The bold vision of Ontario Health, including the creation of health care teams, took a pause with the arrival of COVID-19. But as Matt Anderson, President and CEO of Ontario Health and Helen Angus, Deputy Minister, Ministry of Health explained at the September 16^th Longwoods’ Breakfast with the Chiefs (BWTC) event – to an audience of 500+ – the pressing requirements of the pandemic led to some interesting and encouraging outcomes.

When the state of emergency was declared in Ontario on March 17, Matt Anderson had been President and CEO of Ontario Health for just six weeks. The 21 agencies at the table had just started creating a set of common goals and figuring out how they were going to work together. “It was a very exciting time,” said Matt.

Then the call came from Andy Smith at Sunnybrook – the first individual case of COVID-19 had arrived on our shores and all those great plans were suddenly shelved.

“That’s why we’re calling this talk the best laid plans,” said Helen. She still has the easel up in her office with the last set of hallway health numbers, a reminder of days when they could tackle priorities – like hallway healthcare, digital health and mental health – a day at a time. Overnight, those priorities shifted as the government and Ontario Health mobilized to respond at top speed to an immediate and pressing set of challenges.

It was not completely unmapped territory for Helen and her colleagues at the Ministry of Health. “I had been working with Dr. Bell when we faced H1N1 and the potential of an Ebola outbreak,” she said. In fact, the apparatus of the Ministry of Health and Long-Term Care (LTC) started to ramp up well before the declaration of a state of emergency. “By the end of February, the first Health Command Table was established, and we were well on our way to coordinating the health system response,” she said.

Those adjustments were not just happening in the Ministry, but in the field as well. A Critical Command Centre was soon up and running, and other essential pieces of a coordinated response were falling into place.

A recent uptick in Ontario cases (300 reported on the day of the webinar) was a vivid reminder that this problem is far from behind us, but the occasion of BWTC gave the two leaders an opportunity to reflect on what they’ve learned so far, the challenges exposed and opportunities presented by the pandemic, and how the healthcare landscape has changed in some positive, and probably permanent, ways.

“A disease like no other”

Matt is more than a few years into a distinguished healthcare leader career, so he’s no stranger to disruption but said this virus is completely different. “I cannot believe how quickly it moves,” he said. “We had to respond fast.”

And that’s exactly what happened. A few months ago, most hospitals didn’t see themselves as being in the Assessment Centre business, but when the virus hit, health organizations and providers sprung into action to provide access to timely testing. Matt said those Centres – essential for reducing the risk of transmission, protecting other patients and minimizing the impact on emergency departments – are not going away anytime soon.

It was the same story with the establishment of the provincial lab network. “Our lab system went from being challenged to being the leading Canadian jurisdiction in terms of the number of tests getting done per day,” said Helen.

Finding strength in adversity could definitely apply to the public health teams, many of whom had to intensify and adapt their efforts as the pandemic accelerated. “Our public health partners have been on the frontlines from the beginning, providing careful guidance and leadership and serving as ambassadors to the public about how to stay safe,” said Matt.

A simplified Supply Chain Distribution Network for healthcare and beyond

Keenly aware of their audience’s firsthand experience of the pandemic, Matt and Helen didn’t sugarcoat the early rough days, when the two organizations struggled with the staggering demands on the system. “In March and April, getting secure access to PPE – ventilators, respirators, N-95 – was a 24/7 exercise,” she said, not helped by the fact that supply was largely based in China, the epicentre of the virus. The government pursued hundreds of leads, and with the fresh ideas harvested by a homegrown portal, Ontario Together, they were eventually able to begin to secure supply.

Local teams have assisted in that effort, said Matt, working together to create a greatly simplified Supply Chain Distribution Network. 

Today we’re in a completely different place. “There is now plentiful access to domestic supply, everything from gowns, ventilators and N-95s being made in Brockville, and tenders are out to make surgical masks in Ontario,” said Helen.

The benefits of local coordination

The silver lining for Matt was discovering that there were wonderful nuances in the changes brought about by the COVID-19 response and the transformation being enacted by Ontario Health. Some of the points of overlap included a focus not just on patients, but on residents and communities and, central to the mission of Ontario Health, empowerment at the local level.

“This experience reinforced that the more we can push decision-making into those areas, the better off we’ll be – coming back to the core premise of the original operating model – the centre supporting the regions rather than the other way around,” said Matt.

There is no concrete data yet, but Helen has plenty of anecdotal evidence that where Ontario Health Teams were meeting and working together around a common set of goals or a population, that those relationships were helpful to the COVID-19 response. “Being able to go from direction to implementation much more quickly without having 14 boards and independent actors helped us get traction on the ground much more quickly than previously.”

Matt’s face lit up when the topic turned to virtual health, an admitted passion project from the time he worked in IT and virtual care. Considering its widespread adoption, this is another area that got a boost during COVID-19. “We’ve accomplished more in the last six or seven months than we did in the last year or two,” he said.

Getting ready for the second wave

After a gruelling six months responding to the pandemic, the prospect of the second wave fills the two leaders with angst. That feeling was confirmed in questions from participants pointing to gaps in the management of our vulnerable populations and a lack of specifics. Registered Nurses' Association of Ontario CEO, Doris Grinspun, pressed for answers: “One a scale of 1-10, how ready do you both think we are to prevent losses in LTC during the second wave?” and “Can we hear details about the role community care will play in the second wave?”

Close attention to vulnerable populations is clearly on the Ministry’s radar. “We know that in the second wave, we need to make better and fuller use of our community capacity and offer more intensive home care than was offered before,” said Helen. She spoke about isolating residents into three groups to prevent the spread and working with primary care and community partners. For those hoping for details, she promised, “There’s more to come.”

In spite of the nagging unknowns, Helen and Matt see many bright spots. “The collaboration that we’re trying to achieve through the Ontario Health Teams definitely helped us in the pandemic response,” she said. “People stretching beyond their borders, being nimble, deploying resources across sectors and their willingness to collaborate on the ground is a lesson learned and a strength of the healthcare system.”