There is no question that the last few years have been challenging for healthcare systems around the world.

We have been managing a global pandemic, and thanks to extraordinary contributions from our healthcare workers – the nurses, doctors, support workers, emergency responders and staff who work behind the scenes to keep systems running – we have met unprecedented demands for infection control, vaccination delivery and patient care, often in high-risk and unpredictable circumstances.

Now, well into the third year of the COVID-19 pandemic, major challenges remain as outbreaks of seasonal flu and respiratory syncytial virus (RSV) add to the strain on limited healthcare resources.

The intense pressures, uncertainties and long hours have taken a toll on healthcare workers. Fatigue and burnout are causing staff shortages and serious recruitment and retention problems, adding to the already difficult task of tackling lengthy backlogs in procedures that were put on hold. 

These issues are widespread across Canada with consequences that could be devastating for our capacity to deliver care.

Healthcare systems are at a critical point, not just in the recovery from COVID-19 but, more fundamentally, in how we redesign and reimagine our systems to be more resilient, sustainable and supportive of our healthcare professionals as they confront current and future challenges.

In this context, work under way at Lakeridge Health – based in the Durham Region in the eastern part of the Greater Toronto Area – offers some important insights. The focus of this work is on health system integration, which may provide one of the only reliable pathways to long-term healthcare success.

More collaborative, integrated healthcare is key to addressing critical challenges

Lakeridge Health is one of the largest healthcare systems in Ontario and, along with regional partners, it delivers a comprehensive range of services. The organization has been pursuing an aggressive strategy of health system integration – connecting all services, from primary and community care to hospitals and specialized clinics to home care and long-term care (LTC) – so they can work together as one. 

The rationale behind more collaborative, integrated healthcare is straightforward: the best way to ensure that patients get the care they need when they need it is by coordinating all of the different parts of the healthcare system. In a fully integrated system, doctors, nurses and other healthcare professionals work in teams. They have access to a common communication platform and work to the same standardized care paths and protocols. Patient referrals and transitions between medical specialties happen seamlessly. Valuable healthcare resources can be shared and used efficiently. The quality and timeliness of care improves and when it does not, the problems can be identified and solved more easily. 

In Ontario, integration is happening organically through a combination of local and regional changes supported by Ontario Health Teams (OHTs), a provincial government initiative that helps bring regional healthcare partners together. The pace and form of integration varies widely across the province.

Health system integration in the Durham Region began in 1998 with hospital amalgamations and the formation of Lakeridge Health. The system now includes five hospitals, with a sixth in the proposal stages.

Lakeridge Health has also been systematically expanding services beyond acute care. Recent developments include opening a new LTC home, welcoming one of the region’s largest mental health providers into the Lakeridge Health System and working closely with the Durham OHT to form and strengthen partnerships with primary and community care providers. Recent investments have included a clinical information system that connects all hospitals across the broader Central East Region and provides a unified digital health platform for all patients.

This drive to integrate, and the logic behind it, is captured in our vision: “One System. Best Health.”

Cross-sector partnerships support a rapid and coordinated crisis response

As COVID-19 case numbers increased, collaboration was no longer an option – it was a necessity.

Our leadership team at Lakeridge Health knew we could not do everything alone. During one of the most intense waves of COVID-19, we extended an urgent call to action to primary and community care providers and, within 24 hours, more than 250 recipients joined a virtual town hall to learn how they could help. 

Clinics across the region provided COVID-19 assessments and care options, easing the burden on emergency departments. Clinicians staffed a virtual urgent care clinic serving thousands of patients. Dozens of professionals with medical and emergency service and policing experience put extra time into allied essential services. 

Throughout the pandemic, Lakeridge Health has been the centre for infection control expertise, supplying resources such as personal protective equipment to the network of community-based providers and supporting LTC homes. We also became the centre of advanced clinical care. Close to 5,000 seriously ill COVID-19 patients from across the Durham Region and other parts of Ontario have been treated at Lakeridge Health as of April 2022, including more than 500 intensive care unit patients.

Regional partnerships played a key role in vaccine distribution, which requires coordination among hospitals, public health, primary care, community clinics and emergency responders. Vaccines were rolled out faster in the Durham Region than in many other regions, and vaccination rates were particularly high in LTC, where the need was the most urgent. More than one million doses of COVID-19 vaccines have been administered as of November 30, 2021. 

Partnerships also helped to deliver COVID-19 treatments. A new COVID-19 Therapeutic Clinic – working closely with primary care and assessment centres across the Durham Region and hospitals in neighbouring areas in the Central East Region of Ontario – was able to prescribe close to 20% of the nearly 675 prescriptions of the novel therapeutic Paxlovid in Ontario during the early stages of the rollout.

All of this has been supported by a coordinated regional communication strategy, led by Lakeridge Health and the Durham OHT, including virtual town halls and social and conventional media campaigns spreading consistent messages about testing and treatment options.

The system worked well during the most intense waves of COVID-19 and enabled a coordinated regional response. Many of the teams, partnerships and connections required to share information, tools and resources were in place, and where they were not, the system was nimble enough to respond. 

Integrated systems can offer the supports and opportunities our healthcare workers need

Not surprisingly, our healthcare providers – especially nurses and others working at point of care and service – carried the greatest burden of crisis response. Some are now leaving for less stressful positions in healthcare or are leaving healthcare entirely. Those remaining face even more pressure and are being asked to work extra shifts and care for more patients. 

The impact has spread to many other professionals and non-clinical staff who have been asked to step in and contribute where they can due to shortages in both clinical and service areas. Everyone in healthcare is feeling the added stress and pressure.

Staff shortages have caused temporary emergency department and acute care closures across Canada, and Lakeridge Health is no exception. We made the difficult decision to close an intensive care unit at one of our hospitals in late summer of 2022.

Staff shortages have persisted as a major healthcare challenge. Seasonal flu outbreaks in late 2022 have added to the pressure on emergency departments. Exceptionally high rates of severe RSV infections have strained paediatric care capacity at Lakeridge Health and many other healthcare systems.

The COVID-19 pandemic, combined with other serious viral infections, is highlighting longstanding issues in the way healthcare human resources are planned, developed, managed and supported. There are positive signs, however, that integration may position Lakeridge Health and our partners to address these issues and move toward sustainable long-term solutions.

Integrated hospitals in the same region do not have to compete for staff. Instead – as a large multi-site system – Lakeridge Health can recruit centrally, offering opportunities to work in different geographical locations, different parts of the healthcare continuum and different healthcare settings. With a team of roughly 8,000 staff and physicians, we have resources for succession planning, education, mentoring and efficiency improvements that do not exist in more fragmented systems.

These advantages extend across the care continuum. Lakeridge Health has a program for healthy aging, for example, with staff working in cross-continuum “clusters.” Cross-sector coordination is important for care providers who want the entire system to work seamlessly so they can work in teams and focus on patient care without the extra work needed to navigate healthcare silos.

A well-supported staff in a well-connected system will deliver the care we need

Healthcare professionals leave public systems because they do not get what they need as employees. This includes better compensation and extends to encompass the full range of robust employee supports along with opportunities for each staff member to do what matches their personal skills, goals and values. It also includes practices that promote health and wellness. We now know more than ever that our healthcare professionals need rest, recovery, mental health support and work-life balance to thrive in a demanding workplace. 

All of this requires substantial investments of resources and expertise. Experience at Lakeridge Health shows how more fully integrated healthcare systems are better positioned to put these improvements in place. This is how patients will get the care that they need and when they need it from healthcare professionals who are, in turn, getting the essential support that they need and when they need it.

No one who is familiar with health system integration will say that it is easy. Healthcare is remarkably complex. Bringing its many parts together so that they operate smoothly involves a lot of work and requires some big changes to long-established practices.

However, the benefits are critically important and achievable. The challenges presented by COVID-19 will hopefully prompt lasting changes that strengthen partnerships and collaboration, and provide the supports and opportunities needed for healthcare professionals to meet new challenges, fulfill personal goals and lead healthy, balanced lives.

At this point in the COVID-19 pandemic our healthcare professionals are not looking for praise or accolades for their courage and hard work during periods of crisis. They want permanent and system-wide changes that will enable them to do what they do best – deliver excellent patient care.

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