Best-laid plans – How a modernization strategy paved the way for a pandemic response

In April this year, the OHA launched a social media campaign with the help of hospital staff across the province, to reinforce the importance of staying home  to reduce the spread of COVID-19 and to protect our hospitals from being overwhelmed.

An Ontario Hospital Association Member Update

This update for OHA hospitals members, initially published online in September 2020, was updated in February 2021.

Before the global pandemic, Ontario's health system was already undergoing the most disruptive period of system change in a generation, and for good reason. Hospitals faced new and serious challenges to delivering care, including unprecedented levels of overcrowding, sharply rising demand and serious sustainability challenges.

The three-year journey of modernization mandated by our current 2018-2020 Strategic Plan purposefully positioned the OHA to remain adaptable to an ever-evolving health care environment, with a renewed focus on service to members while influencing broader, system-wide policy change. This platform for change allowed the OHA to be nimble, flexible and sustainable in its response to the health care crisis brought on by COVID-19.

This year's report to members has a dual focus, highlighting both the OHA's efforts to support the sector's response to the pandemic and year-three progress under the current strategic plan – all in service to hospitals and the health care system.

Part 1: System Collaboration and Leadership – Mobilizing the OHA's Pandemic Response

As the global pandemic quickly escalated in early 2020, the OHA directed maximum resources and around-the-clock attention to influencing decision-making at the highest level in key policy areas, and to supporting members on rapidly emerging issues. A seamless transition to a remote work environment and virtual member engagement and learning opportunities ensured that the OHA was well-positioned to take immediate action when COVID-19 arrived.

Advocacy and government relations 

The OHA's March 19 letter to Premier Ford was instrumental in the government's decision to take immediate action to contain the spread of COVID-19, including the declaration of a state of emergency and encouraging the careful ramping down of elective surgeries.

Throughout the pandemic, the OHA continued to play an active leadership role, offering constructive advice to government and local public health officials on a wide range of policy and labour relations issues. Part of this work involved advising on the development and roll-out of key guidance to the field on a range of topics including ramping down scheduled care, hospital visitors, infection prevention and control, and wave 2 scenario planning. To prepare for a major surge of critically ill patients during both waves, the OHA also took steps to enable hospitals to create additional system capacity through the construction of temporary health care facilities, the extension of existing facilities, and by helping to identify strategies to accelerate the placement of ALC patients, including the potential use of hotels. The OHA continues to support to hospitals in addressing significant capacity pressures resulting from the second wave, such as offering critical feedback on the province's COVID-19 Response Framework. In November 2020, Ontario's Premier and Minister of Health attended the OHA's Board meeting to hear directly from members about these escalating pressures and potential solutions.

The crucial anchoring role Ontario hospitals played in the pandemic came at a significant financial cost. As such, the OHA has been in constant discussion with government regarding COVID-19's financial toll on Ontario's hospitals. In September, as part of its fall pre-budget advocacy strategy, the OHA released a position paper outlining three key recommendations based on guidance from the newly established  OHA 2020-21 Hospital Finances Advisory Panel, which continues to provide insight on hospital finances and inform OHA advocacy. Most recently, OHA President and CEO Anthony Dale met virtually with new Finance Minister, Peter Bethlenfalvy, to provide an update on the financial challenges facing the hospital sector for the upcoming fiscal year and put forward a number of recommendations for the Spring Budget. The OHA has also met virtually with the Minster of Health, Christine Elliot and anticipates a meeting with Cabinet members in the short time ahead, to share these recommendations.

Labour and legal/regulatory initiatives 

A central focus of the OHA's advocacy during wave 1 was the need for legal and regulatory measures as well as supporting resource tools that would enable hospitals to better manage critical health human resources during COVID-19. This included redeploying staff to assist with emerging COVID-19 priorities across the system, such as long-term care (LTC) support, and greater flexibility around the hospital credentialing process, to more quickly appoint, re-appoint and grant privileges to medical and other professional staff, in order to address potential surge volumes due to COVID-19. 

Challenges around personal protective equipment (PPE) and pandemic pay also required the OHA's attention. We worked closely with member hospitals, union and other health sector partners, government and Ontario Health to minimize disruption to hospital operations stemming from grievances and other sources of litigation, as well as issues around PPE supply and demand. Following the government's April announcement of pandemic pay for frontline health care workers, the OHA directly advocated to government and through public channels to rectify the question of eligibility due to its counter-productive impact on staff morale. This included an urgent open letter to Premier Ford alongside ten other associations and stakeholder groups.

The OHA also recognized the need to protect hospitals from legal liability as a result of good faith efforts to work beyond their normal scope and in accordance with the government's emergency orders. Together with the Health Insurance Reciprocal of Canada (HIROC), we successfully advocated for hospital indemnity for supports provided to long-term care. In a similar vein, the OHA was able to effectively request a delay in hospital reporting and compliance requirements so hospitals could continue to prioritize the COVID response.

Hospitals continued to play a critical role in the provincial pandemic response during and beyond the second wave through ongoing support for COVID-19 functions and LTC assistance, as well as by addressing the surgical backlog and mobilizing vaccination efforts. These actions have placed enormous strain on hospitals' health human resources, and in response, the OHA has worked with government and managed its relationships with unions with respect to staffing interventions, in order to supplement the existing workforce as well as remove barriers to effective deployment of health care workers to critical priorities. From a legal perspective, the OHA also supported members with key aspects of the vaccine rollout by reviewing the government's prioritization framework, providing members with advice on consent, and the development of template agreements to assist hospitals with vaccination programs.  

Communications, member and stakeholder engagement  

In a rapidly evolving information environment, the OHA has been working to keep members apprised of critical government and system updates through regular bulletins, as well as resources and guidance through social media, dedicated OHA website resources, and informational webinars. Ongoing media relations and the release of public statements on specific issues helped inform the public and amplify issues of interest and importance to hospitals, such as supporting public health messages and calling for robust second-wave planning as well as a more effective provincial strategy to curb the rapid rise in COVID-19 cases together with partner associations. 

Active collaboration with system partners helped provide valuable resources for members. Together with Ontario Health, the OHA hosted webinars on topical issues such as the framework for resuming elective surgeries and updates on the use and repurposing of PPE. And, as hospitals prepared to welcome care partners after months of strict visitor restrictions, the OHA collaborated with the Change Foundation and the Ontario Caregiver Organization, in consultation with a number of member hospitals, to develop guidance supporting this process. A Patient Experience Community of Practice forum also enables peer-to-peer sharing of questions and policies.

Research analysis and data & analytics 

A new, dedicated research and analysis unit helped ground our policy and advocacy work in evidence, synthesizing and sharing research on a wide range of COVID-19 issues, from international lessons learned, to resources on the mental health of frontline workers to a focus on population health, and a weekly review of select local and international COVID-19 initiatives.

The association's growing capacity for Data & Analytics enabled the OHA to develop daily COVID dashboards, leveraged from Ministry of Health and hospital data, that help monitor local and provincial trends, and support government advocacy on hospitals' capacity challenges and COVID-related pressures. On the advice of hospitals' HR leaders, the OHA also began collecting data on hospitals' hiring, redeployment and sick leave payments during the pandemic, allowing hospitals to benchmark their experience, pressures and practices against peers.

Assuring hospital research sustainability 

COVID-19 also had a major impact on hospital research activities due to decreased fundraising capability, the shutdown of parts of the economy, and continued fiscal challenges facing the hospital sector.  On April 2, the OHA wrote to the Prime Minister requesting an immediate sector strategy be developed to support Canada's researchers. To bolster federal advocacy efforts led by HealthCareCAN, VPs of Research, and other health partners, the OHA played a key role helping to define and quantify the support package needed from the federal government.

On May 15, the Prime Minister announced $450M in funding to support Canada's academic research community during the pandemic. The OHA also submitted recommendations to the House of Commons Standing Committee on Finance as part of the  federal 2021 pre-budget consultations recommending increased funding for health research as a key to securing Canada's economic future and global leadership in research, and the launch of a national discussion on strengthening our health care system and our ability to properly fund health and social services into the future.


Part 2: Fruits of Modernization – A Year of Progress in Serving Hospitals and the Health System

Over the past three years, the journey of modernization embedded into the OHA's strategic plan has focused on areas that could offer longer-term value for members, as well as initiatives that embody the OHA's proud legacy of rallying the sector together to build solutions to some of our biggest, shared challenges.

These efforts, realized in year three of our strategy, provide a solid foundation for the OHA as we reflect on a drastically altered health care landscape and anticipate where the health system needs to go. To allow the OHA to build on lessons learned during the pandemic, this May, the OHA Board of Directors approved an extension of the current strategic plan for up to 12 months. Progress made in service to members and the health system includes:

Advocating for fiscal sustainability

In December 2019, the OHA kicked off its 2020 pre-budget campaign with the release of Ontario Hospitals – Leaders in Efficiency, which powerfully demonstrates extensive efforts that have made Ontario's hospitals national leaders in financial and operational efficiency. As such, without appropriate investment, access and quality of care continue to be at risk – greater now in the aftermath of COVID-19. During the OHA's presentation to the Standing Committee on Finance and Economic Affairs in January 2020 as part of the government's pre-budget consultations, we underscored the need for a national discussion on how to strengthen our health care system, especially given the sharply rising provincial deficit, record-setting efficiency levels among Ontario's hospitals, and inadequate capacity in other settings. In March 2020, Finance Minister Rod Phillips announced $935 million for the hospital sector as part of the province's fiscal update, and an additional $124 million to support over 90 transitional care projects.

The former Council of Academic Hospitals of Ontario (CAHO) pre-budget submission strongly supported the OHA's recommendation for an increase of 4.85% or $922M to hospitals in the 2020 budget. It also called for continued government investment in the Ontario Research Fund (ORF). Subsequently, $22.9 million was allocated for the COVID-19 Rapid Research under the ORF and 25 of the 39 COVID-19-funded projects under this program are at research hospitals.

Mental health and addictions funding reform

The OHA is coordinating the exploration of funding approaches for Mental Health and Addictions through the Hospital Advisory Committee, under its recently established Mental Health and Addictions Funding Advisory Committee (Committee). The Committee will investigate and provide advice on funding methodologies that can support and incentivize improved quality of care for patients accessing mental health and addiction services. Specifically, the Committee's various working groups are developing a phased approach to explore funding of the Quality Standard, starting with Schizophrenia Care in Hospital, and subsequently, Schizophrenia Care in the Community.

Improving mental health care requires adopting best practices and measurement-based care. Committee and working group members recognize the many challenges that stem from the variation in practice and, as such, support standardized measurement-based care across the continuum.  To help achieve this goal,  an educational webinar series focusing on standardized use of measurement-based care for mental health and addictions services was jointly developed by Ontario Health's Centre of Excellence (COE) and the OHA.

Recognizing the value of data-driven decision making, the Committee is advising on improvements required to support data quality and reporting and working with the COE to support their data and digital projects in alignment with Ontario's Roadmap to Wellness Mental Health and Addictions Strategy.

Collaborative System Change

Rethinking aging and long-term care 

Due to COVID's significant effect on Ontario's long-term care sector, on May 19, 2020, the government announced the launch of an independent Commission that would consider how COVID-19 spread within long-term care homes; its impact on residents, staff, and families; and the adequacy of measures taken to prevent, isolate and contain the virus. The OHA developed a submission to the Commission informed by research and interviews with member hospitals that focus on their efforts to assist long-term care partners during the pandemic. OHA staff along with two hospital CEOs appeared before the Commission share members' direct experiences working with LTC homes in their communities. A full transcript of the OHA's presentation was posted to the Commission's website. The OHA has provided additional feedback to help inform the Commission's final report, anticipated in April 2021.   

Collaborating on the future of home and community care

The OHA has continued its productive collaboration with partners Home Care Ontario and the Ontario Community Support Association (OCSA). In response to a government request for ideas, beginning in October 2019, the three associations convened approximately 40 representatives to share knowledge and expertise to inform priorities and objectives for a new vision of home and community care within an Ontario Health Team environment. In January 2020, we shared some of the key features that emerged from these discussions with government. To our knowledge, this is the first significant non-governmental effort in thought leadership in this area, and the first time in Ontario's history that our sectors have collaborated on work of this scale and complexity. The groundwork for some of these changes was laid by Bill 175, the Connecting People to Home and Community Care Act, introduced to build a modern and flexible system to deliver home and community care. On June 16, 2020, the OHA presented to the Standing Committee on the Legislative Assembly on Bill 175 and continues to engage with the Ministry of Health and other stakeholders, including the OCSA and Home Care Ontario, on proposed regulatory changes announced alongside the bill and as home and community care modernization continues.

PHIPA modernization

As part of the government's continued modernization of the Personal Health Information and Protection Act (PHIPA) modernization, the OHA engaged with senior privacy leaders and legal counsel across Ontario's hospitals to provide comprehensive feedback on the proposed digital interoperability specifications.

Expanding data and analytics services

In the fall of 2019, the OHA launched its Data and Analytics platform as part of its core services to members to address hospital needs and facilitate the integrated care agenda. This web-based, Tableau-driven applications offer hospitals access to accurate, insightful data to enable quick analysis and evidence-based decision making. Initial applications within hospital finance and human resources' dashboards focus on comparative performance relative to peers, identifying areas for improvement and customized data exploration.

The OHA is working to enrich its data and analytics offerings by acquiring and expanding the Integrated Decision Support (IDS) solution created by Hamilton Health Sciences. IDS, a leading collaborative solution for sharing integrated health partner data, enables its network of health providers to exchange data about shared-care patients in support of analytics, monitoring patient flow, planning quality improvements and performance measurement. This mature, data sharing network and business intelligence tool will provide a critical foundation for health service providers to meet data sharing needs as Ontario drives towards greater system integration through initiatives such as Ontario Health Teams, while growing the OHA's data assets in support of  benchmarking and advocacy.

People at the Heart of System Change 

Prior to COVID-19, OHA Learning and Engagement continued to focus on strengthening leadership and capacity for change within Ontario's health system. This ranged from continued evolution of a high-impact Healthcare Leadership Summit, to the launch of two active Peer Collaboration Networks: CEOs Out Front for a small cohort of new CEOs; and Board Chair at the Helm for Board Chairs, seeking to maintain continuous engagement at the governance level. In addition, a program designed for stewards of integrated care including Ontario Health Teams, Aligning Strategy and Measurement for an Integrated System of Care, built on the expertise of the Institute for Health Policy, Management and Evaluation and the OHA.

In the wake of the impact of the COVID-19 pandemic the OHA paused in offering most of its established learning opportunities to review its entire portfolio of learning and engagement activities.

Meanwhile, following collaborative discussions between the boards of the OHA and The Change Foundation (TCF) for stronger alignment between the two organizations, TCF announced in October 2020 that its mission re-set would focus on leadership development and change leadership.  This strategy is being shaped in consultation with TCF's board and sector leaders and will benefit from a running start that draws upon OHA's existing hospital and health system leadership development efforts. Both organizations are committed to a smooth transition, and to maintaining a focus on serving and supporting hospital members and health system partners as this work continues through the coming months.

Engaging hospital members  

An internal OHA team is working to provide recommendations for an enhanced, modernized engagement strategy based on interviews with hospital CEOs and leaders from health service and trade associations in Ontario, Canada, and other international jurisdictions. The review process will align with the OHA's strategic planning process, which is underpinned by comprehensive member engagement and scheduled to run through the 2021-22 fiscal year.

Enhancing workplace culture, wellness, resilience

As part of a CIHR-Health System Impact fellowship grant, the OHA examined organizational supports designed to prevent and address burnout. Its purpose is to shed light on organizational policies and interventions that support front-line health care providers experiencing burnout and to continue to explore support models targeted at preventing and addressing burnout.

The Ontario Ministry of Labour awarded the OHA a generous grant from its Human Capital Research and Innovation Fund (OHCRIF) to pursue and action findings from a recently completed five-hospital research study into emotional intelligence, engagement and burnout led by the Yale Center for Emotional Intelligence. Imperative for Organizational Wellness will work to apply and prototype the first phase findings.

Collective bargaining

Prior to the pandemic, the OHA labour relations team was heavily engaged in negotiating a renewed collective agreement with the Ontario Nurses' Association (ONA) – the largest central bargaining process involving almost all Ontario hospitals. As anticipated, the negotiations proved to be complex given the impact of Bill 124, Protecting a Sustainable Public Sector for Future Generations Act, 2019. These challenges were further amplified during interest arbitration in the early stages of COVID-19. Ultimately, the board of arbitration awarded compensation within the Bill's limits; the negotiating team successfully avoided the imposition of ONA proposals on job security and staffing that would have significantly impacted hospital operations. During negotiations, the parties mutually agreed upon several items which came into effect upon the release of the arbitration award, including a number of proposals that are a priority for hospitals, such as the introduction of temporary positions and elimination of the notice period for eliminating positions.

Sector-wide employee group benefits

The OHA and HIROC continue to work together on the development of a potential structure that would provide a voluntary, province-wide plan for the delivery of hospital employee group benefits. Preliminary work regarding structure and governance is nearly complete with work and analysis to design the model now in progress with the help of Willis Towers Watson. This past fall, the OHA reconvened its Hospital Advisory Group to provide guidance on the model design phase and to ensure a hospital-driven approach. An in-depth webinar for hospital members was held to kick off this the next phase of work. There has been strong interest and participation in the design phase of the project, which will continue through the spring of 2021 and culminate with a final report outlining the proposed structure and value proposition of a provincial model.

Physician engagement  

The OHA continues its work to enhance the hospital-physician relationship including a strong partnership with the Institute of Health Policy Management and Evaluation (IHPME), Dalla Lana School of Public Health (DLSPH) at the University of Toronto. A survey was developed to acquire baseline data at individual, organization and system levels, on current Ontario rates of physician engagement for physicians with hospital privileges. Exploring psychological empowerment, well-being and emotional intelligence, the survey was distributed across nine provinces with more than 1,100 responses. Two literature reviews – a scoping review on hospital physician engagement and concept analysis of the term 'physician engagement' – have been widely published.

Additionally, in consultation with the Ontario Medical Association (OMA), the OHA completed a substantive update of the 2012 Professional Staff Credentialing Toolkit, which continues to be one of the most utilized OHA resources. It provides practical guidance to assist hospitals in managing board-appointed professional staff. The template Board-Appointed Professional Staff By-Law was also updated to reflect revisions to the Credentialing Toolkit. Publication of these resources is expected in April 2020.

The OHA also offered detailed recommendations on some of the key priorities identified by hospital-based physicians in support of the Physician Services Agreement negotiations between the Ministry of Health and the OMA.

Renewing and Strengthening Key Relationships

Following careful consideration and wide consultation, CAHO was successfully integrated into the OHA in the spring of 2020. This integration enables a single approach to managing and delivering association services to Ontario's hospitals, enhancing value, optimizing costs, and maximizing benefits for all Ontarians. The OHA is confident that the research and education priorities of Ontario hospitals will be well served within the association, and that the entire hospital sector will be stronger as a result of this integration.

The OHA has also continued progress respecting its affiliated entities including The Change Foundation (TCF), as reported above, and the Healthcare of Ontario Pension Plan (HOOPP).

The OHA is committed to exercising its duties and obligations to ensure effective stewardship of HOOPP. Together with the other Settlors of the Plan, the OHA remains focused on the pension accounting treatment of HOOPP and its impact on HOOPP's independence and ability to deliver on its pension promise. The OHA has also worked with the HOOPP Board to fulfil recruitment needs and establish a new pension observer strategy.