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Ontario health boards moving toward collaborative governance

Health boards across Ontario are looking for ways to collaborate with other service providers in the health-care sector as a way to use taxpayer dollars more efficiently while providing the best care possible, says Toronto health lawyer Kathy O’Brien

“This allows the boards to be innovative and to define their own solutions to problems because each region, each community has its own set of issues,” she tells “Nobody wants a one-size-fits-all solution imposed on them."

O’Brien, partner at DDO Health Law, says part of what’s driving the move toward more collaboration is Bill 41, the Patients First Act, which, if passed, will give more powers to the Local Health Integration Networks (LHINs.)

“I think what we have seen is that the LHINs have governed with a very gentle hand,” she says. “They haven’t been issuing directives and mandating integrations. They certainly have the power to do that but they’ve been more gentle, more collaborative. I think the fear is if organizations don’t go out and find integrations and solutions themselves, ultimately solutions will be imposed on them either because the LHIN says do it or the LHIN says we don’t have the money to fund everybody.

"Ultimately, some of this is about money — how to make the health-care system more efficient and effective because there isn't an unlimited budget.”

The 14 LHINs across Ontario are the funders and regulators of many health service providers, including hospitals, psychiatric facilities, long-term care homes, community care access centres, community health centres, and community mental health and addiction services. Bill 41 would expand that list to include primary care services. 

The LHINs were created in 2006 with a mandate to encourage integration, to break down the silos in health care as a means to get the system parts to work together, O’Brien explains. 

“In the LHIN legislation there’s actually a positive obligation imposed on every LHIN and every health provider that is funded by a LHIN to proactively seek out and identity opportunities to integrate their services,” she says. “That’s certainly been a trend in health care over the last 10 years or so. Everybody is looking at ways to integrate with another health service provider.”

Bill 41 has renewed the push. 

O’Brien, who advises health organizations about integration options and legal responsibilities, says many have questions about the process. She advises them on the range of tools available to them to enable their boards to come up with a collaborative governance solution. Some organization executives wonder whether integration will mean merging with another health entity, which can be a daunting proposal.

“They’re not ready to do the full-blown marriage yet,” she says. “They want to date first. There are many ways to do that but fall short of a full merger.”

O'Brien says an effective place to begin the process of collaborative governance is at the board of directors of the organizations.

”One of the reasons you want to involve the board — comprised of all volunteers — is because the board is above the management in the governance of the corporate structure and is able to look at things more objectively," she says.

O’Brien says the collaboration process can be done very informally and can be as simple as getting different boards together in one room from time to time to talk about their challenges and what they are seeing as gaps in the system. That way, she says, the two boards can start to build a relationship and trust between them. 

“They can also do things like cross-appoint people to each other’s boards so they would get to see from an insider’s perspective what the issues are,” she says. “It would help each understand the organizations — their challenges and solutions — better.” 

The LHINs will often facilitate this collaboration process by providing funding.

“Some health organizations have engaged a facilitator to brainstorm ideas about collaboration,” O'Brien says. “Many have also engaged legal counsel to get advice on the spectrum of options available to them. The LHIN and the health-service providers are working at this hand in hand.”

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