Health services researchers have suggested that challenges in implementing integrated care are partly due to a top-down, ‘command and control’ approach to managing health systems, rather than a flexible, ‘hands-off’ approach that embraces the messiness and uncertainty inherent in complex systems. The third theme, unpredictable influences on program implementation, identified events such as the COVID-19 pandemic and changing government priorities as accelerating, redirecting or inhibiting local program development. The second theme, evolving and flexible professional role identity, highlighted the value and challenges of a functionally flexible workforce and interest in new roles amongst the paramedic profession. The first theme, adapting and being nimble in tension with system structures, related to distributed versus central control of programs, a desire to be nimble and skepticism towards prohibitive legal and regulatory systems. Three themes were developed that represent participants’ experiences implementing these programs in the Ontario context. Participants described a range of programs that included acute, urgent and preventative care driven by local relationship networks of paramedics, hospitals, primary care, social services and home care. Twenty-six participants from across Ontario’s five administrative health regions participated in the study. Ethics approval and consent to participate.Implications for health system governance.Experimentation versus institutionalization.COVID-19 as an accelerant to pre-existing trends.Unpredictable influences on program implementation.Evolving and flexible professional role identity.Historical mistrust and “working around” regulatory barriers.
Local and distributed versus standardized and centralized control.Adapting and being nimble in tension with system structures.Experiences with implementing models of care.Description of programs, drivers, enablers and barriers.
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