Thread by @javedalloo

Join in and share your insights!
Today, I’ll be tweeting ideas & thoughts about #Integrating #ONhealth care as part of an amazing learning conversation with @wwodchis @JodemeGoldhar @Dr_KerryK @jayshaw29, @baker_ross, @Dr_SteeleGray @wwodchis & @Anne_Wojtak from @ihpmeuoft

A map of our current #ONhealth system shows various functions, structures and organizations, but without a clear shared purpose:

So then, without a clear shared purpose, how can #patients, caregivers & providers have an experience of an #integrated #ONhealth system?

Start by building up from the core of care delivery:

.@wwodchis💬
The efforts to join up #ONhealth will always be an ongoing process: it’s about continuously #Integrating care, rather than just focusing on one definition of an end-state.

How #Ontario Health Teams are part of a long term committed process to bring care together.

.@JodemeGoldhar💬
In the excitement to start #ONhealth teams, we can rush to pick a project and start doing things together – to find efficiencies or simplify health processes. But without a clear shared purpose (the “Why”), these efforts can struggle to scale up & spread.

One of the biggest recognitions of #ONhealth teams is that the outcomes we’re looking for will only be achieved with Collective Effort, and not just individual successes.

Important considerations for individual organizations and care disciplines.

The tools to succeed in #Integrating #ONhealth care won’t arise out of organization’s usual ways of succeeding. At its core, it’s about #codesign and equalizing #power between those our health system is designed to serve, and those facilitating & delivering that care.

Building #NewPower to fuel the transformation of #ONhealth care:

hbr.org/2014/12/unders…

As we work through the different shapes that #Integrated #ONhealth care could look like, it’s important not to jump to assuming “connecting” care depends on novel “roles”, when #JoinedUpCare may be more broadly accomplished by connecting “functions.”

As we plan for #ONhealth teams, I’m hearing important examples of how achieving the desired outcome from added resources depends on identifying barriers to optimal utilization of the new products/services; otherwise waste and opportunity costs are more likely to result.

Working with patients & caregivers to develop self-care resources is critical, so that added services & assets meet the needs, are easy to use, and promote shared life and care goals.

An interesting tension is emerging in how we plan to develop #ONhealth teams, between the traditional approach of starting to work on defined populations which, while simplifying planning+reporting, niches the value to #primarycare providers & the majority of patients in an area.

And how to #primarycare providers & organizations reconcile competing priorities and initiatives between neighboring #ONhealth teams?

In developing #ONhealth strategy & implemention, is there an opportunity to identify efforts that are standardized across most/all OHTs to allow common entry+early participation by community + #primarycare, with later complex specializiations unique to specific communities?

.@baker_ross💬 on adaptive work to build #ONhealth teams:

Achieving #CollectiveImpact depends on:
1. Shared vision
2. Shared measurement
3. Mutually reinforcing activities
4. Ongoing communication
5. Dedicated integration support skills/capacity

Do you have the 5th Discipline?

.@baker_ross encourages a great read to help develop more effective #ONhealth systems-thinking capacity:

en.wikipedia.org/wiki/The_Fifth…

.@Anne_Wojtak shares competencies for leading systems of #Integrated #ONhealth care
1. Re/Framing issues
2. Shifting to the perspective of others
3. Co-designing care w/ #patients/caregivers (micro-level)
4. Systems thinking (macro-level)
5. Sharing power
6. Reflective learning

@Dr_SteeleGray💬
How are the technical problems #ONhealth teams will need to solve different than the adaptive challenges?

The biggest failures will arise if adaptive challenges are treated as technical.

Understanding the context of where and how we work together helps uncover all the different people and processes that underlying efforts to integrate #ONhealth care:

The Front & Back Stage framework informs process, journey and emotion mapping:

So if we get past all the planning stages of #ONhealth teams, how will we know we’re getting the desired outcomes for the designated populations as a result of our specific care interventions?

@wwodchis talks about the challenging decisions to evaluate #IntegratedCare

We can evaluate #ONhealth teams in different ways:
•Formative: focusing on design/activities rather than outcomes, to improve the model of care
•Developmental: supporting innovation to adapt to emergent/dynamic realities
•Summative: determine if intended outcomes achieved

#Evaluation in 8steps
•describe program+context
•build logicmodel on patient,provider,manager tasks
•choose questions together
•base essential measures on logicmodel
•data capture plan
•collect data while implementing
•clarify audience+reporting
•answer questions w/data

Your logic model describes...
•outcomes achieved by
•outputs associated wtih
•activities involved in
•resources required for
...the intervention you’re considering in your #ONhealth team.

Eg. Build on a care pathway (activities) with a list of resources, outputs, outcomes