Different circumstances call for different leadership styles. In the turbulent, bewildering and ambiguous world of COVID-19, clear, confident, decisive and military-style leadership was the right and necessary response to navigate uncharted waters. We were fortunate in Ontario to have many excellent command and control leaders who stepped up to take charge at the organizational, local, regional and provincial levels. The troops were rallied – figuratively and literally in our hardest hit long-term care homes (CBC News 2020) – new policies and practices were implemented, data was collected and analyzed, decisions were made swiftly and risks were mitigated.

But the circumstances have now changed, and a different leadership style is in order – one that is more flexible, collaborative, inclusive, open to innovative ideas and less risk-averse. We need an approach that ensures we actually live up to the slogan “we are all in this together”, with more than just a few selected participants at the table and, which builds on all we have learned to date.

Ontario was in the midst of developing Ontario Health Teams (OHTs) when the pandemic arrived (Government of Ontario 2019). Many OHTs were just getting underway but it was exciting to see early signs of positive impact from our work together in communities. Partnering to provide care in new ways was energizing and empowering, and there was optimism about the possibilities of better care for all. Some of these partnerships and relationships demonstrated enduring strength, which led to the acceleration of integrated efforts during the pandemic.

But many others pushed the pause button and reverted to the familiar with healthcare’s historically siloed pecking order with hospitals on top and the LHINs in the driver’s seat. It was appropriate and understandable for priority to be placed on acute care, and we applaud the efforts of our well-resourced and generous hospital partners whose leadership in infection prevention and control, for example, was absolutely critical. Unfortunately, this acute-care-centric mentality tended to pay lip service to other sectors and partners whose voices were muffled at planning tables, and whose access to personal protective equipment (PPE) was limited. Of course when the alarm bells went off in long-term care facilities and other congregate settings, they became the focus of attention out of critical necessity.

From the early days of COVID-19, everyone was advised to stay at home as “home is the safest place to be”. And yet our pandemic strategy for the most part ignored home and community care, and did not prioritize integrated care opportunities. Even more startling was the limited engagement with clients and caregivers, especially when their voices were so brilliantly present in our OHT work. Their input might have helped us see different possibilities, make different decisions and set different priorities. For example, if home is the safest and preferred setting to receive care, did we ask our clients and their caregivers how we might allay their fears around receiving home care services? Many clients put their service on hold at considerable risk to their physical and mental health and well-being — and that of their families who stepped in to carry what for many was a very heavy caregiving load. The full impact of this is yet to be seen.

We did not ask families with loved ones in long-term care about their opinions other than barring them completely from visiting for months in an effort to stop the spread. Shutting them out completely was frankly inhumane, and also meant not having the benefit of their helping hands to lighten the load for the undervalued and underpaid front-line staff in these facilities. I felt this personally when my 95-year-old aunt died in a long-term care facility in April, 2020, a victim of COVID-19. Her quality of life was marginal at best, and yet in her last few weeks of life she did not have the family visits or daily private caregiver support that had made her days tolerable. She died alone, abandoned – by circumstances and not by choice – by those who knew and loved her.

It is very likely that we will get a chance for a “do over” in the near future as the second wave hits us or when the next virus comes along, both of which pundits say are inevitable. It is imperative that we act on our learnings. We know infections primarily start in communities and this is where we should focus moving forward. We need a “home first” strategy that directly addresses the fact that COVID-19 has further impacted health and social inequities within various communities and neighbourhoods. We need to consider how to rebuild trust in home care and long-term care and create alternative models for high-quality long-term care in the community.

To start our “must do” list, let us make sure that there is easy access to PPE for all, that we collaborate to ensure essential human resource capacity is available across all sectors, that we communicate clearly to the public about safe care in the community, that we figure out how best to engage clients and families whose energies have been depleted, and that we expand virtual care options and create more easy-to-access pop-up or mobile testing sites, to name just a few. And for those OHTs that have made good progress to date, let us build on their strengths and continue the tremendous collaborative efforts that are underway with each other and with clients, families and community members.

The Ontario Ministry of Health and Ontario Health are now reflecting on the province’s COVID-19 response in preparation for the upcoming flu season coupled with anticipated COVID-19 waves (The Canadian Press 2020). I hope this critically important rearview-mirror review and forward-planning exercise recognizes the need for inclusive and innovative leadership approaches going forward so we can continue what worked, stop what didn’t and consider what we can do differently together – with emphasis on ”together.”

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