AFHTO Policy Positions

Governance principles for primary care teams

Family Health Teams and Nurse Practitioner-Led Clinics  have matured over the 5 – 9 years that each organization has been in existence. Contracts between MOHLTC and FHTs expire on March 31, 2016, with this comes the opportunity to develop a much more mature and meaningful approach to governing these organizations, from the Ministry and through to the board of each FHT and NPLC, to deliver high-quality primary care and improve the health of people in the communities served.

Principles to guide our way forward

Principles for governance of primary care organizations

Given the strong level of support indicated through the survey of leaders of AFHTO member organizations AFHTO adopts the following governance principles:

FHTs and NPLCs are not-for-profit corporations in a health system mandated to provide appropriate, equitable, sustainable care.  Their boards:

  • Are accountable to the patients, funders and members of their organization.
  • Ensure their organizations are appropriately managed and advocate for appropriate resources so that patients can access high-quality comprehensive care that is sustainably delivered and strives to meet patient and public expectations.
  • Ensure the culture of their organization supports development of high-functioning interprofessional teams.
  • Provide leadership to harmonize and optimize policies and practices for effective and efficient teamwork within the organization and with other entities contributing to the health and health care of the organization’s patients and community.
  • Provide leadership and collaborate with other organizations to spread best practice and encourage growth in capacity so that all Ontarians can have access to high quality interprofessional comprehensive primary care.
  • Ensure that patients and community members are engaged in the development of programs and services.

These principles describe the more mature relationship the leaders of AFHTO’s member organizations want to have with their funders, members, staff and other stakeholders. They will guide AFHTO’s work in advocacy and in developing learning opportunities and support for members to succeed in their roles as governors and leaders.

Principles for accountability and reporting to funders

The strength of the survey results also lead AFHTO to adopt the following principles for accountability and reporting to funders. These principles will guide AFHTO’s advocacy with government, on behalf of members, on development of the next set of contract templates:

  • Financial and clinical reporting should minimize duplication in data collection and reporting.
  • Accountability should be defined in terms of collectively agreed upon measures that reflect value delivered.
  • Reporting requirements should place more emphasis on the work of the team to achieve outcomes and less on individual member activities and patient encounters.

Principles for determining accountability measures

While AFHTO members are strongly in favour of accountability and reporting based on meaningful measures, they are also cautious about how these measures will be determined. Leaders who attended the Oct. 15 leadership session provided the following guidance on principles for determining accountability measures that should be followed by AFHTO, the Ministry and any other stakeholders involved in the process:

  • MOHLTC must engage in a collaborative process to define outcome measures to be used for reporting.
    • Input from providers/engagement of AFHTO membership is essential.
  • MOHTLC must provide adequate support so that FHTs/NPLCs have the capacity (i.e. the people and technology needed) to collect and report their data.
  • Measures must be meaningful, measurable, consistent and comparable.
    • More specifically, measures must be evidence-based, clinically important, include process and outcome, be easy-to-track on an on-going basis, clearly defined and standardized for meaningful comparisons, and aligned with other Ministry priorities and reporting requirements.
    • Measures must also incorporate patient experience, and involve patients in what the measures will be.
  • The approach to accountability measurement must be sufficiently flexible to account for variation in patient complexity and their social determinants of health, in regional and rural-urban settings, and in size and maturity of teams.