Briefing Note

A briefing note is a short paper (2-3 pages) that quickly and effectively informs a decision-maker about an issue. A useful briefing note distills often complex information into a short, well-structured document. You are to write a briefing note, as though you were a director within the civil service (Federal Ministry of Health). You are to provide your minister with a note detailing a situation that has arisen within the media overnight.

The purpose of this note is to present public sector writing practices for briefing notes. The focus is on both style, context, and content. Although style and technique are important when writing for public sector audiences, it is an appreciation of the context that will distinguish you as a writer of superior briefing notes.

Letter to the Editor Example #1 Help Taiwan’s journalists gain access to WHO meetings As the world grapples with COVID-19, journalism, like other essential industries, faces an unprecedented challenge. And Taiwan’s journalists have an additional battle on their hands. The World Health Organization, scheduled to meet on May 18 and 19, has barred Taiwan’s journalists from attending this summit, due to political pressure from China, according to Reporters Without Borders (RSF), the international media monitoring organization. RSF has urged Beijing to stop pressuring the WHO, and has asked WHO director-general Tedros Adhanom Ghebreyesus and UN secretary-general Antonio Guterres to put an immediate stop to this discriminatory practice. Canada is well-positioned to urge the WHO and the UN to open their meetings to all accredited journalists — including Taiwan’s — regardless of political considerations. Canada is co-chair with the United Kingdom of the Media Freedom Coalition, formed in 2019 to advocate for press freedom. Canada also supports efforts to promote media freedom through the Global Media Defence Fund. Canada’s voice will go a long way towards helping Taiwanese reporters, take their rightful place — along with other accredited journalists — at WHO and other UN meetings. Susan Korah, Ottawa Letter to the Editor Example #2 Outdoor rules should be common-sense-based I don’t think anyone should undermine the main message of public health regarding the measures needed to prevent the spread of SARS-Cov2. Physical distancing is reasonable, and hand-washing crucial. However, we do have to inject a little common sense into the discussion about outdoor activities. The virus does not form a cocoon around us, like Pigpen’s dust cloud, nor do we leave a trail behind us like a comet. It is transmitted by droplets, which dissipate in the breeze or drop to the ground quickly. The virus does not linger in the air. It is irrational to dissuade us from being outside. There is no risk of catching COVID-19 from passing someone on a trail or jogging behind someone. If this was of concern to public health, why open the trails along the canal or parks for walk-throughs? If these are opened, why not open Mer Bleu, the Greenbelt trails, and parks in general? Tell people to not cluster in groups, monitor if you must, but let father and son play tennis and siblings shoot baskets.

As for the punishments already meted out to those who have violated the rules, it seems ridiculous to fine someone for shooting baskets alone or sitting on a bench. When the punishment for shooting baskets alone is 10 times the fine for running a stop sign and more than double that of failing to stop for a school bus offloading students, we need to question whether these punishments are sensible. Steve Kravcik, Manotick Letter to the Editor Example #3 We need standards for personal support workers Re: Long-term care in Canada – What happens when the military goes home? May 1. Mohammed Adam makes a compelling case for much-needed change in Ontario’s long-term care. He advocates for necessary standardization of care and staffing, more home care and immunization and less profit-based ownership. These are excellent goals. What is missing however, and applicable to other vulnerable sectors like group homes too, is the regulation of all personal support workers. Although there is some standardization in regulated long-term care, none is mandated in profit-based agencies. PSWs give intimate care to our loved ones and, depending on where they work, may have little or no qualification, appropriate knowledge or skill, including infection control. There is no governing agency to report abuse or incompetence, so being fired in one place does not preclude an immediate hiring down the street as agencies are desperate for low-wage caregivers. For the many who make heroic efforts every day, there is very little in the way of educational opportunity, benefits and salary incentive. There also needs to be enough registered staff (RNs and RPNs) to assess, train and oversee the delegated care and to give the hands-on care where delegation is not appropriate. We need to get our feet of clay unstuck and marching in the right direction. Diane Stephenson, Ottawa

Briefing Note Example #1


File Number: 0167 Classification: Unclassified PREPARED FOR: Honourable Christine Elliott, Minister of Health – FOR DECISION TITLE: Limiting In-Hospital Indwelling Urinary Catheter Use and Length of Duration PURPOSE: To decrease rates of nosocomial urinary tract infections due to catheterization BACKGROUND: Leaving a urinary catheter (UC) in place without indication has been identified as one of “Five Things Physicians and Patients Should Question” by the Society of Hospital Medicine and the Canadian Society of Internal Medicine. Annually, 1 in 217 patients acquire a nosocomial (originating in-hospital) infection, with urinary tract infections (UTIs) being found to be the most common infection type among Canadian Nosocomial Infection Surveillance Program hospitals. Indwelling catheterization, which occurs in up to 25% of hospitalized patients, is attributable to 80% of all nosocomial UTIs. Despite the fact that catheterization is an essential component of many surgical procedures, UCs are frequently overused with a study conducted at Sunnybrook Health Sciences Centre in Toronto reporting that 70% of catheterization occurred in the absence of an appropriate guideline-based reason. In addition, other studies have suggested that physicians are unaware that their patients have an UC in up to 40% of cases. As the daily risk of UTI development is estimated to be 7%, patients are at an increasingly high risk for developing an infection with each day that the UC is not removed. CURRENT STATUS: In 2019, Choosing Wisely Canada released a report titled “Lose the Tube” which provides hospital clinicians with simple tools, resources, and recommendations supported by evidence to help reduce unnecessary UC use in hospitals. While this report represents a positive step forward, this issue has not been an explicit focus at the provincial level. In order for observable change to occur, Ontario needs to take specific province-wide steps to address this important issue and improve the standard of practice regarding hospital catheterization. CONSIDERATIONS:

• Antimicrobial resistance is causing a rise in drug resistant UTI infections which require more complicated and expensive treatment.

• Patients who have a urinary catheter can act as reservoirs of antimicrobial-resistant bacteria and are a source of antimicrobial-resistant infections in others.

• Publicly reported data that tracks and compares UTI infections in hospitals on a provincial level is not available in Ontario.

OPTIONS AND RATIONALE: Option 1: Maintain our current health system priorities for hospital patient safety in Ontario.

• Advantage: This is consistent with current Government of Ontario plans and would be the cheapest approach. Current priorities remain important and require continued attention to achieve set future targets.

• Disadvantage: This maintains the status quo, which has allowed UTIs to persist as the most common nosocomial infection among Canadian hospitals.

Option 2: Implement a catheter use checklist that all Ontario hospitals will be required to utilize and to publicly report on their compliance by March 2021. The checklist will be adapted based on the Centre for Disease Control and Prevention (CDC)’s guidelines for appropriate indwelling UC placement.

• Advantage: This is a low-cost and relatively easy-to-implement solution that has proven to be a successful strategy in hospitals in the past. Checklists provide clinicians with a concise consolidation of a large body of knowledge in one simple document. Furthermore, checklists have been proven to be effective at reducing medical mistakes and leading to improved patient outcomes in a wide range of medical fields.

• Disadvantage: The quality level of conducting the checklist may vary across institutions and it may be hard to ensure that this option will be performed as-per-standard.

Option 3: Publish a report outlining the issue of unnecessary urinary catheter use in hospitals from a provincial perspective by adapting the Choosing Wisely Canada report to Ontario’s needs. Provide evidence-based recommendations which provincial hospitals will be encouraged to implement.

• Advantage: This action will bring attention to this problem and provide researchers, policymakers, as well as healthcare workers with province-specific statistics and information.

• Disadvantage: The information in this report may not be substantively different from the Canada-wide report; therefore, the impact may be limited.

RECOMMENDATION: Option 2 is recommended. Name Director, Ontario Infection Control Date

Briefing Note Example #2


File Number: 0001 Classification: Unclassified PREPARED FOR: Honourable Christine Elliott, Minister of Health

• FOR DECISION TITLE: ONTARIO HEALTH TEAMS: FUNDING TO IMPLEMENT PATIENT-FACING DIGITAL HEALTH TOOLS FOR SENIORS PURPOSE: To provide funding that supports Ontario Health Teams’ (OHTs) implementation of patient-facing digital health (DH) tools with seniors. BACKGROUND

• On June 6, 2019, the Ministry of Health (MOH) enacted the Connecting Care Act, 2019. This formally began a phased approach to establish OHTs and Ontario Health.

• Some key MOH requirements for OHTs are to: • Identify a population on which to focus first year efforts (i.e., Year 1 populations). • Ensure 10-15% of their Year 1 population uses patient-facing DH tools (e.g., virtual

visits, self-management tools, and online appointment booking) in their first year. • Provide equal and fair access to patient-facing DH tools for their attributed

populations, regardless of social factors, such as age. • Follow the Patient Declaration of Values for Ontario, released on February 19, 2019,

which requires OHTs to involve patients as active members of their care team(s). • On August 23, 2019, the MOH released a DH Playbook to help OHTs with DH goals. It

was updated on December 1, 2019. It will be updated again as part of a MOH policy enacted on March 11, 2020 to create a section about using patient-facing DH tools with seniors.

• On December 9, 2019, the MOH announced the first 24 fully approved OHTs. Health Commons found that 70% of these full OHTs have seniors in their Year 1 populations.

• On November 13, 2019, the Digital First for Health strategy was announced. Like OHTs, this strategy is a phased approach to establish DH in Ontario. The MOH announced $3 million for virtual physician visits and committed to ongoing investments in DH.

• There is no federal DH strategy. In the 2017 Budget, the federal government invested $300 million over five years in Canada Health Infoway (CHI), a federal government DH agency.


• Statistics Canada, Telus Health, and AGE-WELL have found that seniors are least likely to use DH tools. Despite lower use, 2017 Telus Health and 2019 AGE-WELL surveys found that just under two-thirds of surveyed seniors are interested in using DH tools.

• Patient empowerment is an integral component of DH and the Patient Declaration of Values for Ontario; however, Canadian seniors are less likely to agree that DH empowers them and less likely to feel comfortable being an active member of their care team(s).

• Systematic reviews and Ontario organizations, such as the McMaster Health Forum, have explored barriers and facilitators to seniors’ DH use. Barriers include lack of guidance, low confidence, low health provider capacity, and funding. Facilitators include senior and health provider DH experience, formal learning, and existing non-profit organization infrastructure.

• Two successful DH intervention strategies are collaborative learning (training occurs with others) and tailored interventions (strategies adapted to individuals’ characteristics and needs). These strategies have been implemented in senior centres, libraries, and clinics.

• OHTs have different members. Core members have governance representation (e.g., primary care and hospitals). Supporting members are actively involved in service design and delivery but are not usually a formal part of governance structures. Supporting members tend to be municipalities and non-profit organizations, but some OHTs have them as core members.

• A division of the MOH’s Health Services division is dedicated to DH projects. CONSIDERATIONS

• There are many actors that the MOH can partner with to co-fund implementation of patient-facing DH tools with seniors. The most promising are:

• CHI – Has and continues to co-fund several Ontario MOH DH projects. CHI has identified virtual care initiatives, like patient-facing DH tools, as a key funding area.

• Ontario’s Ministry of Seniors and Accessibility (MSA). The MSA invested $3 million in the Seniors Community Grant Program in 2019/2020. Eligible applicants include non-profit organizations and municipalities, aligning with OHTs’ core and supporting members. The MSA provides successful grantees with $1,000 to $25,000.

• Ontario’s Ministry of Heritage, Sport, Tourism and Culture Industries (MHSTCI). The MHSTCI invests $115 million annually in the Ontario Trillium Foundation. Eligible applicants include collaborations of two or more organizations where the lead applicant is a non-profit organization. This criterion can align with the OHT membership model. The MHSTCI has funded senior service projects in the past.

• Not all full and in-development OHTs identified seniors as their Year 1 populations and may not require immediate funding to implement patient-facing DH tools with seniors. However, all OHTs will need to use DH tools with seniors included in their attributed populations.

• While current data shows that seniors are least likely to use DH tools, Statistics Canada anticipates seniors’ use of DH tools to increase as cohorts age.

• Research shows that poorly integrated DH contributes to health disparities for seniors. Strategies to combat DH fragmentation and resulting health disparities include efficient scaling and systematic adoption plans.

• While implementation strategies need to be efficient and systematic, the diversity of senior populations suggests that uniform implementation of patient-facing DH tools will not be effective. Age, low income, low education, ethnicity, gender, and health status are important factors to consider when implementing DH tools with seniors. Successful implementation requires approaches tailored to the seniors included in OHTs’ populations.

• Ensuring seniors can use patient-facing DH tools is pressing due to the rise in viral infectious diseases, such as the current COVID-19 pandemic. Seniors are at high risk of severe disease due to age and high prevalence of chronic conditions. DH tools can prevent the spread of infectious diseases to seniors and decrease healthcare system burden.

• Current DH investments will result in long-term financial benefits for Ontario. The DH sector has created 42,500 jobs in Ontario so far and has created $30 billion in benefits in Canada due to increased efficiency and avoided patient and system expenses.

OPTIONS AND RATIONALE Option 1: Collaborate with CHI, the MSA, and/or the MHSTCI to provide one-time, uniform funding for all OHTs to implement patient-facing DH tools with seniors.

• Advantages: OHTs may think uniform funding is a fair approach; quick strategy that costs all partners relatively little to show investment in DH and model intersectoral partnerships; one-time funding will result in fast results for media and elections.

• Disadvantages: Lack of tailoring may result in OHTs receiving funding that does not match their Year 1 population, attributed population of seniors, existing DH infrastructure, and readiness; lack of MOH oversight may result in poor implementation; requires intersectoral partnerships; requires all funding be available and delivered at once.

Option 2: Partner with CHI, the MSA, and/or the MHSTCI to provide tailored, phased funding for all OHTs to implement patient-facing DH tools with seniors using a request for proposal (RFP) process.

• Advantages: Phased funding does not require all funding be available at once and allows time to foster intersectoral partnerships; phased funding reflects the MOH’s approach to OHTs and DH; tailored funding follows evidence-based recommendations; RFP process is systematic and provides MOH with oversight; models intersectoral approach to health.

• Disadvantages: Requires human resources to review proposals; requires intersectoral partnerships; results will take longer to accrue and communicate due to phased funding.

Option 3: Allow OHTs to individually implement and fund patient-facing DH tools with seniors.

• Advantages: Aligns with organic development of OHTs; no current cost to the MOH; does not require effort to partner with CHI, MSA, and/or MHSTCI.

• Disadvantages: Increases risk of DH inefficiencies and fragmented implementation; may result in health disparities across and within OHT populations; ignores a minimal funding opportunity to strengthen government optics with OHTs and the general population.


• As partners are not funding procurement of DH tools from vendors or health provider training and OHTs have existing non-profit organization and municipal infrastructure, expected funding for each OHT ranges from $2,000 to $5,000. This results in a maximum total of $750,000 over a three-year phased approach for an estimated 150 eventual OHTs.

• Funding is contingent on approval by CHI, MSA, and/or the MHSTCI. • Review of proposals will require MOH DH Program staff to assess proposals and

alignment with the MOH’s previously enacted DH Playbook section for seniors. A phased funding approach will allow this responsibility to be dispersed across existing DH Program staff.

RECOMMENDATION: Option 2 is recommended. Name Director, Digital Health Program Date

Briefing Note Example #3


File Number: 0001 Classification: Unclassified PREPARED FOR: Honourable Christine Elliot, Minister of Health – FOR DECISION SUBJECT: 2019 Novel Coronavirus (COVID-19) and pregnancy PURPOSE: To advise on the inclusion of pregnancy in the high risk/vulnerable category for COVID- 19 infection BACKGROUND:

• On March 18, 2020, the World Health Organization (WHO) stated that research is underway to better understand the impacts of COVID-19 infection on pregnant women and their unborn infants. It was acknowledged that due to changes in the immune systems of pregnant women, this population is at risk of being adversely affected by respiratory infections. The WHO continues to review and update its advice as more evidence becomes available.

• On March 16, 2020, UK Chief Medical Officer (CMO) Chris Whitty officially added pregnant women to the nation’s list of ‘most at risk’ for COVID-19 infection. The CMO stated these are precautionary measures based on guidelines from the Royal College of Obstetricians and Gynaecologists (RCOG), as well as evidence from emerging global literature on COVID-19 infection in pregnancy.

• On March 13, 2020, the Society of Obstetricians and Gynaecologists of Canada (SOGC) released a statement on COVID-19 and pregnancy. The SOGC stated that due to physiologic changes in pregnancy, those with lower respiratory tract infections often experience worse outcomes than their non-pregnant counterparts, including higher rates of hospital and intensive care unit admissions. The SOGC expects that adverse outcomes for pregnant women infected with COVID-19 are likely to be strongly correlated with the degree of maternal illness. See Appendix 1 for the complete SOGC Committee Opinion.

• On March 11, 2020, the WHO declared the COVID-19 outbreak a global pandemic. Novel Coronavirus (SARS-CoV-2) is a new strain causing COVID-19, first identified in Wuhan City, China in December 2019. Recent coronavirus epidemics include Middle East Respiratory Syndrome (MERS-CoV) in 2015, and Severe Acute Respiratory Syndrome (SARS-CoV) in 2003.


• As of March 25, 2020, the information provided by the Ministry of Health and Long- Term Care (MoH) and Public Health Ontario states that the risk for COVID-19 infection may be higher if one has a weakened immune system, and this may be the case for:

o Older people o People with chronic disease (e.g. diabetes, cancer, heart, renal, or

chronic lung disease) • To date, the Ontario government and the MoH have not released statements or explicit

recommendations concerning COVID-19 and pregnancy. • Transmission of COVID-19 from mother to fetus during pregnancy has not yet been

detected, however postpartum transmission to a newborn has been suspected in one case.

• As per the SOGC statement, there is currently no evidence to suggest that COVID-19 infection in pregnancy causes birth defects, but the risk cannot be completely excluded.


• Sufficient data on COVID-19 and pregnancy is not yet available. However, as was observed with MERS-CoV and SARS-CoV infections in pregnancy, it is reasonable to predict that pregnant women are at higher risk for severe illness, morbidity, and mortality compared to the general population.

• On March 3, 2020, The Lancet published an article reviewing that MERS-CoV and SARS- CoV were documented to cause severe pregnancy outcomes such as miscarriage, preterm birth, fetal growth restriction, low birth weight, stillbirth, and maternal death.

• There are currently no data suggesting an increased risk of miscarriage or early pregnancy loss with COVID-19 infection.

• There are now several case reports of spontaneous preterm birth in pregnant women with confirmed COVID-19 infection. To date, this is the most commonly reported adverse pregnancy outcome.

• At present, there is one published case of a pregnant woman infected with COVID-19 who underwent an emergency caesarean section for a stillborn infant at 34 weeks of pregnancy. The woman was admitted to the intensive care unit with multiple organ dysfunction and acute respiratory distress.

• As with MERS-CoV and SARS-CoV, adverse pregnancy outcomes are likely to be strongly correlated with the severity of maternal COVID-19 infection and the degree of maternal respiratory compromise.

• To date, there are no reports of maternal deaths from COVID-19 infection. • As with other respiratory viruses, it is important to note that pregnant women are not

necessarily more susceptible to contracting COVID-19, but that changes to their immune system can be associated with more severe symptoms leading to adverse pregnancy outcomes, particularly in the third trimester.


• Possible courses of action:

1. Add pregnancy to list of conditions vulnerable to COVID-19 infection. Advantages: Will require statement to be released, along with immediate changes to provincial documents on COVID-19 information for the public (e.g. websites). Changes will state that pregnant women are advised to take extra precaution by avoiding contact with those who are ill, practicing social distancing/isolation (particularly in third trimester), and following recommended hygiene practices. Specific guidelines for pregnant health care workers must also be provided. Disadvantages: This addition is anticipated to cause increased public concern. However, this course of action demonstrates the province’s commitment to public safety, as well as staying up to date on the best available evidence.

2. Await sufficient data, and plan for possible addition of pregnancy to list of conditions vulnerable to COVID-19 infection.

Advantages: Will require the MoH to create a working group tasked with analyzing new data and publications on COVID-19 and pregnancy as they become available. Will be imperative to stay up to date on new recommendations from the SOGC and WHO. Avoids increased public concern until changes are deemed necessary by new evidence. Disadvantages: Will require substantial financial commitments.

3. Make no changes to list of groups/conditions vulnerable to COVID-19 infection. The MoH takes no action. Will continue to monitor the COVID-19 outbreak closely, maintain stability, and emphasize importance of social distancing, proper hygiene, and self-isolation for those who are immunocompromised. RESOURCE IMPLICATIONS:

• Addition of pregnancy to vulnerable groups will likely result in influx of calls to Telehealth Ontario. Adequate staffing must be secured, as well as availability of consistent, reliable, and updated recommendations for pregnant women. Expenses estimated at approximately $1.6 million over next six months.

• MoH staff will be required to prepare for public statements and press releases, and to implement changes on provincial websites and other public health documentation. Expenses estimated at approximately $800,000.

• Creation of COVID-19 and pregnancy working group will require staffing changes and a significant number of working hours. Expenses estimated at $8.4 million over next year.

• See Appendix 2 for detailed financial analysis of human resource requirements.


• Preferred course of action is option 1: add pregnancy to the list of conditions vulnerable to COVID-19 infection.

o Demonstrates commitment to public safety during a global pandemic, and prudent action given the uncertainty around pregnancy and COVID- 19 infection.

o Reflects best available evidence from the WHO, SOGC, and RCOG, while following precedent set by the UK government.

o Informational support to be implemented and regularly updated to manage public concern and support health care providers.

Name Director, Provincial Council for Maternal and Child Health Date

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