Identifying Levers for Change in Healthcare Coordination Between the Emergency Youth Shelter and Health Systems in Toronto, Canada Through Stakeholder Engagement: A Qualitative Study

Background: Healthcare coordination involves supporting youth experiencing homelessness (YEH) with accessing appropriate healthcare; synchronizing delivery of their healthcare across multiple systems; sharing healthcare and discharge plans with youth and providers who fall under their ‘circle of care;’ and coordinating post-care follow-up as necessary. Challenges with coordinating healthcare within and between the emergency youth shelter (EYS) and health systems include poor accountability for healthcare coordination across systems; information-sharing and privacy policies inhibiting communication between sectoral staff; inconsistencies in system-based and organizational norms, operations, and funding; and each system’s historically fragmented structure. Methods: We used a system thinking framework to identify levers for change in healthcare coordination within and between the EYS and health systems in Toronto, Canada. Six stakeholders who work at various levels of each system participated in online breakout room discussions as part of a two-hour forum facilitated by our research team. A series of four questions were asked to identify levers for change in system parts and system patterns in healthcare coordination within and between the EYS and health systems. Breakout room discussions were recorded, transcribed, and co-analyzed by the research team using reflexive thematic analysis for each question. Results: Organizational and system-wide goals discussed to strengthen healthcare coordination include clarifying accountability in staff roles, revisiting discharge policies to improve continuity of care, prioritizing funding for programs evaluated to be effective, establishing more opportunities for system cross over, enhancing accessibility for YEH, integrating social medicine into healthcare approaches, and streamlining health communication across both systems. When asked about what is realistically possible, stakeholders were optimistic about enhancing information-sharing through digital health platforms, adapting organizational policies to consider the holistic needs of YEH, and dispersing funds more intentionally to support coordination initiatives. Furthermore, poor staff-youth relations, harmful discharge policies and the Toronto housing crisis were noted as patterns impeding meaningful change in coordinating healthcare. Finally, stakeholders identified systems integration and alignment of well-defined healthcare coordination processes across systems to harmonize efforts in achieving healthcare coordination goals. Conclusions: Stakeholder forum participants discussed promising levers for change that are recommended to strengthen parts of the EYS and health systems along with patterns that influence healthcare coordination between them.