Improving Patient Care and Health Outcomes in Ontario Via Sector Partnerships

May 7, 2023 annieparkerfoundation

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By Patricia Thangaraj

The Ontario Government plans on addressing the issues plaguing their health care system by maintaining current relationships and building new ones with health, community and other sector partners, which they hope will improve patient care and health outcomes in Ontario. One of the goals of this plan is to improve health equity by tackling the social determinants of health that are apparent among the diverse populations in this province.

In doing so, they recognize that they must first address the issues which are currently impacting the capacity of physicians and other frontline workers in hospitals and other health care institutions to deliver optimum health care such as a shortage of health care workers and increased surgical backlogs and how this leads to some of Ontario’s diverse populations being unable to access affordable decent, quality health care services.

Silos of care are lacking for health care providers. This can lead to bottlenecks, which increases the pressure across the continuum of care in Ontario. There are also several, infuriating, mismatched electronic record systems to contend with. And they fundamentally rupture relationships with patients, which is the basis of medicine, and, for many health workers, professional development.

Hiring and training more health care workers in one of the ways that the Ontario Government plans to ensure that the residents in this province are able to see a health care professional when and where they need it. They know that having highly-qualified physicians, nurses and personal support workers among others is critical in this regard.

Thus, they will ensure that there are more health professionals in Ontario every year by creating:

• 455 new spots for physicians in training

• 52 new physician assistant training spots

• 150 new nurse practitioner spots

• 1,500 additional nursing spots

• 24,000 personal support workers in training by the end of this year

This will require a number of actions.

Improving on Current Programs

The Ontario Government will address the various obstacles that small, rural and remote communities face in recruiting and retaining health care workers by expanding the Ontario Learn and Stay Grant initiative. Here, they will pay for the tuition, books and other direct educational costs for postsecondary students who enroll in high-priority programs in various growing and underserved communities, providing that they commit to work in those communities after they graduate.

Around 2,500 eligible postsecondary students who enroll in medical laboratory technology/medical laboratory science, nursing, paramedic and other high-priority programs at the diploma, advanced diploma, undergraduate, masters and postgraduate levels will benefit.

It is hoped that these efforts will lead to a more resilient health care workforce in priority communities, which have been challenged by staffing shortages. It will also help to ensure that communities in rural Ontario have the same access to the care they need, when and where they need it, similar to how those populations in urban areas of the province have.

Developing an Effective Human Resources Strategy

The Ontario Government is also planning on developing an effective human resources strategy that would include making it easier for nurses trained in other provinces and countries to work in Ontario by allowing health care workers registered in other provinces and territories to immediately start caring for the residents of Ontario without having to first register with one of the province’s health regulatory colleges. This change will help health care workers overcome excessive red tape that makes it difficult for them to practice in Ontario under the “As of Right” rules. Ontario will become the first province to do this.

They will also help hospitals and other health care organizations temporarily increase staffing when they need to fill vacancies or manage periods of high patient volume, like during a flu surge. Here, nurses, paramedics, respiratory therapists, and other health care professionals will be granted permission to work outside of their regular duties or areas, providing that they have the knowledge and skills to do so. This will help hospitals and other health care institutions reduce staff shortages, especially during critical times.

Moreover, they plan to make it easier for foreign trained health care workers to work in Ontario by collaborating with regulatory colleges such as the College of Nurses of Ontario and the College of Physicians and Surgeons of Ontario, to make it easier and faster for qualified health care professionals to work in the province. This partnership will include working with these institutions to ensure health care professionals do not have to undergo unnecessary barriers and costs by requiring regulatory colleges to make registration decisions within given time periods.

This is a worthy plan. However, what makes them think that internationally trained health care professionals need to undergo training under Canadian trained health care workers to ensure that their skills are up to par? This whole notion of “Canadian work experience” needs to be decolonized and institutional changes and anti-racism education needs to be implemented for Canadian Federal, provincial and territorial Governments as well as Canadian employers so that they can recognize that internationally educated and trained professionals have the same exact work experience, skills, knowledge and expertise to perform the jobs for which they were trained for just like those who received their work experience, training and education in Canada do.

Nevertheless, the Ontario Government and their health care, community and other sector partners must ensure that there is equity and equality in administering this plan for internationally trained health care professions, regardless of where they got their work experience and education from in terms of curriculum, time periods of training and the way that they are treated within the system.

For example, health care professionals educated and trained in the U.S.A., England, the rest of Europe, Australia and New Zealand must not be given shorter time periods for training before they can branch out on their own compared to workers trained in Asia, Africa, the Caribbean and Latin America.

Another critical component of this would be ensuring that the Canadians who are training the internationally trained health care workers treat them all the same. This means letting go of stereotypes that internationally trained health care workers from racialized populations are less qualified and therefore require more training and also that they cannot speak English as well as their White counterparts.

Using Portable Benefits to Retain Health Workers

The Ontario Government is developing a new portable benefits program where part-time, temporary and contract workers can access benefits, even if they move from job to job by providing them with a package of workplace health benefits that move with them.

This would improve their health and financial security, support labour mobility and help hospitals and other health care institutions recruit and retain highly-qualified staff among other benefits. Many employers do not provide their temporary and part-time workers with health, dental and vision insurance. The Ministry of Labour, Immigration, Training and Skills Development will administer an advisory panel this year to make recommendations on portable benefits.

Streamlining the Registration/Licensing Process for Nurses

The Ontario Government will also partner with the College of Nurses of Ontario to reduce the financial barriers that prevent retired and foreign educated nurses from receiving accreditation so that they can resume or begin practicing in Ontario, respectively.

They will invest an additional $15 million to temporarily pay for examination, application and registration fees for retired and internationally trained nurses, saving them up to $1,500 each. This will ensure that around 3,000 retired nurses and 5,000 internationally educated nurses can start working sooner to support the Canadian health care system.

This will include creating a centralized site for all foreign educated health workers to streamline their access to supports like education, registration and employment in their chosen profession or find another career. This program will provide these internationally trained health care specialists with the support they need to navigate the system to get licensed to practice in Ontario.

One of the ways that this centralized site can ensure that they are catering to the needs of all internationally trained health care professionals is to have a system in place where they hold the same value and appreciation for the previous work experience and education that internationally trained health care professionals have received and not have preconceived notions that the work experience and education gained in Eurocentric countries is higher than that gained in Africa, Asia, the Caribbean and Latin American countries.

Planning for the Future

The Ontario Government is planning for the future by training the next generation of doctors, nurses, personal support workers and other health care professionals in this province.

This involves investing in postsecondary education and removing financial obstacles to education and training wherever possible. One of the groups that they will target under this initiative are medical laboratory technologists, so that doctors have the assistance that they need to effectively diagnose and treat patients.

They will accomplish this goal by developing a strategy where they would work with their education partners to establish bridging programs and create additional education seats for more students to become medical laboratory technologists.

Physicians will also benefit as the Ontario Government will add 160 undergraduate seats and 295 postgraduate positions in the province over the next five years. Of the 295 new postgraduate positions, 60 per cent will be dedicated to family medicine and 40 per cent will be dedicated to specialty programs.

All six medical schools across Ontario will benefit from this expansion, the largest of its kind in over 10 years. They will also launch the physician practice ready assessment program this year, where internationally educated physicians with experience overseas can do a screening and assessment to prove that they are ready to start practicing in Ontario immediately without having to undergo lengthy re-education programs. This will ensure that they have at least 50 new physicians by 2024.

They will also add 52 new educational seats for physician assistants and work with physicians, nurses and other members of interprofessional health care teams to provide patient care. This would result in a reduction of wait times and improve patient access in high-need areas such as emergency medicine and primary care.

The College of Physicians and Surgeons of Ontario will deliver a framework for regulating physician assistants as a class of members later on this year and physician assistants will be regulated in 2024 so that physician assistants can be integrated in Ontario’s health care system.

They will also increase nurses’ access to training over the next two years by adding around 500 registered practical nurse and 1,000 registered nurse training spots, which would lead to faster access to primary care. They are planning on investing approximately $100 million to add 2,000 nurses to the long-term care sector by 2024-25.

They will also partner with the Ministry of Long-Term Care, Ministry of Health and the Registered Practical Nurses Association of Ontario to assist personal support workers in furthering their education to become registered practical nurses, and for registered practical nurses to advance their education to become registered nurses. To be eligible, persons must commit to working in the long-term care sector for the same period of time as they receive their educational financial assistance.

There must be a system in place like a written and signed agreement by both parties to hold these people accountable to this deal, otherwise, after they received their free training, they would find some excuse to transfer to higher paying positions, which also have fewer hours and lower patient numbers like private practice.

The Ontario Government will also increase the number of nurse practitioners to ensure faster access to primary care, long-term care; add capacity in northern and rural areas and create 150 more education seats for nurse practitioners starting in 2023-2024.This will increase number of seats to 350 every year.

They will also invest in hiring over 3,100 internationally educated nurses to work under the supervision of regulated health professionals so that they can meet the experience and language proficiency requirements to become fully licensed to work in Ontario. This new funding will also include the home and community care sector as well as the Enhanced Extern Program for an additional year. Increased funding for both the Supervised Practice Experience Partnership and Enhanced Extern Program will ensure hospitals can continue to hire more professionals to work with students and internationally educated nurses.

Likewise, Canadian trained health care workers can also learn from internationally trained health care professionals not just the other way around. The principles of medicine are the same worldwide. Hence, there is a need to let go of this racist mindset and superiority complex in Canada, where they believe that work experience, education and training attained internationally is inferior to that gained in Canada.

Another racist mindset that needs to be changed in Canada is that internationally trained professionals, especially those from racialized populations, are not fluent in English. While there would be some workers that would need to undergo additional English language training and tests to ensure that they are meet the language requirements to practice in Ontario as stated, adopting a generalized view that health care professionals from racialized populations cannot speak, read and write is English, when in actual fact, many of them can, is racist.

Furthermore, is it not enough to train internationally educated and trained professionals. They must also provide training for Canadian trainers in areas like cultural sensitivity. Too often the focus is on training those coming into the country, with no focus on training those already in the country.

This involves ensuring that Canadian health care workers who would be supervising the internationally trained health care workers have the experience or get the required training to work with Ontario’s diverse populations. The Ontario Government cannot assume that they do because many of these persons claim they have this experience, but then this is proven to be false in the way that they treat persons from racialized populations such as the racist things that they say, which prove that both systemic and structural racism – inequalities and barriers – continue to exist in Canada.

Further investments by the Ontario Government include funding the training of 24,000 personal support workers by the end of this year, improving health care provider training and financing the new Health and Supportive Care Providers Oversight Authority so they can become fully operational by the end of this year. This authority will provide quality care and consistency of education and training of personal support workers, which will eventually expand to other health care providers.

Adopting an Integrated Approach to Health Care Delivery

The Ontario Government’s partnership with the College of Nurses of Ontario will also include creating regulation changes that would ensure that patients access care for certain procedures more quickly by increasing the scope of practice for registered practical nurses. These increased responsibilities would allow them to perform certain procedures like starting an IV when a patient requires medical attention and delaying it if it is likely to be harmful to the patient.

They will also partner with the Ontario College of Pharmacists to explore options to increase scopes of practice for pharmacists, which would also result in residents in Ontario being able to get the care that they require within their own communities.

Furthermore, the Ontario Government recognizes that health care requires an integrated approach, which capitalizes on the experience, skills and knowledge of various regulated health care professionals. Therefore, they will continue to explore and consult with midwives, respiratory therapists, naturopaths and other partners to bring changes to their respective scopes of practice.

Developing Innovative Ways to Increase Health Care Workers’ Scope of Practice

One of the ways that the Ontario Government will do this is to build on the success of 9-1-1 models of care by creating a Models of Care Innovation Fund that will ensure that hospitals, long-term care homes, home care providers and Ontario Health Teams can find creative ways of maximizing the skills and expertise of the health care workers currently working for them.

These projects could include:

Interprofessional Staff Pooling, which are shared in both a hospital and a long-term care home for Registered Nurses.

Building a Long-Term Health Care Strategy

Given that Ontario’s population is likely to increase by approximately 15 per cent over the next decade and the population of seniors aged 75 and older is expected to grow by 49.3 per cent from 1.2 million to 1.8 million over the same period, the Ontario government aims to increase the number of health care workers in this province to meet the needs of this growing population.

This year, they are analyzing current gaps within the Integrated Capacity and Health Human Resources Plan for Ontario, which started last fall, to anticipate needs over the next decade and to find solutions to tackle the increasing health care demands. The plan will build on how they can meet this demand through investments, health human resources and innovative solutions.

They are also shifting their focus to partnering directly with health care system leaders on a workforce plan that would include where to prioritize current and future resources, addressing and minimizing system gaps and building a more resilient health care system for the long term.

Another part of this plan includes evaluating various strategies to increase the number of health care professionals starting with registered nurses, registered practical nurses, nurse practitioners, physician assistants, and medical laboratory technologists by recruiting and retaining these health care professionals through incentives and leveraging programs like the Learn and Stay program.

This would be facilitated by developing a greater understanding of the needs of each community so that they can cater to those needs more effectively by recruiting and retaining family doctors, nurses, specialists and other health care providers. They will prioritize areas most in need such as rural and remote communities, where gaps continue to exist.

This plan will incorporate lessons learnt from COVID-19 and ensure that they are prepared to meet the health care needs of Ontarians, regardless of which area of the province they reside in, for years to come.

Building a National Health Care Data System

The Ontario Government will measure their performance by adhering to the federal government’s requirement for a national health care data reporting system as part of its funding partnership with the provinces and territories because they recognize that sharing information will help them learn from each other and grow stronger. As a result, they will partner with other provinces and territories to create a mutually-beneficial national health care data system.

There needs to be a mechanism in place to ensure that the provinces and territories are complying with the Federal Government’s requirement to implement this collection and sharing of health care data from coast to coast. Otherwise, there is a possibility that the provinces and territories, whether unintentionally – because they get busy with other obligations – or intentionally – because now that they have received the Federal Government’s funding, they believe that they do not have to put in the time and effort to implement this system, but rather they can use the money in whichever way they desire with no accountability, is dangerous.

To ensure that they are building a system that works for all Ontarians, the Ontario Government will continuously measure their progress in tracking residents’ capacity to access services like primary care and mental health care, reduce wait times for MRI and CT scans and time spent in the emergency rooms and increase Ontario’s health care workforce to ensure that the specific needs of this province’s growing and aging population are being met.

Measuring their progress will allow them to identify and fix existing gaps that impact on Ontarians ability to access quality patient care services by incorporating solutions that will ensure that the people of this province are connected to the health care services that they need, when they need it the most, via better data collection and sharing methods and other initiatives.

The Way Forward

Addressing both the implicit and explicit bias that exist within the Canadian system that includes Ontario and health care workers, and active steps to reduce and eliminate these forms of structural and systemic racism is critical in moving forward.

There is a tendency in Canada to put people from racialized populations in a monolith and to make stereotypes based on that, such as these persons do not have the work experience, knowledge and skills – both hard and soft – to work in Canada in professional jobs.

The principles of medicine are the same worldwide. Therefore, there is a need to let go of this racist mindset and superiority complex in Canada, where they believe that work experience, education and training, especially if it is acquired in the Caribbean, Africa, Asia and Latin America is inferior to that gained in Canada. In some cases, there is also a believe that their education and work experience is also not as good as that acquired in the U.S.A., Europe, Australia and New Zealand.

Another racist mindset that they need to get rid of in Canada is that people from racialized communities cannot communicate in English, when in fact, many of them can speak, read and write in English better than those born, raised, and educated in Canada.

All of these stereotypes only serve to impede any progress that Ontario and the rest of Canada desires to make in improving health and health equity by reducing the social determinants of health. Additionally, it can also lead to other negative outcomes such as adversely affecting the mental health of internationally trained health care professionals, which in turn would impact on how they deliver care to Ontarians.

Furthermore, while this Plan outlines training for internationally trained professionals to work under Canadian trained professionals, to ensure that they have the expertise, skills and knowledge to work in their chosen profession, it fails to acknowledge how Canadian trained professionals can also learn from internationally trained professions in order to deliver the most optimum health care services to Ontarians, thereby ensuring that they can meet their goal that the residents of this province are provided with the health care services that they need, where they need it, and when they need it the most.

Adopting an anti-oppression approach (AOP) at both the micro and macro levels by eliminating the Apartheid requirement known as “Canadian work experience” and recognizing that these internationally trained health care workers have the same work experience, skills, knowledge and expertise as their Canadian educated and trained counterparts to work in their chosen profession in Canada, would help to advance patient care and enhance Ontario’s health care system in the post-COVID-19 era.