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Ontario Medical Review
Oct. 25, 2021
Patchen Barss
OMR writer

This article originally appeared in the Fall 2021 issue of the Ontario Medical Review magazine.

How research refined the recommendations

Researchers used techniques like “paired choice” exercises to really winnow out what is most important

The OMA worked with several innovative research organizations to gather comprehensive data and to back those data up with deep empathy and understanding for people’s real-life situations.  

“I applaud the OMA for doing more work than just traditional polls,” said Sandra Guiry, a senior vice-president at Ipsos, which was one of the companies that worked with the OMA on this project. “Scientific surveys, as useful, valid, and helpful as they are, become even more powerful when they’re supported by the other methodologies they undertook.”

Ipsos’ own work went far beyond standard survey-taking.

“We used a multitude of techniques, tools and methodologies,” Guiry said. “For some data gathering, we used an open-ended approach that allowed respondents to speak about issues in their own words. This provides a broader view of what’s on their mind on this particular topic.”

Researchers dug deeper, though, using techniques like “paired choice” exercises where respondents are asked to rank priorities two at a time to really winnow out what is most important to them at that moment.

“We were interested in looking not just at issues within health care itself, but also where health care sits among other issues including climate change, economic recovery, and so on. We get a quantitative measurement of how much importance the public places on one issue over another,” Guiry said.

Because most people believe all these issues are important, the exercise of asking people to weigh, say, the backlog of medical procedures against expanded mental health services, or paid sick days against subsidies for green industries, helps clarify how members of the public would make difficult decisions about competing priorities.

“We find consistently — in pre-COVID times and post — that health care is right up there as a top priority.”

Get the full plan

We need a more collective way of thinking about health care, one that focuses on solutions, strengthens the alignment between patient priorities and system capacity, and directs provincial financial and human resources toward the best possible health outcomes.

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The OMA’s new health-care recommendations are informed by months of consultations with members, stakeholders, community leaders and the public and align with research findings.

“We were interested in looking not just at issues within health care itself, but also where health care sits among other issues including climate change, economic recovery, and so on.” —Sandra Guiry, Ipsos

Documenting the primacy of health-care issues among Ontarians isn’t the end of the story for Ipsos researchers. They go deeper into specific follow-up questions to participant responses, asking people to weigh how these major challenges should be addressed and whom they see as responsible.

“People tend to say everything’s important,” Guiry said. “It’s because all of these issues are important to the public that you need techniques and tools to force them to make trade-off decisions — in the same way, governments have to decide, where to prioritize resources.”

The research also involved other innovations, including an artificial intelligence tool known as Polly.

Polly was originally developed by researchers at the University of Ottawa who were interested in gaining a deeper understanding of why people make the decisions they do — what makes them skeptical or receptive, what changes their mind about an issue, and what triggers them to act based on their opinions. Polly slowly grew into a powerful tool for analysis that augmented what human beings could do on their own.

“It took five years to develop an AI that could allow us to work with population-level research and statistics, and even more importantly, that could really get us inside people’s motivations. We can now add awareness about what goes into decision-making and the processes people follow,” said Erin Kelly, the CEO of Advanced Symbolics Inc. (ASI), a company that now uses Polly to study and understand public opinion and behaviour on a wide range of subjects.

For the OMA, Polly analyzed terabytes of conversations and posts from social media sites to get a sense of how people feel about Ontario’s health-care system, and where they’d like to see change. Polly’s insights often provided new nuance on issues, including the secondary impacts of COVID.

“We kept hearing in the popular press that the pandemic was having a big impact on mental health, but that turned out to be quite a simplistic interpretation of what was actually happening. Polly found we were seeing a deepening of what people were already experiencing. People who had depression or mental health or marital problems got a lot worse under COVID, but it wasn’t always expanding to others,” Kelly said. “In fact, for others, we found that the lockdown allowed them to slow down and enjoy more connectedness with family and that actually improved their mental well-being.”

In other words, the need for expanded services existed before the pandemic laid bare the current crisis in mental health. Polly’s help ensured the OMA plan reflected the need for long-term solutions to a long-standing issue.

With a provincial election looming in spring 2022, Polly’s insights provide a next-level analysis of how public priorities are evolving. And as another of OMA’s research partners observes, health-care issues seem to increasingly influence how people vote.

“More than a million people in Ontario don’t have a family doctor. Access to health care was a huge priority for most people. And people want the government to invest more money.” —Brian Fox, Enterprise Canada

Brian Fox, a principal at Enterprise Canada, a national strategic communications and public affairs firm, worked on community consultations for the OMA across the province. He also looked at other parts of the country, including Nova Scotia, whose recent election upset might also be a lesson for Ontario.

“People always say health care is a top-of-mind issue, and it’s a major part of every election campaign. But elections don’t normally turn on health care,” Fox said. “The Nova Scotia election, which was a surprise victory for the Conservatives, is one of the first elections I’ve seen where health care has been a deciding issue. That really speaks to its current importance.”

In Ontario, Enterprise Canada found that in almost every community, more people are unhappy with their health care than at any time in recent history.

“More than a million people in Ontario don’t have a family doctor,” Fox said. “Access to health care was a huge priority for most people. And people want the government to invest more money.” 

Fox says public opinion on health-care issues is unusually clear and unified — people agree both about what’s wrong, and how to fix it. But he also knows that data and facts on their own don’t always hold sway in political platforms.

“It’s not just a matter of, well, I know such-and-such and so we should do this. You’ve got to present a case,” he said. “And what the OMA is doing is actually building and presenting a case to government.”

The OMA’s multi-pronged research approach, he said, allows them to make a persuasive argument to politicians, candidates, and political staff.

“They’re saying, ‘We’ve talked to people right across the province. We’ve talked to people in the communities you represent. These recommendations reflect what people are telling us, and why it’s important to them. They’re making a case for change.”

Patchen Barss is a Toronto-based freelance writer.