A Comparative Study of Three Transformative Healthcare Systems: Lessons for Canada

Full Report (PDF, 571 KB)

G. Ross Baker, Ph.D.
University of Toronto

Jean-Louis Denis, Ph.D.
École nationale d’administration publique, Montréal, Québec

Key messages

Several regional healthcare systems around the world have achieved high levels of performance through system-wide efforts to improve quality that include long-term strategies and investments to improve the delivery of care and outcomes, while limiting cost increases.

An analysis of three such systems in Alaska, Utah and Sweden suggests 10 themes underlying the creation and sustaining of high performance. These themes are:

  • Quality and system improvement as a core strategy
  • Developing organizational capabilities and skills to support improvement 
  • Robust primary care teams at the centre of the delivery system
  • Engaging patients in their care and in the design of care
  • Promoting professional cultures that support teamwork, continuous improvement and patient engagement 
  • More effective integration of care that promotes seamless care transitions 
  • Information as a platform for guiding improvement 
  • Effective learning strategies and methods to test and scale up improvements 
  • Leadership activities that embrace common goals and align activities throughout the organization 
  • Providing an enabling environment buffering short-term factors that undermine success.

Healthcare systems in Canada have experienced difficulties in creating and sustaining large-scale improvements; local initiatives are difficult to replicate and spread, and improvement efforts are often limited in scale.

Canada could support a broader strategy to implement many of the elements responsible for success in the three exemplary systems studied. These elements include: 

  • Expand and enhance the roles of quality councils and similar bodies to support the development of improvement skills and to facilitate system-wide efforts to improve the quality and efficiency of care 
  • Create greater local capacity for improvement through training and leadership development 
  • Place greater emphasis on physician leadership training to enhance organizational capability, not just individual capability 
  • Identify priority areas for improvement with specific targets and timelines to help align system-wide efforts 
  • Continue to focus on the development of electronic clinical information systems; but enhance supports for collecting and using data on current performance even if such data require manual collection 
  • Expand current projects to improve patient engagement in the design and improvement of care delivery in order to promote patient-centred care and to engage and align clinicians