Figure 1
East Toronto’s 21 Neighbourhoods served by East Toronto Health Partners, including 5 Priority Neighbourhoods (circled).
Figure 2
Main characteristics of the East Toronto Health Partners’ collective response to COVID-19.
Figure 3
COVID-19 case counts in East Toronto from March 2020 to February 2022 and important milestones in the ETHP pandemic response.
Figure 4
COVID-19 case counts in two priority neighbourhoods (Taylor-Massey and Thorncliffe Park) and two high SES neighbourhoods (The Beaches and South Riverdale) from March 2020 to February 2022 and important milestones in the ETHP pandemic response in priority neighbourhoods.
Figure 5
COVID-19 vaccination counts in two priority neighborhoods (Taylor-Massey and Thorncliffe Park) and two high SES neighborhoods (The Beaches and South Riverdale) from December 2020 to May 2022 and important milestones in the ETHP vaccination effort.
Figure 6
IFIC’s 9 pillars of integrated care.
Table 1
Summary of findings.
| 9 PILLARS OF INTEGRATED CARE | WHAT WORKED WELL | QUOTES | OPPORTUNITIES FOR GROWTH | QUOTES |
|---|---|---|---|---|
| FUNDAMENTALS | ||||
| Shared values and vision |
| “When you sit at those tables, and try to solve problems together, that’s how you build your relationships. So it makes it stronger, and then when people have ideas, you’re able to kind of flow with it.”(CL) “Hospitals were inundated, and this fortress mentality wasn’t going to work…so with the whole ‘I need you and you need me, how can I help’ thinking opened a lot more doors.”(PO) “We did what was right, because it had to be done. Even sacrificing ourselves. Some people’s instincts would be protectionist. We helped as many people as we possibly could.” (CL) “I felt responsible and they (MGH team) made me feel that this would be okay, you will get through this” (PO) “(MGH IPAC team) came into to observe staff. They were coming to help, not take over. In other (LTC) homes, the reception of this team was not positive, but we recognized they were here to help.” (PO) “putting our hats aside and rowing in the same boat” (PO) |
| “We need to be proactive to start thinking about what our communities need”(PO) “…we have some disadvantaged populations, and we want to work together to figure out how to serve them best. This unifies us, brings us together, and is a big driver for creativity, innovation, and motivation to do something differently.”(CL) “Thinking about the health of a community through the partnership with schools and hospitals – we can be more proactive on population health.”(CHA) |
| People as partners in care |
| “The Community Health Ambassador role has worked very well from the beginning, because they not only reflected the diversity of the people in East Toronto, but also most of [them] were not new to the community, they were already active, involved in projects, committees – they were well known and trusted in the community.” (CHA) “I’m absolutely proud of the collaboration on the ground and addressing some of the unique needs of our community and providing them language and culturally sensitive information, and really giving the community the autonomy to guide us and decide how we should support them.”(PO) “Every Thursday we are doing mobile testing in every building, outreach to promote testing and vaccine clinics. People are really engaged with us.” (CHA) |
| “Not much space for partnering with community member patients and caregivers (starting to do it now), although observation and gathering feedback was part of the process.”(PO) |
| System wide governance and leadership |
| “We were able to adapt in real time to be out in front, finding options, getting testing to people.”(CL) “Would not have been able to do what I did without the full support of [hospital] leaders. [Name of Hospital CEO] said ‘I have your back’. This was huge.” (CL) |
| “[We did not] fully catalyze our relationship with government agencies.”(PO) “A model of convening and collaboration is important, but we need a governance model that addresses true integration.”(CL) “[There are] challenges in working collaboratively with organizations that are at your level, or maybe a bit higher, and in the ranking of our healthcare system. I’m not saying that the hospital is higher than the community organization, but it might be perceived that all the resources goes to the hospital first, because we’re […] not putting much emphasis on the importance of community partners and community organizations”(PO) |
| ENABLERS | ||||
| Workforce capacity and capability |
| “Can’t speak enough of [IPAC Champion], I could email, call every time I had a question.” (PO) |
| “We should’ve delegated. Same people doing everything was helpful, but exhausting.”(CL) “For collaboration to work …staff need to feel they are not losing control.”(CL) “We missed opportunities for reform… we could’ve done something about PSW wages.”(PO) “This was a field we had no knowledge of. How do we keep everyone safe?”(CL) “Better recognition of sacrifices made…e.g., say thank you, share success stories, share struggles in a safe place.”(PO) |
| Digital solutions |
| “We saw everyone who came in, called everyone, we had a real pulse on what was happening, a sense of responding to peoples’ stories – challenges of self-isolating, etc really helped us plan.” (CL) “Data was shared by MGH and used for planning testing, clinics, vaccines, pop ups…[we used data] to plan response at micro, meso, macro levels.” (PO) “the City missed prioritizing Taylor Massey at the beginning, but we had data to show otherwise.” (CL) “Having virtual ward supports for home monitoring was helpful.” (CL) |
| “Digital component is key. There is funding. How can we really leverage this to be a foundation for the next decade?”(CL) |
| Aligned payment systems |
| “They dropped the supplies off at our front door until we were able to manage our own PPE.” (PO) “We all believe an integrated system will drive better health outcomes and resources being used differently. The only way to be truly responsive is for providers to think about how they might operate differently. Not just with new funding, but with current funding.”(Gov) |
| “Individualized funding in a crisis does not work. And it speaks to that idea of how do you build integrated funding models, where you have fluidity and common goals and outcomes.”(PO) |
| OUTCOMES | ||||
| Population health and local context |
| “It was clear that we were prioritizing testing in areas where there were more barriers. [We] created structures to support local neighbourhood testing and ran multiple testing sites. This was very key.” (CL) “The vaccine testing strategy that changed everything was the pop up at Iqbal foods. We had no idea what would happen.” (PO) “We wrote letters to prompt the government on things like preparing for expanding testing, preparing to do 100,000 tests/day. When [the] Minister came, [we] gave her the truth about Armageddon coming, [but] there was no way to escalate. This was frustrating.” (CL) |
| “You cannot achieve health outcomes without addressing social determinants. That’s the simplest. And I think the pandemic really highlighted this. If we didn’t have food security, people would not be able to self isolate. And the spread would have been much higher than what we have. The [way] we control this is by addressing social determinants of health, and you cannot accomplish health equity without addressing social determinants.”(CL) |
| Resilient communities and new alliances |
| “[We] knew early on this was a community issue not a hospital issue, so we needed to pull in our partners.” (CL) “The match between CHAs and community agencies was a match made in heaven. Prior to the pandemic, many of the agencies were working in silos. With the pandemic they joined hands together.” (CHA) “[We] respected and tapped into the knowledge residing within the [East Toronto] community.” (CL) “Shelter providers really appreciated our work and assistance. They felt that they were not abandoned. They felt we were accessible[…]. They appreciated no bureaucracy around our response. [ETHP] got a lot of shout out in the media.”(PO) |
| “As members of an OHT, now that we develop a rapport with LTC partners, we should play a significant part in helping address some of the LTC challenges and how we deliver care for older adults, e.g., staff/resident ratio; standardized pay; physician care model; advanced care planning and palliative care; integration of acute, LTC and home care.”(PO) |
| Transparency of progress, results and impacts |
| “[It] took us longer to react to the issues in LTC than we would have liked. We should’ve been working with that sector 4 weeks earlier than we did.” (CL) “[We] underestimated how hard it would be to work in Taylor-Massey. [We] took the vaccine rates very personally.” (PO) |
| “There were factors beyond our control such as funding, but we could’ve allocated our existing resources in a better way such as investment in food security and mental health …as people really needed these services.”(PO) |
[i] Legend. Representative from a partner organization (PO) (i.e. schools, long-term care homes, community agencies, acute care) PO; community health ambassador (CHA); clinician leader (CL); provincial/municipal government (Gov) (includes public health).