MHA CEO-in-Residence Webinar with Matthew Anderson, President and CEO of Ontario Health

(calm music) – Good afternoon, everyone and welcome to this annual edition of the MHA program at Telfer’s CEO-in-Residence It’s great that you were able to join us today This is, in fact, the second event of the day as part of the CEO-in-Residence undertaking We had an excellent career planning session with the students and Matt Anderson just finished about half an hour ago, and learned a lot of things about Matt’s career and his lessons learned that I know will certainly serve our students well as they enter their careers This event has a long history of engaging health leaders and managers and in this particular event, and this tradition is certainly been kept up this year with Matt Anderson agreeing to be our CEO-in-Residence Obviously the medium this year has changed as we increasingly learn to live in a virtual world We’re so grateful that we can continue this important event, despite that so before calling on Jonathan Patrick to introduce Matt, I’d like to read our indigenous affirmation We pay respect to the Algonquin people who are the traditional guardians of this land We acknowledge their long standing relationship with this territory, which remains unseeded We pay respect to all indigenous people in this region from all nations across Canada, who call Ottawa home We acknowledge the traditional knowledge keepers, both young and old, and we honor their courageous leaders, past, present, and future Thank you Just a couple of instructions as we move forward Please note this webinar will be conducted in English only It will be recorded and emailed to all participants in the next few days Secondly, please use the Q&A feature to add comments, react to other messages and submit your questions for the Q&A at the end of Matt’s presentation So without further ado, I’ll call on Jonathan Patrick to introduce Matt Anderson, Jonathan – Thank you, George And thank you all for coming in this unusual version of our CEO-in-Residence As many of you know, Telfer’s commitment to health management dates back over 50 years to the foundation of the MHA program What you may be less well aware of is the recent commitment that has been made by the school And the 12 years that I’ve been here, we have added an MSc in health systems, a health stream in our PhD, and a health analytics option to our undergraduate program In lockstep with that, we have been hiring a number of professors who have an interest in various aspects of health management, from operations to policy, to health governance, to information technology I would encourage you to explore our website, to explore the programs we have on offer, and to encourage promising candidates in your own organizations to consider our programs in the future I would also encourage you to take a look at the profiles of our professors There may very well be a question that’s been bugging you that you might not have had time to explore, and that might work well as a research partnership with one of our professors In addition, next year, we will be continuing the MHA speaker series, as well as our health research seminar series And I encourage you, if you’re interested to let us know and we can notify you about those events Now it is my great pleasure to introduce Matt Anderson He is an experienced healthcare leader, team builder and advocate for positive change He is widely respected among Ontario’s healthcare system for his intense focus on the needs and experiences of patients and caregivers Before joining Ontario Health, Matthew was president and CEO of Lakeridge Health, one of the largest community hospital systems in the province And what I found out this morning, much to my excitement, is that Matt has a major in English And then he took all his electives in math and computer science That excited me because I’m a math guy who took all I could in the English department, so I was quite excited to hear that Anyway, please welcome Matt Anderson – Great, thank you, Jonathan We’re a kindred spirit, you and I, I’m sure Thank you very much Thank you, everyone for the Opportunity

to come and spend some time with you today, I very much miss the opportunity to come to Ottawa I love Ottawa I love the town And as a Toronto Maple Leafs fan, I love the Ottawa Senators On the occasions that we’ve met in the playoffs, you’ve been most accommodating So thank you And I’m sure we’ll get another opportunity when this pandemic moves past Maybe George will invite me out one more time I’ll sit on the other side, though I’ll listen to someone else and ask the tough questions So thank you, I’m gonna spend a few minutes today I know you’ve welcomed me and allowed me to speak for about a half an hour So I will try to stick to around those timelines I will tell you now I enjoy the question and answer portion the most I love to hear about what’s on people’s minds Had a great session as you heard, about a half an hour ago, particularly for the students out there I really wanna promote the students to ask questions Questions from the students are, in fact, a payback for me in all this I love to know what’s on the minds of our young folks, tomorrow’s leaders, what are they thinking about? What are the questions and don’t be afraid to ask me the tough ones and particularly the ones that seem most obvious, like why do we put our financial model the way that it does when it incents completely the wrong behavior, things like that, feel free to ask those questions And I’m happy to do my best to answer them and to take you through So I will take you through a little bit I’m gonna just walk you through Ontario Health and before I take you through Ontario Health, I’m gonna back up just a tiny little bit Some of you may have been on the discussion this morning So I won’t spend too much time talking about my background and there is the brief that Johnson just gave The only thing that I really want to highlight is that I’ve been at Ontario Health for four months And if you do the math, COVID has been in our environment for three 1/2 months So that gives you a sense as to what my experience has been at Ontario Health So some of what I’m gonna be talking to you about is, in fact, what Ontario Health is or is what I’ve come into And we’re gonna talk a little bit about some of the challenges that I face as we go forward, particularly because I’ve spent a lot of time on COVID and not spending as much time about Ontario Health, and I’m gonna unpack all that for you as we go through our talk So maybe why don’t we get started And Genevieve, if you could give me a next click there So a little bit about Ontario Health, and I won’t walk you through all the different bullet points This is some of the core messaging and the concepts behind Ontario Health And it’s really trying to build upon some of the work that’s been done by the agencies that have moved into Ontario Health and as you can see, we brought together 21 agencies I’m going to unpack that a little bit more for you in just a moment and the kinds of things that we’re trying to do are down the the right hand side of your page And I would say that a couple of the things that are there that are particular attraction, one of the big challenges that we’ll face as Ontario Health, one of the biggest challenges we face in the healthcare system, is this concept of patient experience And what does that mean? And how do we build that in a true and meaningful way And those words patient experience have been around for a long, long time And I would say we’ve got a long way to go, in truly knowing the patient experience into our healthcare system I’m gonna throw a few teasers out there As we’re talking, I believe you’re gonna start putting questions in the chat room right away So as I go, I wanna ake some of these comments, if they’re at all interest to you, please put them on the on the chat because I think there’s lots of talk around patient experience and what does that really mean? Digital first, so for those of you who were on the call this morning, or earlier this afternoon, you’ll know that I started in IT My passion is for IT and for digital and e-health, whatever is the words that we’re using these days But really the idea of virtual care and in Ontario Health, we’re trying to bring together very disparate elements of the virtual care system in Ontario and trying to get that into one place And then the concept of clear accountability, one of the big challenges that we have is that we do have so many different parts of the system funded in different ways, very difficult to get that into one particular place The Ontario Health teams, which I’ll comment on in a few minutes, is a little bit of a part of that So lots of different elements, the clinical guidance up at the top Genevieve, is moving me along so I’m gonna move along to the next slide The clinical guidance concept actually fits in very nicely, Genevieve is reading my mind She already knew where I was going No, it’s okay You can get me to that next slide, Genevieve, we’re perfect Health Quality Ontario and Cancer Care

So these are the agencies that are part of Ontario Health now 21 agencies I was going with the clinical guidance and Genevieve knew I was going with the clinical guidance is that Health Quality Ontario and Cancer Care Ontario, that is really sort of their (mumbles), right? of putting out and trying to establish a core way of being and a core way of doing things And I say Cancer Care Ontario in particular, has been very successful in this over the years, over the decades The cancer system in Ontario is as fine as any in the world And I would say largely to do with the work of Cancer Care Ontario in this concept of standardization of guidance, getting it across the healthcare system, sprinkle a little bit of money in there for incentives and moving that forward You can see the other organizations that are listed there And one of the tricky things about this organization, Ontario Health is that this merger of 21 agencies, mostly came into being on December the 2nd Thinking about where we are as Ontario Health, December 2nd was when most of these agencies came together, although Ontario Telemedicine, the OTN, that joined on April 1st, so here we are June, whatever day in June we arem just a couple months ago, Ontario telemedicine joins So we are very, very new organization You can see the stats, throughout, I wanna walk you through all those different pieces, big responsibilities, transfer payments, $25 billion that we manage and get out into into the field an operating budget of over 6 billion So lots of different components to Ontario Health and also different things that we’re gonna try to pull together In particular, we’ve got the homecare system and if you can give me a flip there, Genevieve, our home care system and home community cares is a big part of Ontario Health And so we run homecare services And now for many who are on the this call may know that what we really do largely is subcontract that work out We subcontract out largely to private, for-profit or not-for-profit agencies who deliver homecare, although we do do some direct service programs and we’ve got them listed there and certainly a number of partnerships that have been developed, and the same concept of care pathways, which is very similar to this concept of clinical guidance So a big organization that’s just getting started and an organization that we’re finding our feet on If you can give me the next slide there, please, Genevieve So I was asked to talk about the vision of Ontario Health and right now, I would say, we’re working on that There’s the concepts on that first page, the ministry vision of bringing all these agencies together into one agency that will provide guidance and oversight to our healthcare system and sure enough, those are certainly parts of Ontario Health and where we wanna go with as a system But I thought I would put some of these concepts in front of you today as we think about what’s gonna happen for Ontario Health So Ontario Health right now, as I said, is 21 agencies We largely still function as 21 separate agencies underneath an umbrella agency And no criticism on that, we just came together on December 2nd in many ways And then they have a brand new CEO who’s spent the last little while trying to help the province in the fight against COVID So we are where we should be, where you would expect us to be in coming together One of the first things we’re gonna do is put together a strategy, a strategic plan and it’ll have vision, mission, values, all those concepts to it And I thought what I would do here is just put a few things on the table in terms of the first three being some thoughts about what will be core to what will be in the vision for Ontario Health And then a question at the bottom that I think Ontario Health is going to have to grapple with And by the way, where we happen to be in our cycle right now, you’re learning more with the CEO of Ontario Health on some of what Ontario Health is Being so new, I’m still meeting many of our 12,000 team members and sharing these kinds of ideas with them But a couple things that I would point out on this slide; number one is integration And that really wouldn’t be a surprise I think perhaps where we will be a bit surprising is how aggressively can we push on the concept of integration and true health system integration and I’m gonna talk about Ontario Health teams in a moment But this idea that the health teams embody

this idea of having all services truly wrapped around the patient and stop me, for those of you who have been around the healthcare system for a while, stop me if you’ve heard this before, right? We’re gonna have all of our services wrapped around the person, we really do need to do that We need to do that from not only the traditional health care services, so think primary care and hospital care, but certainly in the other healthcare services, like home care, like long term care, but also social services So how do we hook up with community social services largely that are provided by others, in particular, municipalities or regions? And so when we’re thinking about integration, really, first off, I would say maybe a little broader than we thought about before, how do we bring the social services in and make that a little broader? And I would also say a little crisper We have some wonderful examples of integration, all across the province in all kinds of jurisdictions, oftentimes they are based off of MoUs, memorandums of understanding And they’re a little bit loose How do we make that a little tighter? And how do we make these really enduring, integrated systems moving forward And at what scale will we do that? So I think that’s gonna be a critical part of the vision that comes out of Ontario Health in the strategic plan The second one again, stop me if you’ve heard it before, we’re gonna be really focused on the patient We really do need you It’s going to be a little different I think what we have to do is start where the patient is, where the resident or the client or the citizen is Someone just recently reminded me that the most cost effective patient is the one who never needs to see a doctor So is that citizen, how do we keep everybody healthy at the beginning of all this journey, how do we move our system, our whole system upstream, and focus on people as residents, or as clients or citizens and perhaps focusing on them before they ever become a patient, but truly focusing on their needs? And one of the things that I would say is going to be core to that is how we embed patient and family, caregiver into our decision making? I would say, in Ontario, we’re doing okay And again, there’s some places in Ontario that are doing exceptionally well But as a discipline, I think we still have a long way to go And then the last bullet point that I put on here is I went with less is more And I’m not actually a believer that too often less is less and more is more But I think that there are scenarios where less is more and what I mean by less is more is I think one of the core mandates of Ontario Health, and one of the things that my board wants me to push on, and one of the main reasons I came into this agency in the first place is we have, because of the very siloed nature of our system and our reporting, we’ve built up a tremendous amount of overhead, a tremendous amount of overhead inside Ontario Health and therefore, if you have it inside your funder or your agency, you tend to end up being a receiver of that out in the field So we’ve got this massive amount of administration over the system and is there a way in which we can really substantially pare that down and take some of that, that challenge and that administrative burden off of the system, all the while respecting the first two bullets And in fact, I would argue that if you do the first two bullets correctly, the third bullet almost becomes a byproduct of it If we’re far more integrated, if we’re thinking of ourselves as a system, not as 10 or 12 different parts, but actually one system, the administration of that should be much easier and much clearer And also, if we’re really focusing, every time we’re asking for a piece of information, every time that we are putting in a rule or a guideline, we start with the question of how does this improve things for the patient? And if we can’t answer that, how does this improve things for the client, when we think about our community mental health services? How does this improve things for our client? And if we don’t see how, by asking people to put in a report or submit something, or whatever it is that we’re doing on the other side, you can’t see a direct line to doing that, then why are we doing it and can we just get rid of it? So those will be some of the main concepts that will drive Ontario Health over the next while One of the questions that I think is still in front of, Genevieve is moving along a little too quickly again I’m still within my 30 minutes, Genevieve, I don’t know if you’re trying to move me along As Jonathan said, he’s got the headset on,

he’s saying move along, move along I promise I will finish within the 30 minutes, I promise I’m giving poor Genevieve a hard time We practiced this for days The population health versus Health System This is gonna be a core thing, I think, for Ontario Health to think through and to get some feedback on from the field And this goes to what ultimately is going to be the measure of Ontario Health And I would argue that if you have a measure for Ontario Health, you probably are also measuring your health system, just de facto because of the nature of Ontario Health So what’s the measure? Is the measure going to be a measure around population health? So how healthy is our population and truly a measure of outcome? Is that what our measure should be? Or should it be a measure about our health system, how well is our health system performing? And this is, I think, an important debate that we’re going to have over the next few months as to where do we want to land on these things? And I would say, from an academic, esoteric view, I would look at it and say, well, of course, it’s population health, because at the end of the day, why are we here? The whole purpose is to drive the health of the population, reduce the risk for low weight babies, reduce smoking, what are the things, reduce the incidence of diabetes So this is what our healthcare system is here for However, in very practical terms, in measurable terms, in the ability to actually link what we’re doing to those outcomes, it gets pretty tricky Some of those measures, really, you’re only gonna see a change over many, many years How would we know, in the interim, that in fact, Ontario Health is doing the things that it needs to do, when you think about in those terms, arguing that what our real goal is just to have a very high performing healthcare system perhaps as measured through the World Health Organization standards or through the in comparison to the OECD countries, do we wanna set a measures that say, we are an outstanding world class health care system, we certainly like to say we are Should we put measures around that and should that be our goal? And trust that if we are an outstanding health system, the population health and the improvement in health and our populations will follow So those are some of the questions that we’re gonna be working our way through over the next little while Now we’re ready for that next slide, please, Genevieve Thank you Some sentinel things that we’re gonna be sorting out in the next short while as well as we look at defining who we are as Ontario Health The first one is, and this is just, there’s more but just a few that I wanted to speak about today One, and I’ve already touched on it is we do have to complete this merger We’re the bringing together of 21 agencies And for those of you who are more on the business side of healthcare or on the business side period, all the same rules apply in healthcare We like to think that they don’t, but they do We’re bringing 21 agencies with 21 different cultures, 21 different ways, rules on benefits and payroll and all those sorts of things And we’ve got to merge all of this into one agency that functions as one and all the things that go along with that, in creating a compelling vision and direction for the folks who are part of these 21 agencies So we have that underway now It’s been a bit of fits and starts, both because of legislation, and then, of course, our friend COVID and all these other things that have gotten in the way but we have to do this merger We have to complete this Right now we are mostly one, but we really need to become truly one over the next little while So that’s a challenge for us Our relationship with the Ministry of Health So this is also going to be something that will need to be defined over the next couple of years We are the health agency in the province of Ontario So what does that mean in terms of our relationship to Ministry of Health? What’s the boundary line? In the legislation that formed us, the boundary line between us very, very clear that ministry develops policy, Ontario Health implements And if the world was that simple, then this would be very simple But of course, the world isn’t always that simple What’s going on out in the field will influence policy How well things are implemented will influence policy Policy will influence what are the different things that we’re doing and trying to implement out in the field

How we’re going to work together, how together or separate we’re going to be allowed to be will also be determined over the next couple of years If you think about it, in one sense, we are a arm’s length agency from the Ministry So what’s the value of doing that? And there’s many theoretical values of separating out away from the Ministry into an arm’s length agency, in theory In practice, will we see them? You move outside the agency, outside of government because that gives you the ability to hire differently, to hire different people, to explore different things Will that be true? Will we be able to set up our own pay grids? Can I do things in Ontario Health, I’m not allowed to do if I was inside the Ministry of Health? So we’ll test some of that I would say that our first test has already come and I think we, if we didn’t get an A, we, at least got a B+ And that was with COVID We’ve had to learn very, very rapidly in intense situations How does this division work? What does the Ministry of Health do and what does Ontario Health do? And the reason I would give us a B+, maybe even an A is without really having a detailed guideline, we have an act called the Connecting Care Act and that’s all we had to guide us We just figured it out in terms of setting up this concept of policy versus implementation But there’s a few places where we continue to trip a little bit as we think this one through And a great example of that would be on digital health Inside the ministry, there are tools Inside the ministry, doing digital We have teams out in Ontario Health doing digital So how does that work? And how are we gonna put these pieces together? Right now I think it’s gone well, but more out of collegiality than it has gone out of us having a clear definition as to what does Ministry of Health do, what does Ontario Health do? And what are the freedoms that Ontario Health has that really makes it worthwhile to have a separate agency outside of government? Because if you can’t take advantage of those freedoms, then why did you do it in the first place? And then the other one that I’ll just quickly comment on is relationship with providers And this is where we have to work with, there’s about 650 long term care homes, about 115, I think, hospitals, I don’t even know how many primary care docs there are out there and whether they’re solo practitioners, or they’re part of large groups List goes on We have community support service agencies, community mental health agencies, and so on And so there’s just a lot of players in the system And we have to think about what role do we play? And at the end of the day, how do we make them stronger? And when I think about all of this, remember, my midpoint, the middle bullet points on the previous slide should be all about the patient or the resident, or the client or the citizen So when we think about defining our relationship to the providers, how are we doing that, that is actually making it better for the patient or better for the citizen? And when we put that lens on it, I would say we’ve got a lot of work to do In many ways, many of the agencies that we’ve inherited have been more about administration and I don’t mean that in a editorial or negative ways, just what it is, it’s administration It’s making sure that the forms that got created over here in the ministry flow through and get there to the providers, they sign them and then back they go through the agency, we checked the boxes to make sure that they’re all there, and then boom back into the government again Sure, it makes it efficient, perhaps But it’s not really about making the provider stronger, and enabling them to provide better care to the patient, to the resident, to the client or to the citizen So a lot has to be determined And a lot has to be earned as well I would say that, in these scenarios, and this is true of the Ministry of Health, true with the providers The worst thing you can do is force people to do stuff, to sign to say under this circumstance, and this would happen to me when I was at the LHIN, I was at Toronto Central LHIN many years ago And I can’t remember what the exact occurrence was but an occurrence happened at a hospital and we found out about it a couple days later And the feeling was we should call that hospital and chastise it because under the rules,

they were supposed to call us My belief is, is that if we’re going to be the central agency, we have to earn that call There has to be a reason, a value-add reason, for the patient or the client, or the citizen or the resident, there needs to be a value-add reason why that provider would call us If there’s no value add reason, don’t make them call us That’s just bureaucracy So we’ve got a lot to figure out in our relationship with our providers Move on to the next slide Genevieve is like she’s just never gonna jump ahead again She’s gonna wait right to the bitter end, got it Why don’t we just spend a minute on integration and I’m just getting close to my half hour And I get a couple more slides, more slides that I would like to do So on integration, I would say that, first is, you may have heard about Ontario Health Teams And so this was an effort early on before COVID and I guess we’ll see about that So before COVID, and the idea was to have the province self identify into a number of smaller regions, and that these regions would bring together all the healthcare providers within the region And they would function as a single system and become, ultimately, go through a bundled payment model where all of their funding would flow through a single payment down into the agencies and then the agencies would spread it out, across themselves, loosely built off of, for those of you who are in the program, and maybe have been studying ACOs, Accountable Care Organizations down in the US, they’re a similar type of model, elite agency funding goes down and then they essentially subcontract to the other agencies So a great idea, a great idea In very early days before COVID hit, although some and I can’t remember the number now I think that we approved somewhere in the neighborhood of between 20 to 30 of these things across the province A handful of them are very, very mature and are working very well Most of them did a little bit of pause when we headed into COVID And we’ll come back and look at that in a moment We had these Ontario Health teams And the idea is that these Ontario Health Teams would report up into Ontario Health The funding model, the funding policies would be done over at ministry, would come into Ontario Health Ontario Health would then fund these Ontario Health Teams, and there would be a relationship back and forth between the Ontario Health Team and Ontario Health and presumably, in this Ontario Health team would be your provider agencies, your hospitals and your primary care and all sort of stuff So we’ll see, it’s an ambitious agenda, and there’s a lot to like about it, but we’ve got some work to do I’ve listed the other areas on here for system integration and I could have gone on and on, I could have formed hospitals on there, community mental health I just wanted to call it a few, I would say that these are the four that, right now, are on the front burner, so to speak, on what does integration really look like when we’re talking about system integration? Certainly, I’m sure everybody on this event is aware of what’s going on in our lunchroom carrels and it’s gone from big challenge to absolute tragedy A big question in front of the government right now and I’m pondering myself, I don’t have the answers is what to do about long term care, which largely has been outside of the system and what would be an appropriate way to integrate our long Term Care mortgages, there’s an easier and better way to do it Is there a way to do it? And is it a way that’s going to bring value to the residents Primary care, a huge challenge with primary care Any model of care, any system of healthcare really needs to start with primary care as its focus, in my opinion A big challenge there because we have so many different funding models and so many different setups all across the province Some areas, primary care in the province are very well organized Others, it’s still a lot of single, single docs, very difficult for us to work with primary care as a sector So how do we move that forward? And frankly, if we don’t move it forward, I don’t know how we’re gonna make really, really stellar gains on the efficiency of our healthcare system and particularly in the areas, including population health Public Health has been in the spotlight through this experience with COVID As we know, most of public health is delivered very, very locally I think in most instances, that works extremely well When we’re trying to do mass coordination, it’s been more of a challenge So what can we do there And by the way, across the province, we’ve seen where public health has integrated very, very nicely a working partnership

is probably the better words, very, very nicely with local healthcare system And we’ve seen really great outcomes Kingston would be a great example where public health, hospital care, primary care, they’re all working very, very closely together And we’ve seen really stellar outcomes in that community So how can we consent that a little more, and then Home and Community Care, as I mentioned, Home and Community Care, at least, the commissioning of Home and Community Care, all sits back with Ontario Health And we’re this gigantic central agency So why is it sitting over here when you’ve got all of this system working over here? And is there a better way to do that? So lots to work on on system integration And onto our next slide There we go Second to last slide I just wanted to end, had to end with COVID And I’m gonna do a quick next steps after this and then turn it over to Jonathan I would say there’s a lots talk on COVID and happy to talk in more detail I just wanted to call out a few very simple points One is that we’ve seen tremendous, in many instances, heroic performances from our institutions, and more importantly, our caregivers Our frontline care providers are second to none in the world And they’ve demonstrated that time and again, through what’s going on with COVID And whether it’s through their agencies, often it’s been through their agencies, but we’ve also seen their commitment to leave their agency and go work in other places, whether it’s leave the hospital and go work in the long term care home, working out in the community This is an incredible commitment beyond their organization and to the people of Ontario and to what they’ve committed to So this is a tremendous strength for us Our healthcare workers are absolutely fantastic and have made the difference in our COVID challenges Our silos did become chasms, and these are cracks in our system where we have these silos, many of which, I just referenced on the previous page They really got exaggerated through this pandemic response And one of the things that we’re gonna have to square up at the end of this, is that by most measures, the Ontario Healthcare system, when compared to the other provinces, performs extremely well If you looking through CIHI or any of those measures, we perform extremely well But we’ve really struggled through this pandemic because we are all these different pieces Now, we’ve risen above it, because of the first few bullet points, and overall have done a very, very strong response to COVID But we have to learn from these lessons and the siloed nature, which perhaps contributed to our strength as competitive organizations pushing each other to be that much stronger and that much more innovative, that maybe has become a bit of our weakness now and is there a way in which we can be more integrated, but still hold on to those things that have made us exceptional? And then I think that’s gonna be our next challenge And so finally, our last slide and our next steps from here Yeah, there we go, thank you So a couple of things, just to say, and I’ll point out to Genevieve, there’s a question at the bottom there, Genevieve so we’re gonna hang on there A couple of bullet points on this is that in terms of what’s gonna be happening at Ontario Health in the very, very near future, as in right now, we’re definitely thinking about, wave one isn’t completely done yet We still have a little, the remnants of wave one, more than the remnants of wave one still present in Ontario, and we’re supporting everybody on that But we also have to think about wave two We have to get our schools open and we have to keep them open So one of the things that we need to be putting in place to do that, and we’ve got to be quick, we’ve got a few months, hopefully, to make sure that we are well prepared for wave two and it does not have the impact that wave one had, which from a health perspective, generally we did okay, we did tragically in long term care, but generally we did okay from a health perspective, but look what the impact was on our economy, and on our society, and we can’t do that for an entire year So we’ve got to make sure we’ve got the things in place and get those schools open, keep them open and keep our society up and functioning Meanwhile, while we’re doing that, inside Ontario Health, we’ve got to do our functional integration, we gotta complete that merger and get ourselves focusing And then the last point there with a little question mark beside it is, is that our hope is to develop the strategy that I started with, at the beginning of this in terms of pulling together a clear view as to what Ontario Health wants to deliver, might be a bit of a challenge, when you put bullet points one and two together, how much strategic planning, we’re gonna be able to do, hopefully, we’ll be able to do all three, but if one has to go, it might be a strategy We may have to hold off on that a little bit as we get the other two things under control And with that Jonathan and Genevieve, you’ve been great, thank you very much And I’ll hand it back to Jonathan for any questions Thank you – Thank you, Matt Was that an echo? Hopefully, that goes away

We got lots of questions that have been presented to me, which is unfortunate for me, because I had all sorts of questions myself We still getting that echo or we good? No, wait, it’s gone, excellent I will curb my questions and ask the ones that have been provided A number were provided before the registration So if you’ve put your questions in the Q&A, there are other questions I’m also going to be pulling from so I hope we can get to as many as possible The first question, obviously COVID-19 is on everybody’s mind So as you were involved, as much as you were involved in the decisions around how we responded to COVID-19, and you looked around the world and you saw different approaches, whether it be South Korea or Taiwan or Sweden or other European countries, how was that decision made? And how did you discount some approaches versus others? – There you go Can you hear me okay? Yep, good, excellent So great question I would say that we certainly relied on evidence from other countries We also looked at, we had a group called our science table, who helped inform us quite a bit They were from a different university, whose name I won’t mention and they’re far, far inferior to the University of Ottawa, just to say although I think there was a few people from Ottawa on that It was a pan-provincial group I can’t remember all the folks who were on it, at any rate So it’s a little bit of, I guess, three things One is that we would be looking at the evidence of what’s going on in the other countries and what can be learned and that was more of a Gestalt way and reviewing articles and reviewing that which was in the public domain Second is that we did have a science group who were running models for us and as much as possible And I would, just say that when you’re dealing with a disease as young as this one, to talk about evidence is a little sketchy You’ve only got a few months worth and certainly, when we think about going into the third bucket, which was understanding what interventions worked in other countries, and would those interventions work here, which gets into societal norms as much as anything else, when we think about what restrictions would you put on? How would the communities respond to those restrictions, and all of it, off of a relatively small evidence set, so it’s really was bringing those three things together, to direct where we could go and from there, we looked at the different parts of the system And largely tried to do what we could, certainly in terms of the social isolation and putting in the public health measures, which I think were quite successful And I would have to say, as Ontarians, thank goodness, Canadians are good rule followers, because we largely follow the rules and without the harsh restrictions of other countries And that made a huge difference for us So it’s really bringing those three things together, trying to make it as science based as possible, recognizing that the science was being made up as we went And I would point out, just as an example, in late January, early February, there was a little science that said that people would be asymptomatic The general consensus at that time was that if you had COVID, you had symptoms and if you did not have symptoms, you did not have COVID And of course, we’ve learned that that is absolutely not the case And we’ve had more and more evidences that has gone on So we’ve had to roll with as the science has emerged and become stronger, we’ve had to roll with that – Fair enough And not easy decisions to make for sure Perhaps you could talk to what was your primary learning through that COVID response? And perhaps what was your biggest surprise? – I think that the, I’m only pausing because there were so many I think what I would say is, and goes back a little bit to my presentation on the learning was how big the gaps are in our system from an integration perspective Because the system is strained and I wonder if there’s any system engineers here or any assistant PhDs on the phone, if this is true in other organisms, but when everything is running smoothly, that distance, that relative distance,

we don’t feel it as much And largely, that relative distance is made up by the patients themselves So what I’m thinking is, as an example is that ability to move from primary care, to an emergency room and back into primary care in your home that, those transitions and the gap in that care, in that care continuum, in non stressed environments, we manage it, it’s not a beautiful thing, but we manage it Those gaps got so exaggerated when we got into COVID, and more so than I would have really been anticipating in terms of how that goes So I think coming out this other side, we need to take a hard look at the Ontario system and can we close some of those gaps in a very concrete way in the next few months, so that they’re not quite so extreme And I would say that was both what I learned and what I was surprised by So I answered both questions in one but I would say I don’t think I would say that this common isn’t so much surprised as maybe pleasantly surprised, maybe pleasantly reinforced the reaction of our frontline care providers and their willingness to go into very, very troubling situations that were not of their making but because people were suffering they went I don’t know that I was surprised by that but I was certainly heart-warmed by it and impressed by the people that we call our health care workers here in Ontario – Is there something you would have done differently based on your four-month experience? – With COVID or with Ontario Health or just in general? These are my five months, my difference is I may not have taken this job The big difference that I may have done So is this specifically Jonathan, can you refine the question a little bit for me? – [Jonathan] I could try The questioner was not specific as to whether this is COVID-related or not – Yeah, I guess what I would say over the four months, I don’t know that, the 2020 hindsight, I would say we would have ramped up on testing of healthcare workers, particularly in long term care homes and other congregated settings faster We know that the main transmitter of COVID in congregate settings tend to be the workers And I would say we would wanna do that more aggressively, and we’re examining that now through the summer, we’re testing different models of testing to figure out what is the best way for us to, as best as possible ensure that we’ve got healthy workers going in And I would say the epidemiologists of the world, there’s lots of debate about the relative value of surveillance testing and prospective testing At the end of the day, from my perspective, while we understand that testing in and of itself is no panacea for ensuring the absence of this particular disease, it’s just one tool that helps to reduce risk And in congregate settings, what we’ve seen, we’ve seen worldwide and we certainly saw here in Ontario, once COVID gets in to one of those settings, it spreads and it’s very, very difficult to get it under control afterwards So even if it’s only reducing risk by not a quantum, but by degree, it’s still worth it And I would say we will be far more aggressive on that next time around – Thank you That brings us really to a set of questions A lot of people are asking about what you foresee as changes to the long term care setting now that COVID has highlighted some of the shortfalls, we’re thinking particularly of the lack of full time staff, the understaffing, the four-person-ward rooms, those kind of things I know you mentioned this in your presentation that you don’t have the answers yet But are there thoughts that you have on those issues? – Yeah, and I would say that, recognizing there are as you just described, they’re my thoughts, I’m not long term care Strictly speaking, Ontario Health has a relatively small role in the long term care system But I’ve been kind enough, or people have been kind enough to invite me in to share my thoughts on various things I think that there is a long list of things that we need to do to really support long term care better The things that I think we need to focus on immediately,

the capital infrastructure You mentioned the four bedrooms That’s a big one That is a really big challenge And it’s not so easy We looked very early on as to basically, decanting strategies Could we decant a residence out of these long-term care homes The big challenge became to where and would it be safer in that other environment And we looked at retirement homes as a for instance, some trickiness there, I could be maybe bringing COVID into another congregate setting So we’re moving COVID from one congregate setting and putting it in a different one albeit largely a safer one because the retirement home ostensibly has single rooms, but you’re still moving a disease into another place and we had to be very careful Doing that ahead of time, if we can confirm the absence of disease and we can mostly do that, that might be an option We looked at hotels, that became a non-starter fairly quickly If you think about the people who are in our long term care homes, generally, these are people who are very ill Generally, these are people who are suffering from various forms of dementia Generally, these are people who are not particularly mobile So immediately you would get into situations like to get people in and out of beds, you need lift to boy your events, you don’t have lift this in hotels, you need to be able to put the wheelchair, their wheelchair must be able to go into the washroom Many of the hotels’ washroom doorway is not wide enough for a wheelchair, and on it goes So decanting out of long term care is something we haven’t given up on but it’s first blush as to how quickly could we do it There were a lot of lessons there Second is, we definitely and these aren’t in order of priority just stream of consciousness Second, would be the health human resources factor These were homes, many of them were struggling in the first place for staff, for team members, you throw in there then that somebody got sick, you throw in there that people are afraid to go into a place where someone got sick You can get yourself into staffing challenges very, very rapidly We started up a provincial staffing model to try to build on that I think what we would be doing, among other things, over the course of the summer is really beefing that up and getting more and more of a roster of folks who are trained and able to go into these settings Many settings weren’t ready from a PPE perspective And so protective equipment Now when we’ve largely, we’ve addressed it and we can address so we would make sure that that is the case as well I would say the more fundamental for me, I mentioned it in my talk is is there a way that we can make the long term care homes much more part of an integrated system Bringing doctors and nurses in or in other medical professionals in after COVID has already taken hold? Sure, they can provide a lot of support But are there ways in which we can take some of those principles, those clinical principles and AIPAC and all that sort of stuff and build that in up front and have an integrated relationship between the hospital and the long term care homes in their communities and primary care and long term care homes in their communities? And do that in a little bit more of a standardized expectation way? I think that that, for me, personally, I think that might be one of the big triggers Don’t know how to do that yet Certainly, it’s something I would like to explore It’s going to be up to you others to decide if we’re gonna explore that, but that would be something that I think we really need to explore – I assume that would apply for home care as well? – For sure, going back to our lessons learned from all this, we didn’t do a great job of really supporting and beefing up home-care, and really supporting and beefing up primary care If you think about the nature of this disease, the last thing you wanna do is put people into any kind of institutional care The risks go up from them with respect to the spread So we certainly want to make sure and look at how, we actually saw a decline in homecare over this period Now part of that was people who are receiving low intensity homecare, so think more of our wonderful PSWs And people who are receiving, there’s a tough word that’s escaping me at the moment ADLs, is the, we use acronyms for everything in health care, activities of daily living, I got it, activities of daily living, and so these are laundry and groceries and dishes and all that sort of stuff

So we saw a big reduction in those things, mainly because the client was nervous about having somebody coming into their home, understandably So A, what did we learn from that? Can we do that a little bit differently? And most importantly, can we build confidence for people, that the person coming into their home is safe to have that person come into their home? Because not only would they be coming in, and my-father-in law, received homecare services for many, many years And the people who are coming into his home who were seeing him every day or every second day, they would know well in advance how his health was We could get early warnings for them It’s not so much that that yes, so fine, maybe he wasn’t getting his laundry done But the bigger impact is nobody’s checking in on him Nobody’s doing that check to say you know what, things aren’t looking so good And doing a call back to the care-coordinator to say my client here, he’s been complaining about it, whatever and then let’s get some medical care for him while he’s in the home So we’ve lost that bit And we have to find a way to get that back Because keeping people in their homes with extra services, they’re more comfortable, it’s safer And in a COVID world, it’s safer for everybody But we have to build up that confidence that they’ll allow those home care workers into their homes – I got some math models if you want about our lack of capacity in the sub acute system I can share with you later – [Matt] All right, sounds good – Onto a different question, what is the plan for the health teams to address the strategic importance of staff engagement in the planning, scheduling and deployment of critical clinical resources? – [Matt] Wow, can you give me that one again? – Sure, what is the plan for health teams to address the strategic importance of staff engagement in the planning, scheduling and deployment of critical clinical resources? – That feels like there’s a whole bunch of things wrapped into that question So I’m gonna try to tackle that as best I can with respect to the scheduling elements of that I think maybe where that question is going is as a sector, we’ve had some really, we continue to struggle with team engagement People are feeling very, very stretched and very burnt out And that was before COVID I think a big part of that So there’s all kinds of staffing models and things, I’m gonna skip that for the moment and just go to, I think that this really speaks to, actually, I will tie it into the question from before Jonathan, into your comments about in the subacute land, do we have the right people in the right places, doing the right things? And oftentimes, what we’re doing is we are overloading into particular job classifications and moving everybody to the highest job classification from a need perspective, even though they don’t need to be there and finding some balance back into So again, just I’ll use the example that we were just talking about, finding balance back and keeping people healthier And in the scenario that I just described of the PSW who’s interacting with a client, the next immediate step might be for that person, the PSW and that person to be able to access a nurse practitioner and get the nurse practitioner involved So before we send our poor client off to the emergency room and start that entire cycle, and all the challenges that are going on there, and let’s not forget that before COVID, we had very significant challenges in our emergency rooms, before we even go down that path, is there a way in which we can triage quickly what’s going on in the home or in other care settings Long term care is another great example of understanding what’s happening and bring the right level of resource to the client or to the patient at the right time and try to stop this constant escalation up into the acute care sector, where we see a whole bunch of constraints coming in and start to overwhelm So I don’t know if I’m anywhere close to answering the question that was brought up But in my mind, this idea of work load balance and critical resources, making sure that the right type of resource is being used at the right level, I think, is part of the answer And something that only comes when we think about ourselves as an integrated whole and not as individual silos – Absolutely The question on underlying strategic importance of staff engagement So I’m thinking the question had more to do with the worry that as you create these teams, that maybe the frontline staff don’t have the same ability to engage? – So thanks for that clarification And I know we’re almost, are we until 3:00? 3:30, I’ll speak forever then

So let me pick on that one, a little bit on the staff engagement I don’t know if I have an answer that will come across as a bit trite The reality is that the truer answers are the best answers to our problems coming from proper engagement of the frontline, the people who are actually doing the work And there’s a whole bunch of reasons why we don’t do that very well as a system Some of it has to do with we don’t even really know how to do that well Some of it comes from those frontline folks are so busy that even engaging them properly, becomes a big challenge And the classic story of the misalignment in engagement in our healthcare system, is that guys like me, I do meetings virtually all day every day and so setting up a meeting with me at four o’clock in the afternoon and you’re probably booking it three months out But I’m used to a meeting at two o’clock in the afternoon, try getting a physician or a nurse into sitting down at a table to talk at two o’clock in the afternoon It’s not reasonable So then it’s about, well, really the best way to do that engagement is at six o’clock in the evening The problem then becomes, well, these are very overworked people And even for myself, every once in a while you’d like to be home with your family So now you’re asking these clinicians to give up some of their work time, which is already overburdened, and many of them are being asked to do more with less in their work environment, or give up some of their family time, both of which have a very, very high cost So I appreciate although I know that the textbook answer is that we must engage our frontline folks, they’re the people who know the answers, that’s absolutely true How we do that is far harder because of the circumstances that we’re operating under And even in some environments that I’ve been in, and some of the environments that I’ve actually led, the answer has been well, great, what we’ll do is, is that we will hire more people and bring more people into the environment, so that it frees up these people, so that they are now free to participate in whatever is the planning activity or the design activity they were doing That’s also a lovely theory The challenge is that we’re running vacancies in most of our areas So we can even put the funding there And it’s still difficult to find the folks, all that to say, I don’t wanna say that we can’t do it, it must be done And we have to find ways to do it And frankly, we have to get a little more comfortable with the tools that we’re on right now, this Team’s tool There are other ways in healthcare that we can get that feedback But I only want to recognize that while I give you all the tried answers, there’s some real real challenges underneath that have to be overcome because you do have to get to the right answer which is that they have to be involved – I appreciate the honesty there There are also a number of questions around the choice that was made towards the revamping of the system and other provinces have gone to regional health system And the question is, why did Ontario choose not to go that route? – Yeah, so I would say, I guess a few observations So Ontario has tried the Ontario version of regionalization And that has been largely, keep the agency’s structures in place and then try to put some kind of overhead on top of it And in fact, that’s what we’re doing right now with Ontario Health and Ontario Health has five regions and we work out into the field Let’s just pause on that for a second And we’ll look at across the provinces what’s happened with regionalization? First is that it’s morphed over time And largely it started with more and then became less, almost like my slides, less is more So it started with more regions, and that devolved down out into fewer regions Alberta is the, the bellwether of a single region All of Alberta Health reports into Alberta Health as a single system You can get into long academic arguments about which model is better And, for those of us in Ontario, we would point to, particularly our hospital system, we would say that, we have the lowest cost per rating case We have a tremendous clinical turnaround times We have tremendous clinical outcomes Show me the evidence, the hard evidence that these regional models are actually more effective

Then the Ontario model where we’re largely still our separate agencies, which is sort of a soft regional model on top of it My personal view is that that’s more to do we’re measuring the wrong things than it is about that the measurements are telling us that we shouldn’t do more regionalization I happen to believe that we should move into much more of a regional model I don’t know, I tend to stay away from the hardcore governance discussions I think that those are, one of the big challenges that we get into in Ontario and probably in every jurisdiction, but certainly here in Ontario, is function follows form We worry first, about governance, we start at governance as compared to start with the patient and start with the resident And when we start there, would you design the system the way that it is right now And largely you would get into how you need to move to, you start to describe all the things that you need to do for this person And I believe that what you would start to describe is much more of a regional model And to bore the people who are not bored already, the people who were on my chat this morning, there’s a reason why I moved to, just before this job, I was at Lakeridge Health and Lakeridge Health basically runs all the hospitals except one small hospital, it runs all the hospitals in Durham Region And what that meant to me as an opportunity is how can we create an experience for the residents of Durham, where their social services which were largely run and funded by the region or the municipality where there’re social services and there are health services, which is largely funded by the province can actually function as though is one system My belief is that you can go a long way without ever touching governance I’m not a zealot on there can only be one governance or there must be multiple governance Again, for me, I think that that has to come out of your local conditions involving the person and the patient first I would say that if you don’t move to a full single governance model the way that the other regions have done In BC, they’ve got their regions, et cetera, then you’re gonna have to have some very clear, strong contracts between agencies to truly embed an integrated model that has multiple governance structures in it, can be done a little tricky and frankly, is a little against the culture that we have in our healthcare systems Largely, we do a lot off of mutual agreement And we shy away a little bit from hardcore contracts that say these are the things you’re gonna do and these are the things that I’m gonna do But I think if you’re going to have a regional model, without actually merging all the agencies, you’re going to have to embrace the idea of these very strong contracts that are gonna be in between the agencies One of the flaws in that and one of the challenges is that what are the penalties if you don’t honor that agreement? And fortunately, in our history, when we don’t like these things, the penalty, the agency, or the person that actually suffers is the patient, not the agencies that are left behind So there’s some flaws in that as well So at the end of the day, I would say, Ontario has resisted, I can’t speak to why Ontario made the decisions that they made, I have my guesses, but those would just be guesses I would say that where we are right now, we should be focusing on, definitely on sub-region models, as we talk about with the concept of VOHTs Look at the ACO model, which is what we’re doing And the ACO model, the Accountable Care Organization model is trying to embrace the concept that don’t start with governance, start with an outcome and a funding model, and figure out what the governance structure will look like to move that funding model into the outcome that you’re looking for Worked to some degree in the US for sure, maybe that’s something that’s gonna be successful here in Ontario – As a user of health system, the idea of starting with the patient makes sense And it leads really into the next question, which is concerned with the significant amount of healthcare costs associated with direct treatment

of chronic health conditions, many of which are preventable So what role do you see Ontario Health playing in health promotion, disease prevention, and ultimately lifestyle medicine? – So great question and it goes to my slide earlier on about are we about population health or are we about a high performing healthcare system? And it’s a nuanced difference as I described in the chart, but it’s an important one, is one that we’re gonna have to grapple with My hope is that, and my desire from a leadership perspective on Ontario Health is we wanna move upstream as far as we possibly can And the good news is that, in a weird sort of way, having so much demand for service, we can really start to reorganize without there being an agency or a provider group that quote, loses, right? Now, this isn’t necessarily true across all the province And let me just unpack this a little bit So in high growth areas, so if you think about in Durham Region as a for instance, it’s a very, very high growth area on multiple dimensions It’s high growth, just on pure population It’s growing It’s also aging, I suppose we’re all aging, but like most of the province, there aren’t a younger cohort coming in behind the aging cohort So the relative demand on healthcare is growing, even if the population wasn’t, the relative demand on healthcare is growing So when you have growth in demand, presuming that that can be funded, then that gives you room, in a sense If Jonathan’s getting $1 and I’m getting $1, but there’s a new $1 coming in, it’s a lot easier to integrate and to change the system when there’s a new $1 coming in So we could be asking Jonathan to do things that he wasn’t doing before, because now there’s a new $1 In other areas in that province, where we don’t see this kind of growth In fact, we have areas in the province where we see negative growth, it gets a little tougher, because now Jonathan’s been getting $1 and I’ve been getting $1 Now, there’s only $1.50 coming in, and we’re going to be scrapping over well, who just lost the 50 cents or the quarter So it’s hard to make some changes All that to say, I think that what we’re seeing across the province is that if we continue to operate in a way we are, even if another dollar is coming in, it’s $2 worth of demand that is coming in but only $1 of supply These two factors can create the opportunity to change the way that we’re operating And we see that in different models, I’ll use an acute model, but we can use non-acute models as well In acute model where we’re moving more and more to day procedures and starting to offer the idea that why do we have to, for everybody involved, why are we doing procedures that require an overnight stay when, in fact, if you change the procedure, the technique, you can do it on a same day basis? So now you’re seeing a lot more people for a lower price point and a relatively same amount of resource So that’s one model Another model that is tougher and only works when we are in an ACO type model, is where we truly get into the preventative care models that I think the question was really speaking about An example in this model would be where we set up a model that would say, instead of going for an MRI, you go for an appointment that says you don’t need the MRI and in fact, they offer an alternative to going for the MRI So that’s wonderful That’s absolutely fantastic But if that person who did the consults, let’s say it’s a nurse practitioner, or even a surgeon or a member, if they’re not being funded for that, they would need to be funded for it So that’s a new amount of money coming in, you can say, well, that was offset by the fact that you didn’t do the MRI But where, in fact, is that savings occurred by not doing something unless you actually close the shift on the MRI, you actually haven’t saved any of those dollars So switching our funding model to a prevention model is going to be a challenge And I would say impossible if we stay in a siloed-based model where the hospital gets its funding, primary care gets its funding, because once we separated all that out, the new behavior in primary care or in preventative care may result in some savings over on the hospital side,

the hospital doesn’t necessarily experience it And now from a system perspective, it just feels like an additional cost So all the way back to Ontario Health, my hope is, is that we can start to change some of these funding models to incent what you’ve just described in the question, keep people healthier If you keep people healthier, there’s a gain across the system, which again, is the AOC model If we’re not gonna tackle that integrated funding model, then I think we’re gonna struggle as we have been in truly moving to a health and preventative model – Agreed I think, when you look, I go back to your hospital example with the day surgeries, it’s a lot, it’s difficult to see how you could manage chronic care, in a way that we would be more less is more type approach So it really does leave preventative as the primary way of treating more people with the same amount of resources A follow up question that was posted was about the use of virtual care, particularly for managing chronic care And that may be an opportunity – For sure, for sure and virtual care is in my wheelhouse I’m a big fan and supporter of virtual care and spent a little bit of time on it Virtual care is a prime example, a prime example of where our funding models have really challenged us to use virtual to its fullest capabilities Now, we’ve seen a shift in that through COVID, mainly because the province opened up the billing codes for the physicians so that they could do it And that, that, by the way, is not the job of physicians The reality is that we all like to be paid for our work, every one of us and so that’s how it is and so much of our health system, the funding models is based on the geography upon which the transaction occurred Our funding models are based, if you’re a physician and you do a telephone consult or a virtual consult, often you won’t get paid at all If you make them come into your office, you will be paid If you see them in the ER for the exact same thing that you would have seen them in the office for and the same thing you could have done on virtual, you’ll get paid even more So we’re incenting people to go to the most expensive place in our system So with virtual care, the concern has always been, one of the concerns anyway, has been that what will happen if we open up on virtual care is that and I’m gonna just use the physician model because it’s easiest, but it’s not limited to the physician model If you open up virtual care, if a physician typically sees 10 people a day, the concept behind virtual care would be, but yeah, if I see if we opened up on virtual care, then I can see 20 people in a day virtually and because the virtual fee code was half of what the in-person was, it’s cost neutral But I’ve seen now 20 people So that’s the theory The fear is, is that no, no, you’re still gonna see the 10 physically And then you’re going to do the other 20 in the evening And you’re gonna bill for that And now the cost of the system has just shot through the roof, and we’re not gonna have any control over the cost anymore Fortunately, there’s been many studies done on this over the last while and we’re also have the study of all studies, which is COVID And that’s just not bearing itself to be true, that at the end of the day, physicians are right sizing and they’re saying here’s how many I can do virtually, here’s how many need to be done because virtual can’t replace certain types of visits, obviously but we can find that balance It’s not going to outstrip our costs So we have to go after those funding model I’ll give you one more example if I can remember the specifics of it This was when I was at Osler And we put in a model, it was a fantastic model where a person would come in for a procedure into the hospital, they would go home And these folks, we had been tracking this particular cohort with people who were frequent users of our ER and frequently, on our in-patient units So very high costs, if I can say it that way What we put in was a model where we were to have a nurse and/or a nurse practitioner, and we gave him some very basic, the patient, we gave the patient some very basic digital tools so they can upload some information for the nurse Once a week, they had a scheduled call with the nurse and they loved it, the nurse loved it ER visits dropped conservatively

like somewhere in the neighborhood of 67% Need for inpatient care dropped very, very substantially, somewhere in the neighborhood of 30 or 40% So by every measure, this is fantastic The issue who’s gonna pay for this? Because what happens in reality from a hospital perspective is, so what that did was it took several, in this case, with these particular patients, it took several hundred, even a couple thousand ER visits, theoretically, it took those out of the system We never incurred the cost of those people coming into the ER Here’s the problem when you’re in a high growth area Those thousand visits that were taken out were washed over by the tens of thousands of new visits that were arriving into the ER So we never actually saw that savings, there was no way that we could pull those dollars out and say we’re gonna pull those out to continue to fund this program So it ends up that that program becomes a net cost to the system because we’ve only moved that one little piece into that virtual world and we haven’t figured out a funding mechanism for it So lots and lots of challenges as we think about how do we change the incentive models around our virtual, however, virtual care, there’s no question and we’re doing it now, I would also add, I think about my father-in-law, who part of his homecare was wound care, he had terrible ulcers wound injuries on his feet And the homecare nurse would come in every once a week, once a month, I can remember what it was with some regularity and with an iPad and take a picture of it and upload that picture and send it over to the physician They would take a look at it and be able to give advice back as to are the creams working and all that sort of stuff So it’s out there but to truly embrace it and to embrace it in a way that the person put the question forward in terms of treatment prevention, we really are gonna have to look at our funding models and incentives and tweak them because they don’t really support the mass scale of virtual care in the province – Thank you On a different topic, can you speak to the mental health roadmap, particularly the resource hub? And has the timeline or content changed due to COVID? – Thank you, yeah, so Ontario Health is home to our mental health and addiction center of excellence that got launched in early February, in that little period where I started at Ontario Health, but COVID hadn’t wrecked my life It was just in there And it’s main, one of the early initiatives that it’s pushing on is this concept of moving out, and I’ve forgotten that I know they’re called a hub but I think we’ve got an even nicer name for them, moving this capacity to do psychological supports out into the community using a number of hubs across the province Fortunately not unfortunately, fortunately, that has largely progressed per schedule COVID has not had too big of an impact on that In fact, COVID has pushed us, the province to think about, can we put more services online in that way and get more services distributed out into the communities because clearly, there’s been a very substantial impact from a mental health perspective on COVID In fact, some of you may have seen, there’s a little chart that talks about the third wave of COVID and the impact that it’s gonna have The first two, we know about; the third being the impact on societal mental health and addictions, negative impacts because of the impact of the first two waves So I would say on the one hand, directly answer to the question COVID has not impacted it, it’s on the same timeline moving forward On the other hand, COVID has probably increased the demand even further than what we thought was out there and we’re already struggling, as an understatement to meet that demand – [George] Jonathan, perhaps one more question before we wrap up? – Sure Now you’re gonna make me choose one – This is my COVID hair, by the way, the question was what the hell’s going on with that guy’s hair? My COVID hair, I can’t get a haircut You should pin the picture up from before, that was much better – Well, I’m not gonna comment given the size of my growing beard here Given that Ontario Health is still the integration process has the framework, vision, mission or funding priorities of the agency changed dramatically post-COVID? – Not in a written down way But I would say in a, almost in a moral way I think that we are, it’s caused us to, it’s caused me,

I think it’s caused many of our leaders and it’s caused, I think the Ministry of Health, and our board to think differently about what is it that we really need to do and how are we really gonna support our providers And just to give you a very concrete example of what I mean, we’re struggling through, if you think about the models that I talked about before and this concept of out in the regions, we’re going to have, we have the hospitals and private care and home care, et cetera We’re gonna try to meld that together a little bit better, whether it’s through some form of the OHT vehicle, and then what’s that support that Ontario Health is going to bring to that Ontario Health Team and into the field And I think our thinking, my thinking around what that might be look like, what kind of support is necessary to truly make a difference, a positive difference for the patients and the residents I have a bit of a different view about that We’ve played a very different role than I ever thought we would in integration Certainly, Ottawa is a tremendous example of that, bringing together public health, the hospitals, primary care, maybe not quite as much as I would have liked to have seen, but a different rule of integration than what I would have imagined going forward Probably, if you think of, in terms of thick and thin, I was thinking that we would be a pretty thin group out in the regions I think maybe we need to be a little thicker than I originally thought, but what functions that would mean particularly as it relates to supporting clinical care, might be a little bit different than what I was originally thinking And in a very specific way, thinking a little more about the Cancer Care Ontario model, where we have regional clinicians embedded into the 14 cancer centers, maybe we need to do a little more of that kind of thing of putting more clinical resource support into the environment that have this dual relationship where they’re fully embedded in the environment, but with a connection point back into Ontario Health Maybe that’s a model that we would have to do So certainly has caused us to pause and think about how we might do that And then lastly, I think accelerating as best as we can on the ground integration Because at the end of the day, it comes back to how are we presenting ourselves as a collective to our patients, and our residents, and our clients, and our citizens and what can we do to improve that – Regretfully, we have to draw this to a close And Matt, for a guy who graduated in modern English poetry, and despite your Toronto MHA, you’ve done extremely well – It’s been a lot of things that I had to overcome, George – I’m personally, and I’m sure many of the people that are online are are thankful that during this perfect storm, where we’ve got health transformation, and COVID working hand-in-hand, that you are at the helm of Ontario Health, very grateful for you taking on that leadership role You’re a great role model for our students So I wanna say thank you for taking the time and for sharing your insights on the vision, the future of Ontario Health within this very complex mosaic as we try to create integrated systems of care Just a couple of other thank yous I wanna thank Colin and Genevieve and Jonathan, for all the work they’ve done to make this event possible Thank you very much And Genevieve, I know you hold a special spot in Matt’s heart now, as a very progressive, maybe aggressive slide changer, well done Just a couple of words to all of those who have attended Keep an eye out for the post event survey We’d love your feedback, and also for the recording of the presentation which will be made available to you And I’ll conclude with a plug for the MHA program We see ourselves as a very supportive resource, education resource and research resource to our community And we are still in the process of accepting applicants for September 2020 So I speak to the employers out there

if you have anyone who you feel you want to support in this respect by providing them with the MHA credential, we are still open for applications for September 2020 So on that note, I’ll conclude, I’ll thank Matt again Thank you to Evelyn too for all the rounding up she had to do to ensure that Matt’s schedule was available Thank you and have a great day – [Matt] Thanks very much, everybody