Health systems in developed countries face escalating challenges, including rising costs, workforce crises, safety concerns and persistent inequities. Despite widespread recognition of the need for transformation, progress has been slow and fragmented. The Canadian experience underscores this reality: a decade after the federal health minister's Advisory Panel on Healthcare Innovation released its landmark report, many of its key recommendations - including a $1-billion innovation fund and a national healthcare innovation agency - remain unfulfilled. During this period, system pressures have intensified, compounded by the COVID-19 pandemic and growing financial constraints. At the same time, digital technologies, particularly artificial intelligence, offer unprecedented opportunities to redesign care delivery, though adoption has been patchy and uncoordinated. This commentary argues that health systems must embed innovation into their core mission, linking transformation with economic development through clinician- and patient-driven solutions, commercialization, procurement reform and sustained national strategies to ensure that healthcare becomes both sustainable and socially generative.
Progress on the report of the Advisory Panel on Healthcare Innovation (2015) for Canada is limited. While Manns et al. (2025) advocate for a national innovation agency and fund, their analysis underemphasizes the catalytic role of health data infrastructure as the foundation of an innovation engine. Consequently, Canada has not cultivated the strategic infrastructure necessary to enable spread and scale. This commentary argues that pan-Canadian health data ecosystems are foundational to scaling innovation. By prioritizing data liquidity, real-world evidence generation and data stewardship, Canada can transform its "perpetual pilot projects" into a learning health system that accelerates the scale and spread of value-based innovations.
In 2023, federal, provincial and territorial governments created Health Workforce Canada with a mandate to transform health workforce planning. Strategic initiatives focus on convening networks, advancing data, catalyzing modelling and forecasting and sharing promising practices. Early successes feature extensive collaboration and co-creation, data dashboards to assist planners and decision makers, an early microsimulation modelling tool to enable working with imprecise data and an artificial intelligence-powered Digital Front Door to enhance access to quality health workforce information and support informed decision making. Early efforts are having a positive impact on health workforce planning, data accessibility and catalyzing innovation and transformation.
According to Manns et al. (2025), Canada struggles to turn good ideas into routine care because functions for evidence, funding, procurement and delivery are fragmented. In the UK, these functions are, in part, connected within a tax-funded service free at the point of use. This commentary maps the architecture, linking research translation, independent assessment, regulation, procurement, adoption support and data and explains how evidence moves into practice through principles aligned with the nonadoption, abandonment, scale-up, spread and sustainability framework, which addresses nonadoption, abandonment, the challenges of scale-up, spread and sustainability. Two worked examples, placental growth factor testing and stroke imaging artificial intelligence, show that national assessment, adoption support and procurement enabled rapid adoption at a national scale. Practical implications for Canada include a single repeatable pathway from promising evidence to routine use, conditional adoption with evidence generation, national frameworks that reduce transaction costs, investment in implementation capability and secure data environments for real-world evaluation.
It is valuable to reflect on what progress the federal, provincial and territorial governments have made on implementing the Advisory Panel on Healthcare Innovation Report's recommendations. The recommendations offered by Manns et al. (2025) are a good starting point but are too modest. New entities need assurances of independence from federal, provincial and territorial governments; scale system interventions; ability to influence provincial and territorial health system funding policies including physician remuneration models; and capacity to integrate with regional priorities. To pursue the sought innovations, political will for reforming the structure of pan-Canadian healthcare organizations is needed.
It has been 10 years since the Advisory Panel on Healthcare Innovation Report (Advisory Panel on Healthcare Innovation 2015) recommended patient engagement and empowerment as one action to enhance the quality and sustainability of healthcare in Canada. Since that time, patient engagement has become internationally recognized as a key component toward improving healthcare systems. In this article, the author highlights how organizations across Canada have engaged patients in healthcare and health research planning, design and governance activities, and discusses three key areas wherein improvements are needed to leverage the potential of patient engagement: leadership and infrastructure, diversity and representation and power structures/imbalances.
Ten years after the Advisory Panel on Healthcare Innovation's report, progress on its recommendations remains limited across Canada. Coordinated, patient-centred, digitally enabled reforms and stronger interjurisdictional collaboration are urgently needed.
In 2015, the Advisory Panel on Healthcare Innovation (APHI) highlighted shortcomings in Canada's healthcare systems, including weak integration, ineffective workforce planning and deployment, uneven infostructure and misaligned incentives. Progress in the last decade has been modest, underscoring both the challenges faced by provinces/territories in effecting top-down structural reforms and the limited yield from federal attempts to "buy change." APHI anticipated that outcome and argued for a new bottom-up model of collaborative catalysis, evaluation and scaling of effective innovations in healthcare. This model also facilitates the selective commercialization of novel Canadian goods and services and bears consideration given our healthcare crisis and weak innovation indices.
Federal Health Minister Rona Ambrose created the Advisory Panel on Healthcare Innovation, asking them to identify five priority innovation areas that would improve accessibility, quality of care and health spending. Their 2015 report found fragmented systems, a lack of collaboration across jurisdictions to share learnings and best practices and undercapitalized technological advancements, among other barriers to spreading successful innovation. Ten years later, we review the report's main recommendations and examine progress in the key areas identified for action. Progress on many of the recommendations is lacking. The panel's main recommendations - creation of a $1-billion innovation fund to enable sustainable changes in care delivery and a national healthcare innovation agency - have gone largely unanswered. We illustrate the need for an innovation agency that spans all provinces using several examples, including ones where digital health innovation is required, including central intake and triage for specialist referrals. We discuss the conditions needed for successful implementation: An interoperable digital solution, changes to models of care and funding flows, leadership and a patient-centred culture within the health system. We also highlight how local innovation hubs enable the development of new technologies and identify the key local, provincial and national factors for success that should be considered for a new federal agency.
Canada lags its peers in health systems innovation. Ten years after the federal Advisory Panel on Healthcare Innovation released its report, progress remains limited. In this issue, Manns et al. (2025) revisit the recommendations of the report, assess progress and propose a path forward, including establishing a well-funded innovation agency, advancing interoperable data systems, shifting to value-based funding and fostering patient engagement. The lead essay (Manns et al. 2025), along with the rich and insightful commentaries, highlight both systemic barriers and opportunities for change. Despite past inertia, these strategies offer hope for building an innovation-ready health system capable of meeting future challenges.
Canada has a history of innovative pilot projects that have failed to spread and scale to achieve transformative change in the organization and delivery of healthcare. Past experience suggests four essential dimensions of sustainability: funding, including incentives to adopt new working methods and longer-term program funding; strong policy guidance and/or legislation and regulation; sustained focus on addressing a particular problem or issue; and accountability for results. Had the Naylor Panel recommendations been implemented a decade ago, Canada's healthcare system would now be on a much stronger footing to confront today's challenges. The Naylor blueprint offers pertinent, practical solutions for issues such as improving access to primary care, improving digital health and contending with artificial intelligence.
Ten years ago, the Advisory Panel on Healthcare Innovation, chaired by C. David Naylor, gave its prescription to strengthen Canada's healthcare systems. Unfortunately, the report fell victim to politics and shifting government priorities. This commentary argues that key barriers to healthcare improvement in Canada - particularly siloed structures that prevent collaboration, a lack of political will to challenge the status quo and a myopic federalism paradigm - continue to bedevil Canada's health systems, and that the recommendations of the Naylor panel, particularly the proposed healthcare innovation fund and federal healthcare innovation agency, are as relevant today as they were in 2015.
The governance of healthcare systems is inherently complex and often leads to recurring debates about the advantages and pitfalls of centralization and decentralization to address politicization in healthcare. The international experience provides insights to reflect on the analysis of the recent reforms in the Canadian context, such as the one by Jean-Louis Denis. In this commentary, we argue that creating massive structures to shield operational management from political interference generates challenges related to the multilevel nature of decision making and the re-creation of siloes. Hybrid approaches may provide checks and balances and achieve the objectives of both centralization and devolution.
Over the past four decades, the most significant organizational change has been the establishment of health authorities that have been delegated by provincial governments to manage health systems. The continual changes made to the structure of health authorities, including the recent trend to more centralized administration, have caused considerable upheaval. Although a major change in the immediate future would only amplify this upheaval, it is still worth delegating to health authorities the additional responsibility for the payment and management of health human resources, including physician remuneration and bargaining. This is one more incremental change that holds the greatest promise in terms of improving accountability and health system performance.
Looking at the feedback received on my paper on governance reforms in Canada, I was struck by the diversity of viewpoints. Some commentators were more optimistic than others and saw the importance of and the possibility of fixing governance for a better health system. Others were more skeptical, and they were certainly not alone, considering the limitations of past reforms. Being aware of the complexity of achieving beneficial governance, reforms should not deter us from efforts to better align governance with health system improvement. Indeed, critical awareness and perseverance appear through these commentaries' essential ingredients of real governance reforms.
Over the last several decades, Alberta has led Canadian provinces in waves of healthcare system reform: first to regionalize, first to replace regions with a province-wide health authority and, in 2024, first to blow up such an authority for a new combination of functionally based organizations. Yet behind the flux in organizational forms lies a consistent set of storylines. On the surface, reforms have continually tried to find ways to facilitate the transfer of resources from the acute care sector to other components of the health system. Less openly, changes from the Klein government onward appear to be intended to facilitate greater political control over health bureaucrats and professionals, and to pave the way for an expanded private sector role.
The governance of publicly funded health systems in Canada has attracted attention for decades. Governance refers to the steering of the whole health system and goes beyond the role of healthcare boards for hospitals or regions. In this article, we analyze the potential of system-level reforms of governance that have been implemented in seven Canadian provinces since 2008. These reforms involve a movement toward greater centralization of the governance of health systems with the creation of province-wide governing agencies. These reforms of governance are not, by design, a panacea nor an absolute policy mistake. The potential of these governance reforms, as with any structural changes, will largely depend on how actors in power inhabit these new agencies and how patients, citizens, non-governmental organizations and communities relate to them. To assess the potential of these reforms, we first review works on challenges faced by these new health authorities. We then explore the literature on high-performing health systems and on contemporary approaches to governance, offering guidance for leaders of these organizations.
This paper links the "provisional learnings" outlined in Denis's lead article to the results of a mixed-methods study of the state of rural healthcare in Saskatchewan to examine the manner by which the province centralized health system governance in 2017. While the study has limitations that preclude any hard and fast conclusions about those changes, there is evidence to suggest that the reforms were undertaken with insufficient attention to the particularities of rural healthcare organization and delivery. Amalgamation is not the sole cause of Saskatchewan's current crisis in rural healthcare, but the way it was implemented (with little consultation with rural communities, without clear goals and without sufficient planning in advance) may have exacerbated an already worsening situation.
This issue of HealthcarePapers tackles the challenging question about how to strengthen health system governance in Canada and helps to make sense of the wave of structural reforms underway across the country. The lead essay and commentaries in this issue provide the much-needed empirical and experiential evidence on the intended and unintended effects of reforms to governance, with a focus on the recent wave of centralization of regional authorities across provinces. This issue provides the necessary tools for health system leaders to maximize the potential of these new governing agencies.
Healthcare governance shapes health system performance. System leaders can redesign governance to better meet the needs of citizens and communities by strengthening collective impact. To create collective impact, we must engage patients, caregivers and the broader public to create a shared vision and invest in improvement. In this paper, we argue for governance models that enable a culture of ongoing learning and improvement aided by expanded patient and public engagement and co-design. Overarching principles combined with more power at the local level offer levers for transformation based on system integration and the insights of diverse partners and perspectives.
