Transforming Health Care Beyond the Pandemic
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25 October, 2021 Transforming Health Care Beyond the Pandemic
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October 2021
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October 25, 2021

The Empire Club of Canada Presents

Transforming Health Care Beyond the Pandemic

Chairman: Kelly Jackson, President, The Empire Club of Canada; Associate Vice-President, Humber College

Distinguished Guest Speakers
André Picard, Health Columnist and Author, The Globe and Mail
Matthew Anderson, President and CEO, Ontario Health
Chris Wilson, Senior Vice-President, Eastern Canada, Home Health Services, CBI Health

Introduction
It is a great honour for me to be here at the Empire Club of Canada today, which is arguably the most famous and historically relevant speaker’s podium to have ever existed in Canada. It has offered its podium to such international luminaries as Winston Churchill, Ronald Reagan, Audrey Hepburn, the Dalai Lama, Indira Gandhi, and closer to home, from Pierre Trudeau to Justin Trudeau. Literally generations of our great nation's leaders, alongside with those of the world's top international diplomats, heads of state, and business and thought leaders.

It is a real honour and distinct privilege to be invited to speak to the Empire Club of Canada, which has been welcoming international diplomats, leaders in business, and in science, and in politics. When they stand at that podium, they speak not only to the entire country, but they can speak to the entire world.

Welcome Address by Kelly Jackson, President, The Empire Club of Canada
Good afternoon fellow directors, past presidents, members, and guests. Welcome to the 118th season of the Empire Club of Canada. My name is Kelly Jackson. I am the President of the Board of Directors of the Empire Club of Canada, and Associate Vice-President at Humber College. I'm your host for today's virtual event, “Transforming Healthcare Beyond the Pandemic.”

I'd like to begin this afternoon with an acknowledgement that I'm hosting this event within the Traditional and Treaty Lands of the Mississaugas of the Credit, and the homelands of the Anishinaabe, the Haudenosaunee, and the Wyandot Peoples. In acknowledging Traditional Territories, I do so from a place of understanding the privilege my ancestors and I have had in this country, since they first arrived here in the 1830’s. I want to recognize that last month, across the country, many dedicated time on the first National Day of Truth and Reconciliation to learn more about the experiences of Indigenous children who were forced to attend Residential Schools. Many of those individual stories are untold, buried with them in the land; and many survivors who tried to tell their stories were not believed. I hope we continue to find ways throughout the year, beyond the National Day for Truth and Reconciliation, to honour these survivors, and to hear their stories. As we connect past actions to present realities, listening and learning from each other is so important, and we encourage everyone tuning in today to learn more about the Traditional Territory on which you work and live

I now want to take a moment to recognize our sponsors, who generously support the Empire Club, and make these events possible, and complimentary, for all to attend. Thank you to our lead event sponsor, CDI Health, and to our supporting sponsors, Home Care Ontario and Spectrum Health Care. And thank you, also, to our season sponsors, the Canadian Bankers Association, LiUNA, and Waste Connections of Canada.

I'd like to remind everybody participating today, this is an interactive event, so those attending live are encouraged to engage with our speakers, by taking advantage of the question box, you can find it below your on-screen video player. We will try to incorporate as many questions as possible throughout the discussion. If you require technical assistance, please start a conversation with our team, using the chat button on the right-hand side of the screen. And we also invite you to share your thoughts and social media, using the hashtags displayed on screen throughout the event. To those watching on demand at a later date, and to those tuning in on the podcast, welcome.

It is now my pleasure to call this virtual meeting to order. I am delighted to welcome Matthew Anderson, President and CEO of Ontario Health, to the Empire Club's virtual stage for the first time; and I am also pleased to welcome back André Picard, author and health columnist at The Globe and Mail. And I want to take this opportunity to congratulate André on recently being awarded the Sandford Fleming Medal for Excellence in Science Communication, very well-deserved André. If you'd like to learn more about our guests today, you can scroll down below the viewer, and find their full bios there. The impacts of COVID-19 have been felt in every sector, and aspect of our lives. And when it comes to healthcare, the headlines have typically been focused on the pandemic’s effects on hospitals, long-term care agencies, and changing public health directives. Not as widely discussed, has been how it has exacerbated long-standing challenges in care, particularly for seniors, under-served populations, and individuals in need of mental health and addiction services. Today, our two guests will do a deep dive into how the experiences and learnings from the last 20 months can help us transform our healthcare system, to better connect, and provide care for all. André, over to you to get us started today.

Opening Remarks by André Picard, Health Columnist & Author, The Globe and Mail
Thank you, Kelly, for that kind introduction, and for setting up our discussion today. Matt Anderson, welcome to the Empire Club, I hope we have fun today, like many past speakers have done. Now, in the short time we have, I want to try and tackle three big themes. I want to look at the state of Ontario Health, there's a lot of interest in that, the impact of COVID-19, and some talk about the future, and the challenges of what you're trying to do, create a more integrated health system. We've already received many audience questions which I've worked in, and if you add them as we go along, I'll try and incorporate them into our chat as Kelly mentioned. So, we have a big audience today, lots of interest in what you have to say, so I'm going to wade right in without any more introductory remarks. So, let me start with something really basic, give us a sense of what this new entity called Ontario Health is, and why it came to be.

Matthew Anderson, President and CEO, Ontario Health
Great, thank you, André. Good afternoon, everyone, and a huge thank you to the Empire Club for welcoming me here today, I really appreciate the opportunity. So, just very briefly, a little bit on Ontario Health. So, we formed in 2019, and it's the merger of now 21 healthcare organizations from across the province. The main goal of bringing us together, we've been coined the super agency, is really to drive health integration across our system. We have great expertise in a number of the agencies that we've been bringing together, we're looking at how we're going to use the tools, the history of some of those agencies, and a new refreshed mandate around integrated care, as a way of driving forward improvement in the healthcare system.

André Picard
Now, those of us who have been around many years know there have been many structures tried, and many have failed. How is this one differen, and how is it going to be better?

Matthew Anderson
Yeah, I think that, you know, what brought me to Ontario Health and where I'm very excited about, is by bringing all these agencies together. You know, one of the challenges I had, prior to working in Ontario Health, I was a hospital CEO, and I interacted with many of these agencies, all in a series of one-offs. It was hard to bring together an integrated agenda of where do we want to go with a healthcare system, when you have everybody working in their pieces. So, what I'm excited about, and why I think it's going to be different this time—at least one of the main reasons, from a structural perspective—is all of us working together, creating a single agenda moving forward, and one that's going to be more comprehensive, and a little more inclusive of things we're trying to do in the system.

André Picard
Now, people don't always understand, you're not the Ministry of Health, you're not a totally independent agency, sometimes you get a sense, it's neither fish nor fowl. How do we position this? How do we understand the role in the larger system?

Matthew Anderson
Yeah, you know, we're working that through. The agency is still relatively young, but a few, firsts on the structural side. So, the way that we're incorporated, the Ministry of Health, the government, maintains policy direction, maintains overall funding direction for Ontario Health, as it's described, as we implement those directions. I would say that, in practice, what we've seen is, you know, any good implementation needs to be based in great policy and great strategy, and vice versa. So, we're working together to organize the healthcare system and move it forward. I think part of our challenge within Ontario Health, we have multiple different facets to us. Our core bread and butter is we have accountability agreements, and performance agreements, and that's really our main lever for driving the system and creating change. We also operate various aspects of the healthcare system. We operate as a, for instance, the provincial lab network, we operate elements of the transplant network, so we're an operator, we run many, many different elements of the digital healthcare system as well, and we have a role in funding. So, sometimes it's advising government, sometimes working through with funding models, other times we receive envelopes of funds, and then we're directly with providers to put the dollars out there. So, a bunch of different components to it as we try to drive forward, ultimately, an agenda set by our elected officials.

André Picard
But you don't operate everything, you don't fund everything. How do you keep that power? How do you enforce these accountability agreements, if you don't have that stick of money in the end?

Matthew Anderson
Yeah, you know, I think that what we've learned, first off, I would say that you don't have to control all the dollars to control or to influence; we have influence over the funding, so I think that that's something to work through, but it is one element that we have. On the performance agreements, there's different tools that are provided there, integrative tools to work with the boards and management separately. I think at the end of the day, though, what we're really calling out, and is sort of an ethos of what we try to do, is more through the partnerships, and working with agencies across the system, to a common direction and a common goal, and using those different tools in different ways, if needed, to create change. The last thing I'd say, André, is that we also play a very, very big role, is on data and data management. And by putting out, and actually developing our data systems, and being able to focus the healthcare system overall, in a more data-driven and evidence-based way, I think that's a great lever for us, as we look to create change in the system.

André Picard
Okay, great, then we’ll come back and talk about data a little later. Can you give us a sense of how do you compare to other provincial agencies? You know, we have like Alberta Health Services, very centralized, you have other provinces like BC that are very regionalized. What's the mix in Ontario? Is it a regional system? Is it a centralized? Is it neither?

Matthew Anderson
Yes, it's maybe a little bit a little mix of both. And at the end of the day, we still have all of our provider agencies, and then we at Ontario Health, we've organized ourselves into regions, and within the regions into sub-regions. But really, most of the operation of the healthcare system is done at a very local level, through those health service provider agencies. So, we'd be very different than Alberta, for instance, that is actually running most of the system. We work, through our accountability agreements and other structures, with those who are running the system. You know, one of the things that I've learned in my whole 18 or 19 months here, there's been a bit of an advantage in that—and we'll see over time how it all plays out—but it does also keep Ontario Health sort of one step out of the fray, if you will. And that's been a great advantage for us, particularly as we've gone through the pandemic, to be able to step back and look at things from a provincial level or regional level, while the health service providers are doing their thing of providing great care on the ground. So, we'll see if that plays out as one of the advantages of the system, but it’s something that I see now.

André Picard
And maybe we can step back to one of the previous systems. What was wrong with, say, the LHIN system? What didn't it go right? It looked great on paper when it was announced—everything looks great on paper—but it didn't really turn out. What was wrong with that structure that you've corrected this time around?

Matthew Anderson
Yeah, I think that that's a great example of sort of the LHINs, you know, I would say middling results, some of the LHINs were affected, some maybe not as much. I would say that part of that—and it goes back to why the agency came together, why bring 21 agencies together—it was still very fractured from a policy level, to how that will get implemented throughout the system. You know, there are 14 different interpretations, often, of how that might work, and while you want to be able to leverage on the ground and regional differences, for sure, some level of consistency across is going to be very, very important. Also, as one, it allows us to build a depth of experience set and offerings out to the health system that was very difficult to do when you're one of 14. I was a LHIN CEO for a little while, and these were some of the challenges that I felt when I was there; and really feel differently now that we're operating more as one, but still respecting regional and sub-regional differences.

André Picard
And you as you mentioned, you're a LINH CEO, you're a hospital CEO. What were the frustrations you had then, that have been addressed now?

Matthew Anderson
I would say getting addressed, I'm not sure we've addressed them all yet but getting addressed. The first one I've already mentioned is, when we would get inconsistencies across from different agencies, and a little bit of trying to understand how to pull all those pieces together, back down at a at a health system provider level. We're looking as well, at how can we get, particularly on the clinical aspects, so part of what we have on Ontario Health now, we have Cancer Care Ontario, Ontario Renal Network, Trillium Gift of Life, CorHealth, which is cardiac stroke and vascular, will be joining us on December 1st, and we have our Mental Health and Addiction Centre of Excellence. My point in all that—and a few others as well—my point in all that is that that gives us an opportunity to start looking at the system, and patients, and patient care, a bit more holistically than what we were able to do before, as compared to looking at it from a cancer lens or a renal lens. While we still need to do that from a disease management perspective, it also gives us an opportunity to step back and say, when you put these things together, are we addressing all of the needs in a more comprehensive way, in a in a connected way, as we move the system forward?

André Picard
And I know you know, in Canada, politicians tend to micromanage the health system a lot more than some other countries—I’m trying to state that politely. So, how do you how respect the political priorities, which any government has the right to impose their priorities, but not let them interfere too much with your day-to-day? How do you find that balance between the political and the practical management?

Matthew Anderson
Yeah, well, you know, I think in your question, you tipped on the on the key word, which I think is respect; and the other one, I would say is trust. And so, on the respect side, we do have to respect that they are the elected officials, they're going to make the big macro decisions in terms of where to direct, what are the overall priorities, and the directions that are needed to support the people who elected them. On the trust side, is for them to have confidence that we will deliver. We know how we're doing it, and we are a capable, and a good system partner for moving things forward. I would say that, through the pandemic, we've seen those times. And our premier, Premier Ford was clear to point out many times—he used to call me on a somewhat frequent basis, to see how things were going. And so, you know, when things are intense, and there's big elements of delivery, then it's great to have that kind of interaction with our political leaders; never felt interference, self-interest, for sure. And, you know, as long as the political leaders are feeling, they understand where we're going, and they have trust in what we're doing, that it’s aligned to the mandate that they've given us, then I think we can find that right now. It's

André Picard
Great. And you mentioned Ontario Health has brought together these 21 agencies, but there's still some things you really don't have any power or control over. There’s already many audience questions coming in about what about primary care? What happens with that? They're kind of still on their own, is that right?

Matthew Anderson
So, strictly speaking, most of the primary care system would be outside of the strict mandate of Ontario Health. I would say, though, that we're working very, very well with primary care leadership. And I've been around the healthcare system for quite some time, and I would say that there is a real esprit de corps here. And again, on this one, I would point to the pandemic, and to other factors, as really thinking of ourselves as one team, one system. And so, we certainly have relationships with primary care, we think about our relationship around Ontario Health Teams, which I'm sure will speak about at some point this afternoon. But even on our clinical side, when you think about mental health and addictions, there's no possible way we're going to improve the mental health and addiction system without a strong relationship with primary care. So, that's burgeoning. We're figuring ourselves out on that, strictly speaking outside, but lots of elements that interact with us, and so far so good on building out a positive relationship there, working with primary care.

André Picard
Right, and you mentioned a couple of things we'll come back to; there's already a lot of questions pouring in about mental health and telemedicine, for example, we'll come back to those. But I want to turn a bit to COVID, because we can't have a discussion these days without talking about COVID in some detail. I'm interested, you started this job just as the pandemic was beginning. You know, in these 20 months since COVID has consumed the government's attention, the media's attention, has this made it easier or harder for you to do your work of creating this new system? Because you've been essentially out of the spotlight because of circumstance.

Matthew Anderson
I haven't felt too out of the spotlight. I will say, I think directly to your question, the it's a little bit of a mix for Ontario Health, in terms of has it been, has the pandemic made it harder or easier, certainly harder in many of the strict structural components, and really need to acknowledge the thousands of people who work at Ontario Health, who’ve been absolutely fantastic team members, you know, they've been merging for the better part of two and a half years. And so, all the structural things that go along with that, many have been delayed, right? Cleaning up the benefits packages, and the job bands and all those things that you do when you're merging, right? On the other hand, I would say that the pandemic sped up our culture, it did create an esprit de corps, it did create a world where we could define who is Ontario Health. I recall early, we were doing all-team town halls at least once a month during the pandemic, and in one of them, we had our regions report back on what was going on in the work that that part of Ontario Health was doing with respect to the pandemic, and I had leaders from other parts of Ontario Health speak up about how they get it now, they get why they're part of Ontario Health, they get why we're trying to do this, and they get the work that we're going to do together. So, I think culturally, it has advanced things for us, structurally, it has slowed us down and we're trying to get a little bit of catch up now, to get everybody in a solid footing.

André Picard
Can you expand a bit on that notion of culture. Culture is really important in healthcare, but what do you want the culture of Ontario Health to be? And that's something that hasn't always been defined in the structures in the past, that's been a problem, as you know. How do you define it, and how are you going to promote that?

Matthew Anderson
Yeah, you know, I think that the first place it starts with, and it can be a little bit challenging for us, is it always has to start with the patient, the client, the community. Everything we do, we need to be able to measure it back to what was the impact that we had, what was the outcome on client care, or on a community, community population health, or on an individual patient. And that where that can be a bit challenging for us is that, as I've mentioned, most of us are at least once removed from that direct interface to care—not all of us, some of us are there, but most of us are at least one removed—so keeping that at the forefront is going to be critical for us. The second is a spirit of innovation, and the agencies who have come together here, many of them are built off of agencies that have done very, very innovative things. One of the agencies that became part of us was the Ontario Telemedicine Network, for instance, and so really looking at ways in which we can innovate, and have the courage to do that, know that there's the support to do that. And I think that part of that also comes from, going back to your earlier question, André, around the benefit of 21 together. It gives us a critical mass that allows us to perhaps innovate in ways that we wouldn't be able to do if we were split up, split apart into 21 separate organizations. So, we certainly hope that keeping that compassionate care lens on outcome, and thinking about it through a world of innovation, were at least a couple of elements that I hope that we are going for.

André Picard
And there were worries when this plan was announced, that some of these agencies would lose their culture, lose their reason for being, you know, their independence. Is that a concern, are you worried about keeping them as they were, but just within a larger structure?

Matthew Anderson
Well, so what our sort of ethos there, our approach there, is that, for the mandates that we have brought forward, if we see those mandates step back, then we failed. If we see that they improved, but largely at the rate that they would have improved if they were not part of Ontario Health, then largely we failed. What we need to be able to demonstrate, is by bringing these groups together, bringing these mandates together, and the goals to move forward, we need to be able to show how cancer care has been enhanced, how mental healthcare has been enhanced, and how connected care has been enhanced. But these are the things that we need to be able to demonstrate. Otherwise, if we continue on a path, but that path would be not a whole lot different than what it was before, then we really haven't achieved that promise of what we're trying to do by bringing everyone together.

André Picard
Let me let me focus more on the COVID fallout. We know that COVID has shone a spotlight on a lot of things, showed things that are good and bad in the system. So, I'm a journalist, I'll start with the bad, long-term care. Long-term care has been a disaster, COVID, especially in the first wave, it was just as bad in the second, it's getting better now. But how do you start addressing that problem, fixing that? And what's the role of Ontario Health in doing that, and making care better for elders?

Matthew Anderson
Yeah, thank you for that. So, I think just to pick up on a couple of your points there. First off, I would say that through the pandemic, certainly it has exacerbated some of the things that we knew and made them even more challenging. And when I think about as a, for instance, health and human resources, which very much was at play in what happened in long-term care, and in play with what's happening in other parts of our system, we can't think about each sub-part of the healthcare system in and of itself, we have to think of it through an integrated, full lens. And long-term care is a core part of the healthcare system, regardless of how its organized through ministries and other elements; it has to be seen as part of the healthcare system. And in that, we can leverage elements of the healthcare system, medical coverage, IPAC—you know, before the pandemic, not many people talked about IPAC, as a part of the infection prevention and control, as a key element of what we need to do. And, you know, IPAC expertise is a bit scarce. We need to look at how do we leverage that all across our system, and not think about it as how do we do it here, and how do we do it here, and how do we do it here, and separate that out. So, I think we've learned an awful lot from that perspective. I know that the Ontario government is very focused on improvements in long-term care, our role there, like in other parts, the policy and direction, overall policy direction, gets set by government. We're here to support, to lend a hand, and to try to move forward on that as well, through perhaps facilitating relationships between hospitals and long-term care homes, or other agencies, to make sure we have more complete picture of support for long-term care residents. And I also have to just show you, again, with eldercare, I think homecare has to be mentioned in there as well. It is about how do we support our elders where they need support, and in the setting that's most appropriate for them. So, you have to bring homecare to that discussion as well.

QUESTION & ANSWER

André Picard
And we have a few questions on that already, so I'll ask you one of them. Is, you know, where does homecare fit into this puzzle of Ontario Health?

Matthew Anderson
So, homecare is a key part of the healthcare system. And, you know, homecare, primary care, these are all elements that need to be working together, hopefully to take the pressure off. And we've talked about this before, André, and you've written many times about it, taking the pressure off of the acute care system, and at times and overreliance on the acute care system, and being able to focus on keeping people at home, keeping people healthy, so certainly, homecare plays a substantial role in that. I always suggest that our role is to keep our elders as healthy as possible, in their homes, wherever that might be, and that's typically where they want to be. So, a strong and vital homecare system is just as important as any other part of the system as well.

André Picard
And we have to find that balance, we have to try and respect people's choice...

Matthew Anderson
Absolutely.

André Picard
...while being totally reasonable in what you can provide, it's a tough balance.

Matthew Anderson
It is for sure. And again, this is, you know, going back to HHR, right? We have to be looking at this holistically. And if we move to improve, you know, one part of the system typically will find movement, and will weaken another part of the system, so we have to look at that in a wholesome way. I would also say, where I wouldn’t mind going as well, is to say that we're really talking about, in many of the elements of long-term care, homecare, it's really about housing. And for me, you know, the healthcare system, when we think about the social determinants of health, doesn't have necessarily a direct role in all of them, but we do and housing, and we have to accept that, and embrace that part of the healthcare system is housing. We're talking about homecare and long-term care, but you know, assisted living, supportive housing, like they all fit in there. And, you know, from my hospital background, we have people who, the hospital was their home, so we have to embrace that, and recognize that we do have a role in social determinants, health, and particularly in housing.

André Picard
So, let's talk about the social determinants, because that's another thing in COVID that's become part of our daily language—which is a good thing. But we did some creative things during COVID, we did crazy things like house homeless people. Can we keep doing those the innovations, those sensible things, post-pandemic?

Matthew Anderson
You know, we absolutely must. And again, this is where we can't sort of step back. You know, one of the things that was a—I hate to say anything positive from the pandemic, the pandemic was just tragic in every way—but it did force us to think differently about how we're providing services. And when we think about housing, the ideas that you've described, also, you know, when we look at what we were able to do with our testing strategies, our vaccine strategies, you know, identifying communities that are going to often not be able to get equitable access to some of those things, and deliver strategies into those communities. And we're certainly better at that now than we were before the pandemic, and we have every expectation and responsibility to get even better at it as we go.

André Picard
And how do you—I know this is a particular interest of yours—how do you promote that equity of care, rather than just the quality of care, and making sure underserved communities get more because they need more?

Matthew Anderson
Yeah, so there's a bunch of different techniques, but the one that I kind of rely on the most—and it sort of goes back to a little bit of my background—is about data and evidence and getting data and evidence at the forefront of what we're doing. And this has been a big challenge for our healthcare system is getting good data, good evidence on this, we know it, but being able to quantify it, measure it, and then create change. And we've certainly seen improvements on that, through the pandemic, we are addressing the issue of data, we use some different techniques now that aren't perfect, but certainly are, have become very, very valuable to us. As we look at, by community and sub-community, the care that's being delivered and access to care, we were able to do that. It started when we were looking at access to testing capabilities, but we can do that now for access to surgical recovery, to mental health services, etc. And we have to keep building upon that and getting more precise and telling that story. Telling that story, both in the quantitative qualitative ways—which, sadly, there's many examples of that—but we need to beef up and be even better on telling it in quantitative ways, which is what we're working on.

André Picard
So, be guided a little more by the data, because we have great data in Canadam but we don't use it very well.

Matthew Anderson
True, and often we don't have great data. You know, I was reminded just a couple of days ago, the head of our Mental Health and Addiction Centre of Excellence, pointed out that, at any hospital who runs a particular cardiac program, you know your door to needle time. And yet, we run mental health programs, and we don't have the equivalent for that; we wouldn't be able to say, here's how that person is through, and measure each step of the way through; and we have to be able to get there, and we can. I was also reminded by that same leader that we had very little information on COVID when it started, and here we are, within about 9 to 10 months, we had outstanding information on COVID; we could tell you how many cases, how many tests, how many were positive and negative, and the turnaround time on all of them. So, we can do this, and we need to do it.

André Picard
And you mentioned mental health, so it gives me a segue to the next thing. Another big thing, during COVID, all our mental health has taken a beating. There's a great demand for services, we worry about our kids, in particular. How can Ontario ensure that we can meet that demand for psychological services in particular, but psychiatric as well.

Matthew Anderson
Well again, unfortunately, in Ontario, the good news is, is that this is a priority area from this government, and therefore is getting priority attention; the bad news is, is that we started in a hole, and that hole was got deeper, and so we've got a lot of climbing out to do. And so, we've got lots of work to do with respect, we have the Mental Health and Addiction Centre of Excellence as part of the part of Ontario Health, it was the one public announcement I got to attend before the pandemic hit. And so, right now, the core focus has been on the most basic ways of getting the increased access, particularly to structures like psychotherapy across the province. But we have to expand that more, we have to look at the different levels of access, again, going back to the data and evidence, making sure we can measure what's going on in our mental health and addiction system. We're also looking at ways in which we can follow the models that we used when we built out our cancer system and our renal system. You know, we do know how to build good programmatic approaches in the province of Ontario. Now, cancer and renal—mental health and addictions is going to be a bit different, it needs to start at primary care. The others, we are able to start at acute care, and sort of work our way back; with mental health and addictions, we need to start at primary care. And primary care, I say that in the broadest sense; we need to start there and work our way in, because that's where most of our challenges are, and also where most care is delivered. So, we'll be a little different in the way that we approach that.

André Picard
Right. And what about child's mental health in particular? There's a lot of concern of parents out there, how do we how do we address—we know the waitlists are legendary in Ontario, up to 18 months for kids, can we tackle that one quickly?

Matthew Anderson
So, we have to. That one, I would say, first off that there is has to be a funding commitment behind it. And in particular, I know that the government, I'm not sure where they are in their processes, but looking at eating disorders as a particular area for our young folks and making sure that the investments get made there. You know, the other thing, and going back to your comments about, your questions around Ontario Health is, you know, it's these incremental investments, done in a smart way, that can start to have a compounding impact, right? So, it's not just about the dollars that you spent, but if you've spent them in a way that also promotes integration and connectivity across the system, you're actually getting $1.50 back on your dollar invested. And those are the things that we'll have to look at as well, as we make these investments.

André Picard
And you mentioned in passing before, there have been some silver linings in the pandemic, one is the embrace of virtual care. Lots of interest in the audience on this one, in particular the questions coming over and over again, is how do we get the balance right between in-person care and virtual care? This is in the news a lot, how do you address that tough question?

Matthew Anderson
Yeah, so I would say first off, to declare my bias, I started in IT, in digital, many years ago, and I never thought I would see the day where I would say that we may have overshot the throw a little bit on the adoption of our virtual tools, but we may have. You know, we really did grow, and grow very, very rapidly—and largely good story in there, and largely good news, largely good care being delivered. And, also an important sort of shift within the thinking of the providers, as well as our patients, a comfort level that wasn't there before, interacting in this way. Also, building confidence with the with patients and families interacting electronically and digitally, I sort of equate it to when we all got used to bank machines, and now we're a lot more interested or comfortable using internet banking. You know, this is a step function as we go forward. What has happened though, and we're doing some research on it right now, is the perspective that we may have swung a little too far, too fast; there may be a little bit of a retrenchment that's going to need to happen here. We're trying to move out of anecdote, and, you know, oftentimes, what I found is that the anecdotes tend to lead the data by about six months or so. And so, we're hearing about it, we aren’t seeing it yet in the data, we need to drill into it a little bit further to come up with that answer as to how do we recalibrate a little bit? We certainly, to your point, André, we wouldn't want to go all the way back, there's no need to do that. But there is a balancing that needs to be brought in here, to make sure that we're using these tools in the right way. And also, to help us address some of the other challenges in the system as we think about what the capabilities are of these tools. But there is, I think, a little course correction that needs to happen. We're working with other colleagues to identify that, and to come up with strategies to make that happen.

André Picard
Yeah, as a journalist, we often work with these anecdotes, and there's mixed messages coming from telemedicine. You know, people like it, but there's concerns about equity, there's concerns about the technology, especially in the North. You know, the paradox here is, telemedicine is often least available to those who need it the most, right? So, there are issues outside of your control, like access to internet that's affordable and reliable; there's a lot of things that come into this.

Matthew Anderson
That's exactly right. I think that, you know, one of the things that I've championed—forever, it feels—is broadband for all. I think that, in a previous job, I was speaking in a rural community, and I held up my cell phone, and I said that “this is the healthcare tool of the future right here.” And, of course, for many of these folks, they don't have broadband, they don't have reliable internet, so how are they going to take advantage of those tools. In the stories, of course, in speaking and working with rural and remote communities, with people who've got chronic illness who, you know, in particular in the wintertime, sort of hunker down, and that illness gets worse, and, you know, they don't have easy access to these services. So, we have to be able to provide that, and make sure that these are, in fact, creating equity, not harming it.

André Picard
So, let's turn to the future, and that's the important part of our discussion today, and I want to start, I’ll lead off with what you've talking about. Ontario is a big province, there's a lot of rural remote communities in the North, for example, how do we ensure that—and I'm from Northern Ontario, originally, people up there often feel they get second class services. How do you bring that equity piece with Ontario Health, to ensure people are getting what they feel is the care they deserve?

Matthew Anderson
Yeah, it's a great question. It's a challenging one, for sure. I would say a few things; one is that, just apropos the conversation we were just having, there are tools that we have at our disposal now that, if we're very thoughtful in how we bring them forward, can start to address some of those equity issues. And, you know, a very simple example, with the provincial lab network that we have in place now, being able to test and result in the same neighbourhood without having to go somewhere else to collect or to receive the result, we do basic things like that, to try to make sure that we've got better equity models. I think we have to make sure that we are prioritizing this, that this is, in fact, something that we want to address. And that means addressing it, as well, through the funding models. Many of our funding models have an efficiency component to it; when you start talking about the distances in the North, and some of the challenges up there, you always come out on the inefficient side of that model. And so, we're going to have to think through how do we address that, to make sure that there isn't some inherent structural issues. And then, another thing I would mention, is that this is part of why we want to have regional structures within Ontario Health. So, we have a region in the North, all of our regions have a Vice-President who's responsible for equity and inclusion, to go after these exact issues, to try to understand what does this look like on the ground. Because we do—you know, in the example that I was giving in terms of the rural community, is actually only in north Durham. And so, on the one hand, North Durham isn't that far north; on the other hand, what the heck? Why do we have connectivity issues in North Durham? So, we're gonna have to make sure that we've got an understanding of what it looks like in these local communities, to try to address some of those some of those issues and show that it is a priority. And with the toolset that is coming available to us now, and as we think a little more, and maybe a little more creatively about how we incent HHR and other aspects of the system, I think we can get to a place where we've got more equity, particularly in the North.

André Picard
And when we're talking about equity, we have to talk about Indigenous communities. There's a lot of Indigenous communities in Ontario in the North, but also a very large population, even in Toronto, of rural Indigenous people. How do we, what's the role of Ontario Health in the reconciliation part, and improving healthcare to this group that's been neglected for so long?

Matthew Anderson
Yeah, you know, this is a huge question in front of us. First off, is a total commitment on the part of Ontario Health to Truth and Reconciliation; this is a driving force for us inside of our organization. I would say, as well, as we work with our partners in the Indigenous community, we need to understand, first and foremost, their needs, where they want to go. I've been meeting with a number of the leadership of some of our First Nation communities, as they describe their own destiny of where they want to go with healthcare. And we need to position ourselves in support of that, not the other way around. So, we've got some work to do there for sure. I would say the welcoming embrace, from those communities, to chat with me about it, to talk about where we can go, and most importantly, for us to understand, where did they wish to go with respect to their health services, and how do we support that?

André Picard
And when we're talking about the future, you've mentioned the words integration co-ordination many times, this is the raison d'être of Ontario Health. Can these things really make a difference; can they create efficiencies, better patient care; can they save money, ultimately? Because we talk about these things, we've talked about them for decades, but are they making a difference?

Matthew Anderson
We have talked about them for decades, and they're kind of my raison d'être, my personal raison d'être in working in healthcare, is trying to move forward integration and co-ordination. So, the short answer is they absolutely can make the difference, both in efficiencies and in co-ordinated care, and a better care experience. Where we’ve failed—and you know, just a quick example, at one of the hospitals that I worked at, we had a person who had been into our emergency room over 60 times in one year. And in speaking with that person, what we came to uncover was that the challenge was not really medical, the challenge were more social needs. She had no transportation; she did not have a drug plan. Most of the time, when her experience with us in our emergency room, it ended with, you know, a script, we gave her a piece of paper that had some drugs on it, go get this—she had no means to do that, and then would go home, and the cycle would start again. Working with the region and the municipality, we were able to bring services together to support her, social services to support her, to stop that cycle. That's quite possible to do, and the economics behind it are real, and are very, very valuable. Our challenge is that, right now, many of our funding models don't line up properly. So, using that same example, that also means that much of our care is funded, based on the physical place that care occurs. So, that person comes into the emergency room, the hospital gets funded; that person doesn't come into the emergency room, and the hospital doesn't get funded. So, when we're spending dollars to keep somebody out of the emergency room, there's no funding necessarily for that, and then you're taking away your revenues on the other side. So, there's some work to be done, work that does sit with Ontario Health working, obviously very closely with the Ministry, on how do we align these incentives. And that's really, in Ontario, a driver, an initiative that we're looking at, as the Ontario Health Teams. And the idea of the Ontario Health Team, at the end of the day, when you strip it away, is very much how do we make sure we're aligning the financial incentives and the structural tools, so that we are focused on upstream, keeping people healthier, instead of waiting until backstream when they've gotten sicker, and tougher care experience for them, and frankly, a more expensive experience. So, this can work, but we're going to have to do redouble our efforts, I guess, on the structures and the alignment of the incentives, to make sure that we're in a place for success

André Picard
There’s a lot of breaking down of silos to be done, absolutely
.
Matthew Anderson
Absolutely.

André Picard
And there's some interest in this, in the queue, for you to expand on the Ontario Health Teams. Where are they at now? Are they all in place? How many do you have? Are going to have more?

Matthew Anderson
Sure, so Ontario Health Teams, I believe there's about 50 in place right now, we are looking to add a few more. Right now, the Ontario Health Teams reports directly to the Ministry of Health, under legislation that Ontario Health Teams will move over to report to Ontario Health. So, we work closely with the Ministry, and I would say they're at varying stages. You know, some of our Ontario Health Teams are very mature, and in fact, operated as an Ontario Health Team in different elements of the response to COVID. Some are really just forming and trying to leverage as much as possible where there's already strong relationships between community providers and healthcare providers and seeing if we can move that forward. So, a little bit of a mixed bag in terms of how far we are on implementation. This is definitely something that, going back to your question, André, from a structured prospective, was slowed by the pandemic; but a number of Ontario Health Teams used the pandemic as an opportunity to galvanize their services around their community. So, some progress there, but much, much more working.

André Picard
Another thing you mentioned several times in passing was HHR, Health Human Resources, and this is probably the number one challenge in healthcare today. How are you going to tackle that one, getting adequate nurses, personal support workers, lab techs, there’s shortages everywhere.

Matthew Anderson
Yeah, no, I said, you know, this is a great example, as well, of challenges that we had in our environment pre-pandemic, that have really been exacerbated by the pandemic. And really, you know, a lot of folks hung in there through waves one and two, and even into wave three, but we're seeing as we get into wave four, the fatigue is really quite remarkable, and is wearing all of us down, the fatigue on the personal side on the professional side. And, you know, sometimes we forget that our fantastic care providers, our PSW’s, and our nurses, and our doctors, and our housekeeping staff, they're all going through the same personal challenges we are with this pandemic, and yet, they're still doing this fantastic role for us. But there's a big fatigue element there for sure. I think, as we look into the future, this is definitely going to require co-ordination, not just across the healthcare system, but as we think about where we're going with our universities and our colleges, and re-looking at the quotas, and the amount that people train, the amount of people coming out of there. Looking at our professional colleges, as well, as we think about foreign-trained graduates, is there something that can be done there to speed that up, and to get folks into the workforce? I think overall—so that so some long-term things, some short-term things; we've got to look at full scope of practice, the tools we were just talking about, André, with respect to virtual tools. Largely, we've kept our care processes intact, even though we've introduced new tools. So, are there ways in which we can change up some of those care pathways, given that we've got these new tools, and are we using everybody at full scope? And I’d say lastly, the thing that we have to do, and I mentioned it sort of earlier on, is that we have to take a whole system view of this. And if we subdivide the system and say, “here's what we're going to do for hospitals, here's what we're gonna do for primary care, here’s going to be for long-term care, here’s going to be for homecare,” that's not going to work. We need to be looking at this holistically as to how do we address—and you're absolutely right, this is our number one challenge, and our number one rate limiter, what we're going to do, as we start to recover from the pandemic,

André Picard
And for years, we just—and this is not a new problem either, this is since before the pandemic—for years, has just been poaching personnel from other provinces, from other countries, nurses from the Philippines, or from the Maritimes, how do we move beyond that? Because we've run out of the ability to do that the poaching anymore

Matthew Anderson
For sure. I think, and so this is a national issue, and we do need a national table to be able to co-ordinate this against—because poaching from other jurisdictions isn't, as you said, is not going to work. It may work for one jurisdiction, but not for the other, and we need a comprehensive plan nationally and provincially, and then again, locally, right? As we think about how do we pull these pieces together.

André Picard
And there's a few questions, as always, with the health discussion, about privatization. People are interested to hear your thoughts. What is the place of the private sector within the health system?

Matthew Anderson
I think that the—as we think about that question, first off, I always try to separate out funding versus delivery. In my mind, you know, this is a publicly funded system, and needs to stay that way. We do have some aspects of private funding, but this is overall publicly funded system. And we have to cling to the tenants of the Canada Health Act and protect that. On the flip side, as we think about private and private delivery, we sometimes forget that most of our primary care is delivered through, it's actually a private delivery system. So, you know, to my mind, I get less fussed about those aspects, I focus more on co-ordination. And one of the things we have in Ontario, we have these things called the IHFs, which are Independent Health Facilities. My big push is that the “I” should be “Integrated” Health Facilities. We need to be thinking about, you know, whether it's HHR planning, quality management, these things need to be consistent, and our public, the people that we serve, need to know that we're doing that kind of across-system planning, and not worrying so much that, because it's delivered in this way or that way, they would expect different equity of access, or different standards. Weed to be in that space and making sure that there's consistency of access and consistency of standards, regardless of how it's being delivered.

André Picard
And another question sort of comes back to the HHR question, but people are wondering how are we going to deal with the backlog getting surgeries, for example, especially if we don't have enough nurses?

Matthew Anderson
Yeah, I think, on the backlog of surgeries, a couple of things that maybe a bit surprised to hear me say, first is that the backlog of surgeries is not the top of my list of the things that I worry about the most, coming out of a pandemic, and for a couple of reasons. One is, is that the, in Ontario anyway, particularly in the in the later waves, the hospitals and the agencies did a really good job of triaging to get the most urgent people seen. And so, we were able to maintain that element of surgical and diagnostic care. I would say, second is, is that the rate on surgeries and diagnostic care comes back to the first challenge, the HHR. We have to address the HHR, and if we can address the HHR we are de facto going to be addressing the challenges around the backlog on surgeries. And I guess the last point I would make, is that up there on my concerns, and we've talked about a little bit, is really on the mental health and addictions. All of our numbers are indicating that that is having a massive, massive impact. We're seeing the demand going up, we see the opioid deaths going up, so, you know, we have to again bring into balance all these different points of discussion as we move forward. If we focus on our HHR, we focus on enabling our primary care groups, we focus on some of the things we've talked about earlier, André, I think that we will get on top of that backlog, and we will make that difference, and get the system back going again.

André Picard
So, one of our participants is wants me to ask you about your thoughts on the coming election. And I'm not going to do that and get you in trouble, but I will ask, do you worry, you know, sometimes when governments change, they dismantle what the previous government has done. Is there that fear that Ontario Health could be dismantled if there's a change in government? Is that something you worry about?

Matthew Anderson
I don’t worry, not really. I think at the end of the day, again, it was sort of back to your first question around trust and respect. And we want to show that we're adding value, and we're making a difference for the people who live in Ontario, to patient outcomes, and to overall value, and my belief is that if we show that, then we're good to go. And governments, you know, the other thing that I've experienced working with governments is that if they rely on you, and if you deliver, being dismantled it's not your problem, getting too much mandate too quickly becomes your problem. And so, that's the problem that I prefer to have.

André Picard
Okay, so talking about delivering, we're almost out of time to deliver, but I want to leave you with the chance to give us sort of your ideal scenario, what does Ontario Health look like in 5 to 10 years? What have you fundamentally changed for the better, for patients?

Matthew Anderson
Yeah, I think, so thank you, and thank you for the questions. And I would say that, as I think about Ontario Health, I don't have much of a vision for Ontario Health, that isn't really about the health of Ontarians. And to my mind, if we're successful in 5 to 10 years, we're going to see a serious difference on a whole host of health indicators, particularly around keeping people healthier, and more on the population health indicators than necessarily on the health system. One begats the other, but I think our, you know, an important shift in focus to the health of Ontarians, particularly when we think about the underserved populations. And I would say, you know, that I'm remarkably optimistic, at least in my own mind, at this point. And I'm optimistic about our chances of doing this, not so much, not only because of the pandemic, but because of Joyce Echaquan, and George Floyd, and the terrible incident in London, in Residential Schools, like they were different; it feels different in the healthcare system. And we had a wonderful event at Ontario Health, for Truth and Reconciliation, and one of our guests was asked, “what could we do differently?” And the answer was, stay awake. And while I adore that answer, and I'm motivated heavily by it, I think there's more than we can do, and I'm pretty sure I'm not alone in thinking there's more than we can do. And so, you know, for Ontario Health, my wish, my goal, is that Ontario Health, we find a way to galvanize the desire of our system, of our leaders, to do it differently and make it better. And I think we can do that, and I do think it's a different day. And hopefully we can show that in the coming months and years.

André Picard
Great. Well, thanks very much, Matt Anderson for enduring my bombardment of questions. I have a couple of hours worth of questions more, but we have to wrap up. And thank you, especially for ending on a positive note. We don't have a lot of positive discussions about healthcare these days, so that's refreshing. I'm going to turn it back to Kelly Jackson to say some final words.

Kelly Jackson
Thank you, André. And thank you Matthew as well. I’d now like introduce Chris Wilson, Senior Vice-President, Eastern Canada, Home Health Services at CBI Health, to deliver today's appreciation remarks. Chris, welcome.

Note of Appreciation by Chris Wilson, Senior Vice-President, Eastern Canada, Home Health Services, CBI Health
Thanks, Kelly. André, Matt, thank you both for contributing to the discussion about how we can transform healthcare, leveraging what we've collectively learned during the pandemic. Matt, thank you for continuing to be a champion for doing the right thing, and for your belief in the community-based healthcare sector. André, quite simply, thank you for your book this year—my copy has many sticky notes in it—and thank you for your ongoing efforts to shine a light on the possibilities in front of us, to do better by those who need healthcare right now. As the largest community-based healthcare provider in Canada, CBI Health has been providing multidisciplinary homecare for decades. And we've never seen such challenges or such potential, in what we can all do together to improve the health and well-being of our most vulnerable. Matt, today I heard you speak about Ontario Health’s inclusive agenda, and bringing clinical excellence together under one roof, to bring about a more holistic view of the health system and healthcare delivery. You spoke about measuring the impact to individuals and focusing on compassionate outcomes through a strong data strategy. As we leverage lessons learned, we need to make one plus one equal three, by integrating care in the community, and we need to make sure we are appropriately deploying virtual care with access to all. A regional approach will help ensure we put health equity first, and new funding models hold promise in terms of aligning financial incentives, and structural tools, to drive the quadruple aim. We're all watching with interest as the Ontario Health Team model unfolds, leveraging existing relationships, and supporting the development of new ones. Your message about trust, and respect, and inclusion, was heard loud and clear, and we wish you well in your mandate.

I really appreciated your call out about homecare is a key part of an eldercare strategy, keeping people safe and where they want to be. In the event last week, we heard experts speak about what can be done to help support seniors to live out their desire to age at home. I want to thank the Empire Club for hosting two very timely events about topics that are near and dear to many of us. As we emerge from this pandemic, I think we need to ask ourselves some hard questions; are we solving the right problems? Are we causing any unintended consequences as a result of decisions being made, and emphasis being placed on institution-based healthcare. If seniors and other vulnerable Ontarians want to live at home, receive healthcare services at home and in the community, and to end their days at home, are we making the right decisions to make that a reality? As you both highlighted, we have to ask ourselves if we are working to build health human resource capacity at a system level. Do Ontarians have those choices, or is their healthcare journey being constrained because we sacrifice capacity in the community? I know you're both advocates for seniors and vulnerable citizens, and I thank you for your ongoing efforts to make sure we have the right supports in place, so that Ontario can be the best place to age, and to receive healthcare in Canada. Thank you, again, for taking the time to share your valuable insights today. Back to you, Kelly.

Concluding Remarks by Kelly Jackson
Thank you, Chris. And thank you again to André and Matthew, and everybody joining us toda,y or participating at a later date. Our next event is on November 1st, at noon Eastern Time; it is the third in the “Fuel for Thought” series that we are producing in collaboration with the Canadian Fuels Association. Join us for an in-depth panel discussion on “The Role of Hydrogen In Canadian Transportation.” More details, and complimentary registration, are available at empireclubofcanada.com. This meeting is now adjourned. Have a great day. Stay safe and take care.

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Transforming Health Care Beyond the Pandemic


25 October, 2021 Transforming Health Care Beyond the Pandemic