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