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Integration: The Next Quality Frontier

Moving from Sectors to One System; from Ideas to Implementation.

Creating an integrated health care system is one of the great quality challenges currently facing Ontario – and many other health systems. It involves bringing together different parts of the patient journey into a more coordinated experience.

While we have worked to build up individual health care sectors – think new hospitals with wait time improvements, primary care reform, enhancements to Community Care Access Centres, and strengthening of long-term care homes – the trick now is creating a system that becomes stronger than the sum of its parts to allow patients to move through it seamlessly.

Of course, integrating care is more easily said than done. I recently read a brief from the World Health Organization that said there are more examples of polices that call for integrated services than concrete instances of their actual application. Part of the difficulties associated with integrated care is the number of challenges as people transition from one part of the system to another. There are different physical locations, care providers, organizational cultures and information management/information technology systems.

It is at these transition points that the risks to quality increase, because we do not currently have the same kind of quality oversight structures in place that we do in individual care organizations. We have built legislative, regulatory, governance, policy, and best practice standards to monitor and improve the quality of a given part of the system. However these very important structures don’t typically span sectors.

Integrated care closes those gaps and creates seamless patient transitions, through a tight-knit system of “hand offs” between providers and organizations across all sectors. In turn, integrated care improves quality, because it demands that we follow the principles of better data, leadership, communication, transparency, and accountability – all of which are necessary for better outcomes.

Health Links are a good example of how Ontario’s health system is working to embody these principles. Health Links are composed of interconnected teams of family doctors, specialists, hospitals, home care, long-term care, and community support agencies. They are designed to support integrated care for patients with the most complex needs, and they work with Local Health Integrated Networks (LHINs) to coordinate more responsive care, to ensure access, and to improve patient experiences.

Integrated Funding Models are another example of how we can work together to improve health outcomes. It is an initiative that supports sector-led innovation by encouraging health care providers and organizations to test new approaches and align incentives to integrate funding and promote high-quality care throughout a patient’s journey – irrespective of who provides that care and where it takes place. New payment models based on enhancing coordination care will help us move forward to improve patient care and integration across the health system as well as increase value-for-money at the same time.

There are other priority initiatives in place, related to palliative care and mental health, which require a level of integration across sectors.

While we are still a ways off from a fully integrated health care system, it is heartening to see ongoing efforts to push the province toward high-quality seamless care, where the system moves as one for the patient. I look forward to continuing to talk about integration and will be making it a focus in my next blog too.

In the meantime, I’d love to hear your thoughts on what a well-integrated system looks like to you. Please Tweet me @DrJoshuaTepper or email


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