strategy as we monitor and identify risk. We will continue to support transparency, communication, visibility, engagement, identification of clear objectives, the “what” and support our clinicians to develop and implement the “how”. As evidence of our commitment to transparency, the Guelph and Area OHT Core Partner group will be posting this submission to our website shortly after submission.
Our general change management approach is aligned with LEAN methodology including the development of A3s that support the development of clear objectives and setting of high level system priorities. Once priorities are set, we identify both formal and informal leaders to lead the work and ensure ongoing support, engage stakeholders to identify specific deliverables (based on a gap analysis between current and future state), implement, monitor, evaluate and spread. For example, at a leadership level, the A3 process was used to identify our current state, future state, gaps and counter measures. This process helped us to identify our organizational cultural differences and brought focus to the work we will have to do to bring our respective cultures into alignment as our OHT matures.
In support of this approach, we have identified an executive lead from our Core Partner table to sponsor ‘enabling infrastructure’ workstream to ensure that there is dedicated and distributed leadership for each as we transition to a high performing, full mature OHT. The responsibility of the executive lead is to provide guidance and support to the staff who are completing the work, engaging other leaders in the work and removing barriers. As a collective group, the executive leads work together at the core table to mitigate risks within each workstream to ensure collective success.
The group recognizes how critical engagement, transparency and communication are with such a transformational change. Our engagement strategy includes co-design with and sharing ideas of patients and families, clinicians, front line staff and our non-traditional partners such as housing, police, school board and the university, and our municipalities. Together we have drafted our collective ideal end state for the Guelph and Area OHT. Our plan is to continue to work with these groups to ensure that they are contributing partners and co-designers of the transformation as it evolves. To support this, we have created a communication team to assist us to provide consistent messages within our organizations and externally. We have developed an OHT website that enables two-way communication.
Guelph and Area OHT will build on our past successful change management strategies. We have engaged our clinicians, front line workers, patients and families to help create new care pathways. We rely on their expertise to inform leadership about the required changes and on leadership work to break down barriers. We have experienced success and improved patient outcomes using this approach with our Collaborative Quality Improvement Plans (c-QIPs) for Chronic Obstructive Pulmonary Disease and Heart Failure.
Additionally, Guelph and Area physicians have worked with local system leaders to ensure patient access to primary care, with the first step being to ensure that all patients have access to a primary care provider. Physicians are provided with data and supports to both understand the importance of patient attachment and to review their own roster information on an ongoing basis to ensure new patients in the Guelph area have primary care access. As a result the physician attachment rate in Guelph and Area is 97%.
Strong physician leadership has resulted in the Guelph and Area being uniquely positioned for success in the OHT model because all primary care is based on interdisciplinary teams. Physicians were engaged in identifying roles and functions that could help meet the needs of their patients. As teams were formed, physicians and other clinicians worked with system managers to shape and re-define roles and processes to enable effective team-based care. For example:
- Through Guelph FHT, physicians in the area who were not part of any groups were engaged in discussions about the value of team-based care and subsequently helped design and embed models that worked with their practices.
- The East Wellington FHT began with 4 long standing rural physicians and 5,775 patients. Engaged physicians quickly saw the value of team-based care for their patients but also for the way in which they practiced and soon became champions of collaborative, interdisciplinary care, empowering growth to the current 11 physicians and 12,400 patients.
While EMR implementation in Ontario was not done in any coordinated way, Guelph and area physicians came together with other system managers to review EMR options and determined the software that best met their needs. As the result of a very successful change management effort in the Guelph and Area OHT is the widespread use of Telus Practice Solutions EMR (99%) amongst family physicians (excluding University of Guelph) and the complete adoption of the interdisciplinary team-based care model. Over ten years after the initial implementation, physicians play an ongoing role in identifying opportunities to better use their EMRs. This has resulted in implementation of e-visits, e-consults, use of EMR smartphone apps, tablet-based patient tools, Hospital Report Manager (HRM) implementation and many other system innovations. Some of the Guelph and Area physicians are seen as provincial leaders in digital health. G&A OHT will continue to work with physicians, clinical champions and other clinicians to improve EMR tools.
The Guelph and Area OHT will build on these experiences as we expand primary care-based integrated care teams in our community.