Accelerating health system transformation in Saskatchewan: Lessons learned from the Saskatchewan Surgical Initiative

Held October 23, 2014



Healthcare leaders are under increased pressure to deliver consistently safe, high-quality care to citizens. In response to this pressure and findings from the Patient First Review, in 2010, the Saskatchewan government set out to “transform the surgical patient experience” through an aggressive, multi-year, system-wide strategy. The overarching goal of the Saskatchewan Surgical Initiative (SkSI) was to reduce the wait times for elective surgery to no longer than three months by March 31st, 2014. The SkSI strategically involved a broad and diverse group of stakeholders whose collective ideas and energy fuelled the development and implementation of a comprehensive plan to address the wait times issue.

In order to develop a better understanding of the associated change-management process as well as to help accelerate the transformation, in 2011, the Canadian Foundation for Healthcare Improvement (CFHI), working in collaboration with Saskatchewan Health and the Johnson-Shoyama Graduate School of Public Policy (JSGS), embedded a researcher in the Saskatchewan Surgical Initiative. Through the systematic exploration of this single policy case study—the SkSI—this research identifies the critical factors that facilitate and inhibit major health system change.

Learning Objectives:

  • Explore change processes to better understand and identify factors that facilitate or inhibit large system transformation using a unique ‘real-time’ collaborative approach
  • Learn about the critical factors that contribute toward and impede large health system transformation based on a case study of the Saskatchewan Surgical Initiative
  • Better understand how to address and overcome the identified barriers to large health system transformation, as well as how to optimize the application of facilitators that may accelerate large scale change within the health care environment


Gregory MarchildonGregory Marchildon, Professor and Canada Research Chair in Public Policy & Economic History (Tier 1), Johnson-Shoyama Graduate School of Public Policy, University of Regina, Saskatchewan

Gregory currently holds a Canada Research Chair in Public Policy and Economic History, and is a professor in the Johnson-Shoyama Graduate School of Public Policy at the University of Regina. He is a fellow of the Canadian Academy of Health Sciences, a founding member of the Pan-Canadian Health Reform Analysis Network (PHRAN) and associate editor of PHRAN’s journal, the Health Reform Observer. He is also PHRAN’s representative to the European Observatory on Health Systems and Policies’ networked platform, the Health Systems and Policy Monitor.

In 2001 and 2002, he was the Executive Director of the federal Royal Commission on the Future of Health Care in Canada. Launched on May 1, 2001, the Commission was chaired by the Hon. Roy Romanow, Q.C, who was given a mandate by the Prime Minister to provide recommendations concerning the future of Canada’s publicly funded health care system. The Commission’s final report Building on Values was tabled in the Canadian Parliament on November 27, 2002.

From January 1997 until September 2000, Dr. Marchildon was Saskatchewan’s Cabinet Secretary and Deputy Minister to the Premier and advised Cabinet on the establishment of the Fyke Commission on Medicare. During this time, he initiated a number of changes to enhance policy capacity among central agencies and line departments and spearheaded reforms in cabinet and cabinet committee systems to improve decision-making processes. From 1994 until 1996, he served as the province’s Deputy Minister of Intergovernmental Affairs. In this capacity, he built up the province’s international relations and trade policy capacity and was a key participant in the early social union negotiations that led to the National Child Benefit and the Social Union Framework Agreement (SUFA).

Prior to his work in government, Marchildon was an academic. After receiving degrees in history and economics from the University of Regina and a law degree from the University of Saskatchewan, he received his PhD in economic history from the London School of Economics and Political Science (LSE). In 1988, he held a one-year appointment as lecturer in American economic history at LSE. From 1989 until 1994, he was assistant professor of Canadian studies and economic history at Johns Hopkins University’s School of Advanced International Studies (SAIS) in Washington, DC. He was also acting director of the Centre of Canadian Studies at SAIS in 1993.

Marchildon has written extensively on subjects ranging from public policy and administration to Canadian history and trade relations. In recent years, he has focused on health policy, comparative health systems and the policy history of Canadian Medicare. He has published articles in a broad range of disciplinary and interdisciplinary journals. He has authored and co-authored seven books including Profits and Politics: Beaverbrook and the Gilded Age of Canadian Finance (1996) and Health Systems in Transition: Canada (2006, revised 2013). He has edited or co-edited 16 books including Making Medicare: New Perspectives on the History of Medicare in Canada (2012) and Bending the Cost Curve in Health Care (2014). In his spare time, he is an avid canoeist who loves exploring waterways originally used by Indigenous peoples, fur traders and explorers. He is the co-author of Canoeing the Churchill: A Practical Guide to the Historic Voyageur Highway, which won the 2002 Saskatchewan Book Award for Scholarly Writing. More recently, he co-authored Paddling Routes of North-Central Saskatchewan (2014) and is working on a book exploring the San Blas islands by kayak on the Atlantic coast of Panama.

Sharon Bishop-125Sharon Bishop, PhD Candidate Johnson-Shoyama Graduate School of Public Policy University of Regina, Saskatchewan

Sharon is currently a PhD candidate at the Johnson Shoyama Graduate School of Public Policy under the supervision of Dr. Greg Marchildon. She is originally from Australia and has a background in nursing, practicing as a registered nurse over the past 15 years in various capacities. More recently, Sharon held a position as an independent researcher within the Saskatchewan Ministry of Health. The objective of this 29-month collaborative research project was to systematically explore change processes to better understand and identify factors that facilitate or inhibit large system transformation.

Her primary research interests include leadership and change within the healthcare context, in particular how leadership is distributed within the complex Canadian Healthcare environment. When Sharon isn’t focusing on her studies she loves to spend time with her partner and two beautiful children- and if there is any time leftover- she enjoys a long run to clear her head!

Academic Background: Master of Health Services Management and a Bachelor of Nursing from Queensland University of Technology, Brisbane, Australia.

Research Interests: distributed leadership, health system transformation, health care access, governance/ accountability.

Scholarships and Awards: Saskatchewan Surgical Initiative Embedded Researcher Award, PhD Entrance Scholarship.


Stephen Samis imageStephen Samis, Vice-President, Programs, CFHI

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