Background: In the province of Ontario, Canada, Ontario Health Teams were introduced in 2019 to support the needs of their local populations by bringing health care providers and sectors together to deliver seamless care. Ontario Health Teams are a model of integrated care and an example of large-scale health reform focusing on local populations and regional health workforce. However, there is currently sparse evidence and policies to support local health workforce planning. While several approaches have been proposed, many are siloed, focusing on one profession, sector or population. In addition, a substantial amount of the research has focused on the perspectives of the larger scale health system or a specific discipline. The objective of this study was to understand regional health workforce planning from the perspectives of systems leaders, providers and community members.

Approach: A qualitative descriptive approach was used to focus on understanding current regional approaches to health workforce planning as well as contextual factors that influence this planning. This qualitative component was part of a larger mixed methods case study design that was conducted collaboratively with one Ontario Health Team with the overall goal of informing policy to support regional health workforce planning. Key informant interviews were conducted with regional decision makers, systems leaders, providers and community members. In partnership with the Ontario Health Team, we identified and recruited participants to reflect the diverse perspectives across the multiple sectors and roles including primary care, hospitals, community partners and caregivers. Interviews were transcribed verbatim and analyzed using reflexive thematic analysis. Three members of the team conducted the analysis, developing a code book with regular meetings to encourage reflexivity about data analysis coding procedures.

Results: Fourteen individuals were interviewed. Four themes were generated from the data: i) Getting By... which reflected the current reactive approach to planning, issues of supply and demand resulting in competition, lack of collaborative planning and insufficient resources including data, time, staff, tools, governance and funding, ii) Driving Forces which focused on external priorities and pressures that influence workforce planning, iii) (In)Capacity for Change, focusing on structural challenges including funding models, unions, and a focus on organizational needs vs the overall population needs , [AO2] and iv) Innovative Solutions such as 1) standardized, granular and current data on relevant populations, services and workforce both present and future 2) regionalized planning, sharing of resources and a regionalized workforce 3) appropriate resources such as funding, dedicated tables and staff with sufficient time and skills 4) evaluating needs and models of practice and 5) inclusion of, and resources for, patients, informal caregivers and volunteers.

Implications: The results highlight inequity across the sectors to support health workforce planning including the availability and use of data, resources, expertise, time, and models. Integrated models of care can serve as a leveler to conduct this work in a manner that is equitable across the health care system, promoting partnerships, strong leadership, governance and accountability. One key issues is the need for collaborative and pro-active approaches across disciplines, sectors and organizations.

Background: Healthcare systems globally are shifting towards person-centred integrated care (PC-IC) to better support individuals with complex, long-term needs. Goal-oriented care (GOC), which aligns care with patients' personal goals and preferences, is one approach to care delivery which can support person-centred integrated care. However, applying GOC in practice requires interprofessional primary care teams to adopt new routines and skills. There is limited understanding of the specific skills and behaviours needed for integrating GOC into daily practice. Therefore, this study aims to explore how primary care providers (PCPs) apply GOC in their everyday work with patients.
Approach: An ethnography was conducted with PCPs who had completed a GOC pilot training between March 2022 and January 2023. Data were collected one year post-training through non-participatory observations combined with interviews that focused on PCP behaviours during patient interactions. Thematic analysis was conducted to show how GOC was delivered in primary care settings. Through member checks, participants contributed to the final description of the GOC behaviours.
Results: Sixteen PCPs were observed for 166 hours over 34 days (February-May 2024), involving 156 patient interactions and 29 interviews with providers. Participants included physical therapists, social workers, nurses, dietitian, general practitioner, speech therapist, and mental health professionals. Core behaviours that emerged as central to GOC included asking about expectations and goals, defining and recalibrating goals, and evaluating care actions. Additional actions supported the demonstration of this behaviour, such as PCPs engaging in discussions about emotions and the person’s context, which guided care decisions and empowered patients in care planning. PCPs promoted autonomy of the patient by sharing clinical information in an accessible way, enabling informed decision-making. Beyond directly observable actions, interviews revealed behaviours that PCPs viewed as essential to GOC but invisible to the observer. PCPs described being mindful of how they positioned themselves to encourage patient engagement. They also used their knowledge of patients’ lives to avoid burdening them with irrelevant details. Participants highlighted actions before or after patient interactions, such as discussing goals with colleagues, as impactful behaviours that support GOC in patient-provider contact.
Implications: This study shows that GOC involves both visible ("frontstage") and invisible ("backstage") behaviours. While the focus was on observable behaviours, interviews revealed that “backstage” processes also shape GOC delivery. Understanding these “backstage” elements can further add to the development of a skillset needed for applying GOC in practice. Future research should focus on the connection between patient and provider perspectives to refine GOC training for professionals. Identifying barriers and facilitators will also help policymakers and educators support GOC implementation in primary care.

Introduction: Implementation of integrated care for children living with medical complexity (CMC) and their families requires the establishment and support of key innovative workforce roles that span health, disability, community and social care systems. RuralKidsGPS is a paediatric care coordination service implemented in four Local Health Districts (LHDs) in New South Wales, Australia since 2022. Paediatric Care Coordinators (PCCs) provide family-centred care, shared care plans, and link multiple clinical teams looking after the CMC. Understanding PCC experiences, training and support needs is crucial for effective integrated care delivery and model sustainability.

Methods: Ten PCCs participated in one-on-one semi-structured interviews at 6 and 12 months after commencing their roles. The interview schedule covered role scope, training and support, and mechanisms for maintaining PCC wellbeing. Transcripts were analysed by two experienced researchers who inductively identified key themes.

Approach: PCCs felt very supported by their local line managers, however, not having direct access to other PCC colleagues was described as “isolating” and “lonely”. Most PCCs worked part-time (0.5- 0.8 full-time-equivalent) and often they were the only person in the LHD in the role. Even if there were two PCCs in the same LHD, in the rural context their closest colleague could be located >200 kilometres away. PCCs talked about significant role complexity in terms of CMC medical and support needs, highly complex psycho-socio-economic circumstances of families and complex fragmented health, disability and social care systems. Capacity was discussed by all PCCs most of whom held part-time roles and worried about supporting families on non-working days and all PCCs talked about working on days off as “there is no one else to help these families”.
PCCs experienced an emotional toll and vicarious trauma whilst supporting the CMC to access services for their highly complex medical needs, within the context of significant challenging psycho-socio-economic family challenges, including parental mental health, unstable income, housing, and access transport. When asked about how they looked after their own wellbeing, most PCCs avoided the question, some became upset and most talked about de-briefing with their direct line-manager. PCCs displayed resilience, felt their role was important and they were making a real difference in the care of CMCs and their families.
The role of a PCC was highly dynamic and unpredictable: “I think I think it's a dynamic role in terms of…I think sometimes you just do what you have to do and I don't think there is necessarily a really clearly defined”. The importance of professional networks or a “buddy-system” was a theme underlined by all PCCs and the establishment of a virtual community of practice was highly valued by PCCs. They also felt that PCC roles needed greater recognition in the health system and that stock-standard nurse role descriptions were not adequate to cover the skills and role scope as experienced on the front lines.

Conclusion: Organisations implementing innovative models of integrated care must also consider implementing support structures and processes to support key workers without whom model sustainability is threatened.