Shared leadership, decision-making and accountability are essential elements in developing and sustaining effective governance for Ontario Health Teams. The COVID-19 pandemic heightened our awareness that addressing complex healthcare issues of this scale demands more collaborative, distributed forms of leadership. The first module identified key frameworks and tools to support shared governance, including the Collective Impact Framework. Through a combination of evidence-informed materials and facilitated discussion, leaders examined fundamental questions, including: 

• What do we mean by shared governance in the context of OHTs? 

• How has COVID-19 accelerated and/or created barriers to shared governance for OHTs? 

• What tensions are inherent in the OHT environment, and how do they set the stage for negotiating shared leadership principles and practices? 

Building a shared understanding of what authentic collaboration looks like is critical because shared governance is about so much more than putting the right structures in place. Building and sustaining effective OHT governance and leadership requires an enabling culture and structure, the right competencies, and evidence-informed collaborative processes. This workshop examined the following questions:

• What does authentic collaboration look like in OHTs?
• What is required of leaders in a collaborative and adaptive environment?
• How do organizations build an enabling culture and structure for shared leadership?

OHT leaders worked collaboratively to negotiate complex system-level decisions that align organizational and system interests in pursuit of collective benefits and impacts. This work requires a high degree of trust, as individual leaders and organizations are asked to relinquish some autonomy and control to build consensus. Through this workshop, participants explored the following areas:

• The decision parameters that clarify the level and type of decisions to be made, and by whom
• How decisions are negotiated among partners to ensure thorough debate and the incorporation of diverse perspectives
• The most appropriate forums for making different types of decisions

OHTs operate within multiple accountabilities. Alignment between organizational and OHT priorities, as well as clarity around how organizations contribute to shared OHT accountabilities, help determine success with shared governance and, ultimately, improve population outcomes. In this module, participants were coached through the following:

• Ensuring all partners are clear about shared goals, outcomes, and accountabilities
• Identifying who the OHT is accountable and for what, and whether appropriate governance processes and structures are in place to support shared accountability
• Learning about tools that can be used to clarify the contributions and commitments of each partner to various shared OHT accountabilities

Collective Impact successes highlight the need for dedicated backbone supports, including staff and resources, to serve and coordinate collaborative efforts. Effective backbone supports enable OHTs to convene and facilitate leadership meetings, and to support the collaborative processes and shared decision-making required to redesign care for targeted populations.

Governance models are required to promote and enable shared leadership, decision-making, and accountability in order to achieve OHT performance objectives. These models are understood to need to evolve over time to support transformative system-level change. Through this session, participants explored the following areas:

• Key lessons learned about creating effective backbone structures for initiatives such as OHTs
• How Collaborative Leadership Teams create effective shared decision-making processes while maintaining the trust and support of their individual organizational boards
• The range of governance options available to OHTs and how these might evolve over time

In the final session, key learnings from Modules 1 through 5 were integrated, enabling OHT leadership teams to reflect on local strengths and opportunities related to shared governance, both at the time and looking ahead. The session facilitated the development of individual OHT Roadmaps that highlighted areas for further discussion and coaching, supporting continuous improvement in shared governance practices as OHTs progressed toward more integrated models of care delivery. 

This tool is available here.