Resilience and Recovery: Navigating the Ongoing Pandemic Response and Building Back Better for the Future

​The OHA developed educational videos reaching out to youth, featuring Ontario physicians, to answer questions about COVID-19 and combat misinformation.



An Ontario Hospital Association Member Update

Since early 2020, Ontario's hospitals have demonstrated resilience and commitment as they responded to a global health care crisis like nothing ever experienced. Working side-by-side with government and system partners, hospitals faced extraordinary pressure from COVID-19 to provide lifesaving care to their own patients, while stepping up to support long-term care homes, assessment centres and a successful vaccination effort, as well as conducting research to better understand the virus.

CP121686203.jpgThe Ontario Hospital Association (OHA) is honoured to continue supporting our hospital members as we navigate the pandemic and look to the future. A strategic plan rooted in adaptability has enabled us to meet urgent and emerging needs. This included providing advice to government to address a range of financial, labour relations and legal issues, as well as advocacy and public communications to encourage action for the protection of all Ontarians.

Now, work is underway to shape the OHA of the future by incorporating lessons learned during the pandemic and through the development of our next strategic plan. The OHA is gradually shifting its focus from the pandemic response to supporting hospitals with recovery efforts and plans to address needed changes to the health system laid bare during the pandemic. However, we will remain vigilant to a potential surge in patients during the pandemic's fourth wave. Until a new strategic plan is in place, we will continue to deliver on key priorities under the current plan, which was extended following approval from the OHA's Board of Directors in May 2020.

Similar to last year's Report to Members, the 2021 report has a dual focus, with an overview of both the OHA's efforts to support the sector's pandemic response and continued progress under the current strategic plan – all in service of our members and the health care system.


Part 1: Sustaining the Pandemic Response and Initial Steps towards Recovery

With the emergence of more aggressive COVID-19 variants which spiked hospitalizations and ICU admissions during waves two and three and the urgency of the vaccine rollout, the OHA primarily focused on pandemic-related advocacy and providing member support on a range of labour relations, legal and regulatory issues.

Advocacy

In early 2021, the OHA advocated for supports to allow hospitals to rapidly mobilize resources to maximize their capacity to care for patients. In April, the government instituted a redeployment order under the Emergency Management and Civil Protection Act (EMCPA) to support the hospital sector's response, such as implementing new staffing models, accepting assistance from other organizations and potentially other provinces, and preparing for potential redeployment of health care workers between hospitals. Other orders authorized Independent Health Facilities to redeploy staff to hospitals on a voluntary basis, facilitated the flow of patients from acute to long-term care and enabled temporary, emergency-based patient transfers between hospitals. 

The OHA was also a leading voice calling for continued and strong public health measures, underscoring to government and the public COVID-19's growing threat to hospital capacity and access to care.  As the third wave slowly eased, in May, the OHA sent a letter to Premier Doug Ford outlining important considerations to support a gradual, evidence-based re-opening plan. In August 2021, Ontario Chief Medical Officer of Health Dr. Kieran Moore attended the OHA's Board meeting to speak with members about planning for the pandemic's fourth wave and to hear about challenges and concerns for the sector.

Partnership

In early 2021, co-sponsored webinars with Ontario Health (OH) and connected hospital CEOs with OH leaders on emerging priorities related to the COVID-19 response. In May, the OHA Board welcomed OH President and CEO Matt Anderson to speak about the ongoing provincial COVID-19 response, re-opening, and post-pandemic recovery. Hospitals also shared their concerns, such as greater funding clarity and new resources to enable system recovery. A strengthened relationship between both organizations will support post-pandemic re-building initiatives. 

Vaccines

CP121438119.jpgCOVID-19 vaccines are critical to easing hospital capacity pressures, long-term. As such, the OHA proactively engaged the COVID-19 Vaccine Distribution Taskforce early on outlining considerations to guide the provincial vaccine rollout like addressing vaccine hesitancy and the need for a broad and comprehensive communications strategy to maximize voluntary vaccination of health care workers. Outreach to relevant system partners such as the COVID-19 Vaccination Action Council also helped support the vaccine effort.

The OHA joined the Healthcare Reciprocal of Canada (HIROC) to address various vaccine-related issues via regularly held member webinars, covering topics such as legal impediments related to vaccine administration, including the need for a consistent consent process, detailed user agreements, and future use of data for research purposes.

Most recently, the OHA established the Healthcare Worker Vaccination Advisory Group with the goal of establishing a consistent, province-wide healthcare worker vaccination framework and to help the sector increase worker vaccination. On August 17, Ontario's Chief Medical Officer of Health issued Directive #6 which sets out minimum requirements for hospital policies regarding COVID-19 vaccination among healthcare workers, enabling hospitals to tailor vaccine policies to their unique needs.

Funding and sustainability

The pandemic has had a substantial impact on hospital operations and, in turn, hospital finances. To support members, the OHA has been closely monitoring financial challenges arising from hospitals' pandemic response with regular financial surveys to inform discussions with the Ministry of Health (MOH). We continue to be in regular communication with senior MOH staff to ensure reimbursement for incremental expenses and lost non-ministry revenue. 

In response to concerns raised by the OHA regarding the 2021-22 COVID-19 Hospital Incremental Expense guidance document shared on July 2021, the MOH changed its position announcing its reimbursement of first-quarter expenses reported for fiscal year 2021-22 and in August 2021, released a revised COVID-19 Expense Reimbursement Template. The OHA continues to work with the MOH and OH on eligibility criteria for the incremental COVID-19 expenditures for the remainder of fiscal year 2021-22, and to ensure the sector is funded appropriately for surgical recovery. The OHA also facilitated a number of webinars on behalf of the MOH to support hospitals with these new funding investments.

Communications, member and stakeholder engagement

An aggressive, multipronged communications strategy supported OHA advocacy efforts to safeguard the province's finite health system capacity. It consisted of media interviews at the regional, provincial and national levels which resulted in coverage in almost every notable outlet in the province, an updated social media campaign, and outreach to youth via informational videos, which recently won Best Overall Campaign at the Reed Awards beating out international competitors.

Picture1.pngResearch and analysis

A dedicated research and analysis unit also helped support the OHA's communications, policy and advocacy work with research and evidence on a wide range of COVID-19 issues, including a bi-weekly review of select local and international COVID-19 initiatives, and the development of a vaccine resource page and research brief designed to assist hospitals in building vaccine confidence. Another research brief highlighting the elements and principles of effective communication strategies was developed for members, offering guidance that would help increase the impact and reach of their efforts (e.g., choosing appropriate language to promote adherence to public health advice). 

Strategic plan and post-pandemic work

In early 2021, the OHA held a series of member engagement sessions to gather feedback on the pandemic's impact on hospitals and for input on key learnings for the health care system. They were also an opportunity to report on progress towards the development of the OHA's next strategic plan, which will be implemented in 2022. A Special Committee of the OHA's Board of Directors guides this work, and engagement with members, partners and stakeholders continues.

The OHA also convened an internal OHA team to focus on post-COVID recovery and transformation. Partly informed by the member consultations, this project has two components: a retrospective compilation of hospital experiences and lessons learned, and prospective work to inform future advocacy and thought leadership. Our goal is to align and collaborate with partners wherever possible, while being a strong voice for hospitals.

Education and Research Mandates: Building on strong collaboration, work to define the new education mandate has begun – one focused on the areas of health human resource educational needs, comprehensive funding for health professional education, and the learner environment and experience. The vision is to have fully integrated, interprofessional and evidence-informed learning that enables thriving health professionals, a high-functioning health system and exceptional patient care.

With a goal of unleashing innovation in Ontario, the development of the health research mandate will look to optimize the integration of health research and clinical care, including funding, while also looking to utilize the entire hospital network as a coordinated tool for research.  Developing an interconnected community of researchers across all health centres will strengthen science, the community, and patient outcomes.

 

Part 2: Laying the Groundwork for Future Recovery

Advocacy

Picture2.pngAs part of its pre-budget advocacy strategy, the OHA released a position paper in September 2020 outlining three key recommendations based on guidance from the OHA 2020-21 Hospital Finances Advisory Panel. The OHA also met virtually with key government officials including Finance Minister Peter Bethlenfalvy, Minister of Health Christine Elliott and Cabinet members, to update them on the sector's financial challenges for the upcoming fiscal year and share the OHA's recommendations for the spring Budget. The March 2021 Ontario Budget announced over $1.8 billion in funding to help hospitals recover from financial pressures created and exacerbated by COVID-19, including reimbursement for qualifying portions of lost revenues and monies to help cover historic working funds deficits, with a focus on small- and medium-sized hospitals and specialty and rehabilitation hospitals.

A newly convened Advisory Group on Pre-budget Advocacy and Election Preparedness is helping inform advocacy efforts for the 2021 federal election, next year's provincial Budget, and the 2022 provincial election. The group provides advice and guidance to the OHA on the pandemic's long-term financial impact on the hospital sector, particularly those located in hotspot regions, and will help determine the key components of the OHA's policy platform.

Strengthening hospital-physician relationship

Picture3.pngOver the past year, the OHA continued its work to enhance the relationships between hospitals and physicians, which included a focus on strengthening its partnership with the Institute of Health Policy Management and Evaluation (IHPME), Dalla Lana School of Public Health (DLSPH) at the University of Toronto. In addition to the publication of five peer-reviewed manuscripts, the OHA/IHPME research team developed a cross-sectional survey and acquired baseline data on current Ontario rates of hospital physician engagement at the individual, organizational and system levels.

In September 2021, the OHA, in consultation with the Ontario Medical Association (OMA), substantially revised and relaunched the Professional Staff Credentialing Toolkit. Published almost a decade ago, the Credentialing Toolkit was revised to reflect current practices in hospitals, capture general policy and legal and environmental changes since it's original release. The OHA and OMA also jointly published an update to the Prototype Board-Appointed Professional By-Law to reflect legal and regulatory changes, evolution in hospital practice, and lessons learned from the COVID-19 pandemic.

Youth DiverSTEAM Symposium: Promoting careers in hospital research

Picture4.pngOn May 13, almost 300 high school students in Grades 9-12 had the opportunity to hear about the various pathways to a career in hospital-based STEAM research and to network with 200 hospital-based researchers in a virtual environment. Hosted by the OHA and Let's Talk Science, the event was championed by the OHA's Health Research & Innovation Committee, which established an Anti-Racism Task Force in 2020 to identify, challenge and change the values, structures and behaviours in place that perpetuate the differential treatment of individuals based on ethnic identity.

Data and Analytics

The OHA is taking steps to enhance hospitals' access to effective patient experience measurement tools. In January 2021, the OHA launched broad, in-depth consultations with hospital members to inform a competitive request for proposals (RFP) for a new patient experience measurement provider. The RFP was released in July 2021 and a new contract agreement is expected to be in place for the 2022-23 fiscal year. Picture5.png

As a leading collaborative solution for sharing integrated health partner data, Integrated Decision Support (IDS) has helped enrich and grow the OHA's data and analytics portfolio. Since the OHA assumed stewardship of IDS in early 2021, there has been strong and steady interest and expansion with new signed clients, including multi-sector partners from Ontario Health Teams and hospitals. Work is currently underway to establish the IDS Governance Committee and IDS Privacy Committee.

Health human resources

In May 2021, the OHA, together with the Ontario Long Term Care Association, Colleges Ontario and the Council of Ontario Universities, issued a joint letter to government calling for a comprehensive health human resources (HHR) strategy to ensure Ontarians have access to the right number and mix of qualified health care providers now and in the longer-term. Among other things, it requests immediate action to strengthen the HHR workforce in various areas; expanded enrolment in health and supportive care programs; and the establishment of an interprofessional HHR planning table to analyze health workforce data and develop an HHR strategy.

Benefits strategy: The OHA and HIROC are working together to co-design a Benefits Strategy for the delivery of hospital employee group benefits. In May, the OHA and HIROC Management Limited (HML) shared the final report developed by Willis Towers Watson (WTW) with members, detailing a proposed model and structure for a provincial benefits plan. There was strong participation from hospitals, with 90 per cent who provided their employee group benefits data to inform the financial analysis, the proposed model and structure. The OHA surveyed member hospitals to gauge ongoing interest and aid the OHA and HML boards in deciding next steps this fall.

Collective bargaining: For the second consecutive year, 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 was the case in 2020, the negotiations proved to be complex given the impact of Bill 124, Protecting a Sustainable Public Sector for Future Generations Act, 2019, as well as the ongoing response to the COVID-19 pandemic. These external forces ultimately resulted in the parties reaching an impasse in negotiations, with outstanding issues referred to interest arbitration in April. The parties are currently awaiting the decision of the board of arbitration.

Additionally, the OHA team commenced negotiations with the Canadian Union of Public Employees (CUPE) and Service Employees' International Union (SEIU) for a renewed collective agreement at a joint table.  As with ONA, these negotiations take place under the auspices of Bill 124.  Negotiations will continue through late September with interest arbitration, if necessary, taking place in early 2022.

Funding

Hospital Advisory Committee: In September 2021, the OHA, jointly with the MOH and OH, reinstated the Hospital Advisory Committee (HAC) to provide strategic advice and recommendations to the MOH on patient-based funding models, their implementation, and improvements to health funding practices. The HAC will provide advice on policies to address financial stability related to the impact of COVID-19. HAC works across organizations and sectors to promote more integrated approaches to health care delivery in Ontario.  

The Mental Health and Addictions (MHA) Funding Initiative: The MHA Funding Advisory Committee and its Working Groups identified recommendations for developing a patient-based funding approach for mental health and addiction services in Ontario. The Committee has written an interim report that includes short- and long-term approaches to creating a value-based payment system and presented a status update to the HAC in September 2021. The short-term approach includes a funding methodology that will link to quality of care based on process indicators from the Ontario Health Quality Standard Schizophrenia – Care for Adults in Hospitals. Hospitals have since started to collect data to inform the calculation of these selected indicators. The opportunity to integrate community mental health indicators will be discussed in future meetings, along with a case mix system for inpatient mental health. 

OHA and OH Measurement-Based Care Education Series: As part of the MHA Funding Initiative, the OHA and OH's Mental Health and Addictions Centre of Excellence designed a series of free virtual education sessions on measurement-based care (MBC) in mental health and addictions service delivery for Ontario (view the first video in the series below). Each webinar featured local and international leaders who have implemented and scaled MBC in their care settings. The considerable number of participants from senior administrative and clinical leaders in addition to patient care providers, demonstrated a g rowing appetite to learn how local peers have tackled the challenges of implementing MBC. OHA and OH staff are exploring additional opportunities to build on this strong engagement.  

Exploring Integrated Care Funding Concepts and Principles: To better understand funding concepts and principles that support integrated care, the OHA initiated a literature review and discussions with local and international policy makers, academics and hospital executives. The OHA's Research and Analysis Unit continues to undertake the research in collaboration with academics at the Laval University, with the goal of a virtual round table discussion on the findings through HAC governance in fall 2021.  

Research and analysis

The research and analysis unit continues to inform the OHA's policy, advocacy and communications work by exploring emergent issues impacting hospitals from a health care perspective and beyond. This has included the curation of anti-racism and population health resources given the significant health care gaps further exposed during the pandemic.

Organizational/Partner updates

The OHA is committed to exercising its duties and obligations to ensure effective stewardship of Healthcare of Ontario Pension Plan (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.

The OHA strongly endorsed The Change Foundation's (TCF) re-set of its mission that would focus on leadership development and change leadership. This strategy is being shaped in consultation with TCF's board and sector leaders and has benefited from a running start that draws upon the OHA's existing hospital and health system leadership development efforts. Both organizations are committed to maintaining a focus on serving and supporting hospital members and health system partners as this work continues through the coming months.