Table 3 Verbatim quotes supporting Doing Pro Integration Culture

1

[The Chief Medical Officer of Health] certainly felt that she was unable to be that consistent presence, and create that connection with primary care and with physician colleagues. Yet it was a priority for her. But given her schedule and demands on her time, she kept being called away and unable to meet. So she asked [the new DCMOH] to do that on her behalf, [and to connect with the MoH PC team].

2

There’s a new physician lead [hired and] one of [their] jobs is to confer with primary care. And they start doing that, they start conferring!

3

If you want to truly engage and get the most out of those engagements, [you have to] have the right players to the table. So, a champion within that particular group you’re trying to move … So in this case, you’re trying to engage family physicians, you actually have to have a champion family physician.

4

It just feels better because we’ve got an advocate in the office of the Chief Medical Officer of Health. And I think [the MoH primary care unit] is more willing to be collaborative…

[On the ground having that advocate means that] I feel very comfortable firing off an idea for expedited return to work, for instance, in primary care offices to [the new DCMOH, and asking them], “Does this make sense with your guys’ public health order?” I would never have done that with the Chief. I would just go, “Oh, she’s too busy.”

5

It’s been a huge investment as well from AHS, they’ve devoted lots of their staff time to help make this happen. Because physicians are busy people, and they don’t have a lot of hours left in the day, and so it really has been, I’d say, a very strong team effort across various parts, whether it’s primary care or AHS or [the MoH]. We’re trying to work to each other’s strengths, and contribute in whatever way we can to make this happen.

6

[Since the new DCMOH arrived] you see the messaging, you see the open attitude of collaboration to start with, and you see that your input is making a difference in actions and decision-making. That builds trust over time. [You see the DCMOH saying:] “Hey guys, this is an issue we’re looking at. This is what we’re thinking. Are we missing anything? Are there any red flags here? What else do we need to know? What other topics are we needing to discuss?“ [They just] come in with a collaborative attitude.

7

I think there have been a couple of changes within the MoH where some people are a little more interested in listening and not assuming that there’s an agenda behind the advice [that we in PC might be giving.] Which was the feeling that we often had before. [It was like they thought:] “If you’re a physician giving advice, you have some hidden agenda related to compensation or something like that.” So that feels like that’s thawed a bit.

8

[the new DCMOH] just wants to work with us and doesn’t shut us down all the time.

9

we are working towards a common goal.

10

[When the MoH said], “Okay, now let’s bring people to the table, and let’s actually start playing less directive and more collaborative,“ that’s when things started changing. I think [that built] trust at a bureaucratic table, [as] the minister [of health said] “You know what, let’s be more collaborative.”

11

[It was like they realized] if this is going to work, we need [the MoH], AHS and primary care…to co-chair [the work] so that we all have a stake in the game. And we also need to be more open to involving other groups in the process.

12

[Expanding the table became a matter of finding] maybe not the traditional leaders to integrate into the system, but maybe those people that are working on the workarounds of the system. I think a lot of people spend a lot of time just working around the policies that exist to make solutions that make sense for their patients, and [there was a realization that] it would be really great to have a table to voice that.