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Table 5 Themes that represent participants’ experiences implementing programs and models of care in Ontario

From: Building integrated, adaptive and responsive healthcare systems – lessons from paramedicine in Ontario, Canada

Theme Sub-theme Summary of Concepts
1. Adapting and being nimble in tension with system structures 1.1. Local and distributed versus standardized and centralized control - Programs developed collaboratively through local networks of providers and organizations to meet local needs, value local control.
- Lack of standardization created challenges for quality assurance and funding.
- Existing centralized systems for clinical oversight were inadequate, with no mechanisms to share power with local providers.
1.2. Historical mistrust and “working around” regulatory barriers - Ministry of Health and regulatory bodies seen as slow and risk-averse, history of denying program approval.
- Creative strategies used by programs to avoid and work around regulatory and legal barriers.
2. Evolving and flexible professional role identity 2.1. Key leaders with a conviction for change - Some leaders within the paramedic profession actively pushed for new roles, eagerly volunteering to fill local service needs and advocating for program funding.
- Conviction to program implementation despite challenges such as regulatory barriers and lack of funding.
2.2. Role flexibility as a core value - Paramedics seen as flexible, mobile gap-fillers in local systems.
- Reticence to define paramedic role; ambiguity and flexibility seen as a value-add.
- Lack of role definition contributed to interprofessional tensions.
2.3. Divergent views in the workforce - Generational change within the paramedic profession – some eager and some reluctant for new roles.
- New roles contributed to job satisfaction and desirable career pathways.
3. Unpredictable influences on program implementation 3.1. COVID-19 as an accelerant to pre-existing trends - Health system pressures and urgency due to COVID-19 enabled access to funding and overcoming of bureaucratic hurdles that previously existed.
- Paramedics were in the spotlight, leading to recognition of potential value-add of new roles and functions.
3.2. Changing political priorities - Unpredictable approvals for programs due to changing government focus.
- Disconnect between local needs and political funding priorities.
- Frustration with the role of politics and politicians in healthcare.