Assessing initiatives to transform healthcare systems: Lessons for the Canadian healthcare system

CHSRF series on healthcare transformation: Paper 1

Full report (817 KB) 

Jean-Louis Denis, PhD
Professeur titulaire Chaire de recherche du Canada sur la gouvernance et la transformation des organisations et systèmes de santé
École nationale d’administration publique

Huw T. O. Davies, PhD
Professor & Deputy Head of School
School of Management
University of St Andrews

Ewan Ferlie, PhD
Professor & Depa rtment Head
Depa rtment of Management
King’s College London

Louise Fitzgerald, PhD
Visiting Professor
Manchester Business School
University of Manchester

With the collaboration of Anne McManus (MSc)

Canada has invested significant financial resources and energy (including numerous federal and provincial commissions) in efforts to make the healthcare system more responsive to evolving needs. Nonetheless, there is general consensus that Canada’s healthcare systems have been too slow to adapt. A 2008 report by the Health Council of Canada concludes that since the 2003 Health Accord there have been improvements in access to care in some clinical priority areas, such as hip and knee replacement and cataract surgery. However, it also identifies a number of areas where “progress on the accord commitments is not a cause for celebration” (HCC, 2008:34). These areas include drug coverage and safe and appropriate prescribing; home care; aboriginal health; primary healthcare; the healthcare workforce; electronic health records and information technology; and accountability.

This paper suggests avenues that governments can take to support the transformation of the healthcare system to provide better care and services.

Key Messages

  • One key element of any transformative strategy is a clear picture of what needs to be changed. Canada needs an integrated vision and approach to achieve healthcare system transformation.
  • Healthcare systems tend to reproduce their dominant logic (in Canada it means that more and more resources are invested in specialized care) and consequently neglect other areas where major care deficits persist.
  • Without vigorous human resources policies that favour a new mix of skills, including new professional roles and innovative models of inter-professional teams, current care deficits will not be alleviated.
  • Human resources don’t work in a vacuum. An enabling environment and organizations that support professional and clinical practices can have a significant impact on the provision and quality of care and services.
  • New organizations and governance models are essential elements of a large-scale improvement strategy. Initiatives to renew primary healthcare in Canada in the last ten years clearly illustrate that an inherent tension in transformation is how to challenge healthcare professionals and stakeholders to adopt new ways of thinking and working while keeping them fully engaged in the transformation process.
  • Renewal of delivery organizations requires strong leadership from and close connection between the management and clinical worlds. It is essential to recruit and train individuals to effectively bridge these two worlds.
  • Professionals and organizations can make important progress at the local level. However, to support improvement and spread good practices, better communication and mutual learning between the policy and delivery levels are needed.
  • Debates among providers, organizations and the government too often focus on the level of financial resources and incentives available to achieve improvements in the healthcare system. While financial resources and economic incentives can play a role in orienting the provision of care and services, strategies to develop a commitment to better care seem more promising.
  • In order to realign the system to meet evolving health needs, initiatives that support patient engagement and citizen participation, as well as the use of evidence to inform change, are crucial. Both types of levers are potentially powerful instruments to channel organizational and professional strategies toward improvement.