Start Submission Become a Reviewer

Reading: The tenuous beginnings of health system transformation: How Ontario Health Teams enacted cha...


A- A+
Alt. Display

Conference Abstracts

The tenuous beginnings of health system transformation: How Ontario Health Teams enacted change in the context of uncertainty


Gayathri Embuldeniya ,

Institute of Health Policy, Management and Evaluation, University of Toronto, CA
X close

Jennifer Gutberg,

X close

Shannon Sibbald,

X close

Walter Wodchis

X close



In 2019, the government of Ontario launched Ontario Health Teams (OHTs), a milestone in the journey towards integrated care and population health management. Yet, early model development was riddled with uncertainty. This research explores what made system transformation possible even in the context of that uncertainty. It explores how uncertainty was manifested at cross-organizational, sectoral, and professional levels across OHTs, and how it could be successfully negotiated.

Aims Objectives Theory or Methods

A stratified random sampling approach was used to select 12 representative OHTs across geography and sector, from 30 OHT applicants. We conducted semi-structured interviews with 125 participants across OHTs who had played key roles in shaping their OHTs, including administrators, clinicians and patient and family advocates. Interviews were conducted one-on-one, using telephone and videoconference, largely between January to March 2019, by experienced qualitative researchers. Interviews were transcribed, anonymized, coded using NVivo 12, and thematically analyzed through a cultural constructivist lens.

Highlights or Results or Key Findings

A sense of uncertainty was identified at three levels: a) at an OHT level, there was uncertainty about certain healthcare policies that were in flux, coupled with the perception of a lack of direction from policymakers; b) at a sectoral level, certain sectors were uncertain about participating due to historic vulnerabilities; and c) at a professional level, physicians were uncertain about the value of the new model and their place within it. These concerns were countered by a recognition of the need for change, the value of the new model, inclusive decision-making, and awareness of and empathy for each other’s needs. This helped unsettle traditional hierarchies and facilitated new forms of certainty. We present how uncertainty were experienced across OHTs at different levels, followed by three case studies, one at each level, showing how uncertainty was navigated by participants of a specific OHT and the contexts that facilitated this negotiation.



OHT participants’ ability to put in place structures and strategies to navigate uncertainty demonstrates how some forms of uncertainty can be successfully managed and even be productive. Their work was made possible by a deeply felt understanding that traditional power structures needed to be reimagined.

Implications for applicability/transferability sustainability and limitations

Understanding the possibilities and challenges of this endeavour will be helpful to program implementers negotiating uncertain environments as well as to policymakers seeking to provide guidance without stymieing local innovation.

How to Cite: Embuldeniya G, Gutberg J, Sibbald S, Wodchis W. The tenuous beginnings of health system transformation: How Ontario Health Teams enacted change in the context of uncertainty. International Journal of Integrated Care. 2022;22(S2):171. DOI:
Published on 16 May 2022.


  • PDF (EN)