Dialogue on the Future of Health Care in Ontario

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Featured in half-yearly report: G-politik in Industrieländern 9

Abstract

In the fall of 2006 the Ontario Medical Association (OMA) launched their Campaign for Healthier Care, a multi-pronged initiative to explore the future of health care services and delivery in the province of Ontario. One component of that campaign was the engagement of a diverse cross-section of health care stakeholders in a dialogue about the medium term prospects for health care delivery in the province. These dialogue sessions were the first ever sponsored by a provincial stakeholder group.

Purpose of health policy or idea

The goal of the initiative was to engage stakeholders from across the health care sector in a sustained dialogue about the future of health care in Ontario . The hope was to identify common ground amongst stakeholders that could serve as the basis of future collective action to advance the process of health care reform. 

It was the first attempt by a leading provincial stakeholder group to engage in this kind of structured generative dialogue with other stakeholders within the system. The dialogue process was designed to have participants focus on a long-term vision for the provincial health system in the year 2020 and was conducted by professional facilitators and designed by an independent think-tank, the Canadian Policy Research Networks. These results of these dialogues are meant to feed into the Ontario Medical Association's Campaign for Healthier Care which is designed to engage citizens, stakeholders and governments in articulating broad based goals for health care reform in the province.

Main points

Main objectives

The dialogues were designed to create a long-term vision for the provincial health care system in the province of Ontario. Five half-day generative dialogues were held across the province in late 2006 with participation of stakeholders from across the health and social services system. The vision articulated by the participants will hopefully provide direction for the OMA in its relations with governments, the other stakeholders in the system and in terms of redefining its own role as an advocate for health system reform on behalf of its members and the public. The dialogues were professionally designed and facilitated by an independent think tank (CPRN).

Type of incentives

N/A

Groups affected

Ontario Medical Association, Other provincial health care stakeholder organizations (nurses, physio, allied health), Government of Ontario

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

On the face of it, the Dialogue on the Future of Health Care Services in Ontario is a small step in changing the role that the Ontario Medical Association plays in the overall process of health care reform in the province. But insofar as it constitutes a deliberate attempt to engage actively with other stakeholders and to recognize that there are multiple voices inside the system with which it must engage then the dialogues are an important change in the way the OMA has traditionally behaved inside the Ontario health care system. 

Generative and deliberative dialogues are an increasingly common feature of Canadian health care policy processes precisely because they have been demonstrated as being able to bring together organizations with diverse and sometimes conflicting interests to search for both common ground and to develop strategies for collaboration in service of advancing shared positions. 

What is truly innovative in this dialogue is that it is the first time a major provincial stakeholder that had traditionally had somewhat conflictual relations with both governments and other stakeholders in the system has attempted to reposition itself in this manner.

There are likely divisions over this strategy within the OMA that will need to be accommodated if it is to mark a permanent change in the behaviour of the organization vis a vis government and other health stakeholders. 

Political and economic background

The political background to the dialogue initiative comes from what seems to be the desire of the Ontario Medical Association to significantly alter the role it plays in the provincial health care system. The OMA's relations with both the government and other stakeholders in the province had, of late, been conflictual. These conflicts came to a head in recent years over the negotiation of recent contracts whereby governments had tried to negotiate a fee schedule that would have moved more doctors away from fee-for-service practice into a variety of alternative payment schemes. These negotiations also revealed a significant division within the OMA as younger physicians appeared more open to moving away from fee-for-service schemes where older physicians were much more attached to their traditional remuneration schemes. This ongoing conflict between the OMA and other actors had also damaged the organization's standing with the general public.

At the same time, the OMA was rarely seen as being at the forefront of the move to reform the provincial health care system and was perceived by other actors to be a barrier to making progress on primary health care reform (including the increased use of interdisciplinary teams), the better use of health human resources (including new professions such as nurse practitioners and physician assistants) and new governance and accountability relationships.  Unlike its national counterpart, the Canadian Medical Association (CMA), the OMA did not often engage in collective action or joint lobbying initiatives with other professional associations in the provincial health system.  New leadership in the OMA, however, seems to have conceived both the Campaign for Healthier Care and the dialogue with stakeholders as a deliberate attempt to change the role of the OMA and to position it as a more positive force in the health care debates in the province.

Complies with

The dialogue with stakeholders was designed to reach out to other stakeholders in a manner that the OMA had never attempted before and to alter the way its role is perceived in the health care debates in the province.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

The Dialogue on the Future of Health Care Services in Ontario originated as part of the OMA's Campaign for Healthier Care, launched in late 2006.  It originates with the desire of the new leadership of the OMA to change both its role in the provincial health policy debates and the way it is perceived by other actors (both governmental and non-governmental) within the provincial health system itself. 

The purpose of the dialogue was to attempt to find common ground amongst stakeholders that could be articulated as a broadly conceived vision of what the provincial health care system in the year 2020 should look like - how it is structured, how it is governed, what services are delivered and how services are delivered and by who. 

While this kind of engagement exercise is new to the OMA, it is the kind of process that has been successfully used in other parts of the country (e.g. the Saskatchewan government's annual stakeholder consultation conferences on health human resources) and on a national scale (e.g. the Citizens' Dialogues held as part the work of the Romanow Commission on the Future of Health Care in Canada). 

While the OMA sponsored the dialogue with stakeholders, it should be stressed that it did not actually organize, design or carry-out the dialogue sessions themselves.  The dialogues were designed and conducted by an independent think tank that operated at arms-length from the OMA in order to insure that the dialogues were methodologically sound and the results synthesized in a manner that accurately reflected the views of the participants.

The dialogues consisted of five half-day sessions held in various communities across the province and invited policy-makers and stakeholders from across the full spectrum of the health care system (doctors, nurses, allied health professions) as well as community based and social services organizations. While a true cross-section was not achieved in terms of a representative sample in each dialogue, taken collectively the participants represented a reasonably comprehensive cross-section of the health system. 

Participants were give both a discussion paper from the OMA and a workbook & worksheets designed by CPRN which provided participants with an opportunity to reflect on what health care needs might be in the year 2020 as well as to address how the health care system will have had to change in order to meet those needs.

Through both plenary and small-group discussion, the dialogues produced both some common themes and some interesting differences amongst the participants.  These themes were then further refined in terms of the kinds of changes that the health care system will have to undergo in order to deal with the changing nature of the population's health needs.

Initiators of idea/main actors

• Leistungserbringer

Approach of idea

The approach of the idea is described as:
new:

Stakeholder positions

In assessing the outcomes of the dialogue sessions, it was clear that many of the stakeholders were, at first, somewhat concerned about the motivations of the OMA in sponsoring a multi-stakeholder dialogue.

However, the overwhelming conclusion from the participants was that they were very supportive of the OMA's reaching out to others in the health system and were appreciative of a process that began with the search for common ground and the development of a common vision. They felt this marked a change in the traditional way in which the OMA operated and were willing to engage with the OMA on the basis of having a conversation as organizations that collectively wanted to facilitate positive policy reform.

The vision of the Ontario health care system in 2020 included:

A greater emphasis on services across the full continuum of care

• Increased focus on the determinants of health
• Greater resources devoted to community-based care delivery
• Increased patient education and awareness

The changes needed to achieve this vision included:

1. More integration required to allow for better use of inter- and multi-disciplinary teams of providers who not only work together but are educated together
2. Increased use of patient navigators
3. Better use of evidence in health care decision-making
4. More effective use of technology
5. Better ability to manage change - a more flexible system with better policy-research-provider collaboration

In addition the participants delivered some very clear messages to the OMA as part of their deliberations:

1. The OMA has to recognize that physicians are only one of many health providers and that they need to listen to other providers more constructively
2. Physicians are crucial to successful health care reform
3. The OMA can play a vital role in insuring that there are adequate resources for all parts of the health care system

Actors and positions

Leistungserbringer
Ontario Medical Association	sehr unterstützend		stark dagegen
Nursing stakeholders	sehr unterstützend		stark dagegen
Allied Health providers	sehr unterstützend		stark dagegen

Influences in policy making and legislation

The dialogue is part of a broader campaign launched by the OMA that appears designed to reposition the organization's relationship with both other stakeholders in the system and with the provincial government.   It is not designed as a legislative process but could mark a reshaping of the landscape in which policy decisions are made.

 It is not clear yet what the response of the OMA will be to the results of the dialogue and whether it will have a significant impact on the way the organization approaches the broader health care reform issues facing the province. 

The OMA remains one of the most powerful health care stakeholders in the province and will always be a key player in facilitating or blocking reform initiatives from government.  If the result of both the dialogues and the Campaign for Healthier Care is to build better collaboration between the OMA and other stakeholders in the system then there is some reason to believe that the prospect for some significant movement in the areas of primary care reform and a more adaptive and flexible system is greater now than it was a few years ago. 

Legislative outcome

n/a

Actors and influence

Leistungserbringer
Ontario Medical Association	sehr groß		kein
Nursing stakeholders	sehr groß		kein
Allied Health providers	sehr groß		kein

Positions and Influences at a glance

Expected outcome

The dialogue process (and the campanion campaign) launched by the OMA may constitute a significant change in the direction of the OMA in terms of its relations with governments, other actors within the system and its relations with the public. If the OMA chooses to act on the vision articulated by the dialogue and to change its relations with other actors inside the system then this could be a watershed moment in the creation of a different political atmosphere around issues of health care service delivery. 

In a very real sense, the OMA has taken something of a risk in engaging in this way.  It has revealed some internal divisions between older and younger physicians in terms of how they should approach health reform issues and it has taken a risk in terms of engaging with other stakeholders in an unprecedented manner. While it remains uncertain whether the risk will pay rewards, it is clear from the reaction of the participants in the dialogue that they welcome the OMA's change in direction and want very much to see them as a partner in an ongoing process of service delivery reform.  The caveat they place on that welcome, however, is the need for the OMA to take seriously the notion of being a "partner" with other stakeholders and the government -- they want to work with the OMA not be led by the OMA or to take direction from the OMA.

The outcome that should be expected is to see a greater openness on the part of the OMA to dialogue and deliberation both inside the organization and with other system stakeholders. That, in itself, could change the climate of the debate around health reform in the province and allow the government and stakeholders to make progress on some key areas like primary care reform where change has been stalled by past conflicts.

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch

It is too soon to tell much about the impact of this apparent change on the part of the OMA, but if the organization takes to heart the messages delivered strongly by the other stakeholders in the system then it has the potential to open a number of avenues of dialogue around health reform.

References

Sources of Information

The report from the dialogue sessions is currently being prepared by CPRN and will be published at www.cprn.org in the coming weeks as:

Patrick Fafard, Judy Watling and Arlene Wortsman. 2007 [forthcoming] Towards Patient Centred Health Care: Dialogue on the Future of Health Care Services in Ontario. Ottawa: CPRN. 

Information about the OMA's Campaign for Healthier Care can be found at www.healthiercare.ca.

Author/s and/or contributors to this survey

Tom McIntosh

Empfohlene Zitierweise für diesen Online-Artikel:

Tom McIntosh. "Dialogue on the Future of Health Care in Ontario". Health Policy Monitor, April 2007. Available at http://www.hpm.org/survey/ca/b9/4