2019 Ontario Health Teams: Current State Assessment Survey

1. Contact Information(Required.)

First and Last Name:

Name of primary care organization (FHT, NPLC, etc):

Role/job title in primary care organization:

Phone number:

E-mail:

LHIN region:

2. Please indicate what stage in the OHT development process your team most closely resembles:(Required.)

We have not started to formally engage in any OHT discussions with external partners

We are having early conversations with organizations in our region to explore possible options for OHT approach, development and timelines

We are in process of working through the readiness assessment components with collaborating partners, aiming for a Fall submission

We are submitting a readiness assessment with our identified partners for the May 15th early adopter deadline

Comments:

3. Please identify the list of health care providers and/or organizations that would partner to form the proposed Ontario Health Team:
(Required.)

4. Has a lead agency been identified for the proposed Ontario Health Team?

Yes

If yes, please specify lead agency(s):

5. What is the role of your organization in the development of the OHT in your community?

We are leading the development

We are co-leading the development

We are participants in the development

Still exploring what this looks like

Other (please specify)

6. Does the proposed approach include a plan to engage unaffiliated primary care physicians in OHT development?

Yes

No, not at this time

Comments:

7. Has the governance structure been identified for the proposed Ontario Health Team?

Yes, each partnering organization within the proposed OHT will retain their individual boards at this time

Yes, the proposed OHT will be governed by one single board entity. Individual boards will disband.

No. Further discussions are needed to determine the appropriate governance structure for the proposed OHT

Additional Comments:

8. What kind of supports are needed to help you and your team with OHT development in your community?

9. Any other comments?

Thank you for completing this survey

If you have any questions or follow-up inquiries please contact bryn.hamilton@afhto.ca