Problems with patient access and flow can harm patients, burden providers and increase pressure on health systems. "Command centre" technology uses real-time data to prioritize and expedite care, enhancing coordination and system planning. However, evidence is confined to individual sites or small groups of facilities, so the feasibility of the approach at a jurisdictional scale remains unclear. This paper documents Nova Scotia's implementation of the province-wide Care Coordination Centre to describe key activities and challenges from inception to sustainment. We offer insights and considerations for policy makers and decision-makers interested in establishing jurisdiction-wide command centre models.
In response to province-wide reforms to advance integrated care, the Eastern York Region North Durham Ontario Health Team launched an innovative integrated home-based primary care (IHBPC) program for frail homebound seniors in Markham and Stouffville. Findings from patient, caregiver and provider surveys - along with hospital avoidance data - demonstrate that utlizing a team of family physicians and interdisciplinary providers working across community and hospital sectors is an effective approach to addressing the complex needs of high-cost users of health services. A key feature of the program's success is embedding person-centred care across the macro, meso and micro levels of integration, providing lessons learned that can be applied to other integrated care initiatives. To ensure equitable access to high-quality care, IHBPC programs must be a core component of health systems in every jurisdiction where homebound older adults live - not merely an afterthought.
At the time this editorial was being drafted, Team Canada had just completed its best-ever performance in the 2026 FIFA World Cup. This led us to consider the parallels between the worlds of sports and healthcare, with both existing in spaces with high-stakes performance, significant public attention and limited margins for error. In keeping with our Healthcare Quarterly focus on healthcare leadership, additional reflections on the sports versus healthcare analogy include the importance of shared purpose over star power, the value of great coaching, the importance of careful planning and preparation and the role of culture in teamwork. As we think about the work to transform healthcare, there are valuable lessons to be learned from within and outside of healthcare. Our Healthcare Quarterly editorial team is pleased to continue bringing our readers new and innovative reflections on healthcare leadership and how we "coach" our teams to even higher levels of performance.
The growing burden of multimorbidity among individuals with inflammatory bowel disease (IBD) presents a critical challenge for health systems, as it signals the need to shift from single-disease-focused care to integrated multimorbidity-focused care. Recent Canadian population-based research has demonstrated that multimorbidity in IBD follows distinct patterns and that these patterns can be leveraged using machine learning (ML) to predict premature mortality. This column draws on two recent studies evaluating populations with IBD - one identifying multimorbidity clustering among individuals with IBD and another applying ML to predict premature death from non-IBD chronic conditions - to explore how these findings can inform health system planning, clinical care and policy decision-making.
This paper critiques an expansion of Medical Assistance in Dying for psychiatric illnesses in Canada, utilizing Orlando Da Silva's memoir, Thank God I Failed, as a central case study. It argues that severe depression impairs cognitive autonomy, making consent impossible and exposing patients to structural coercion within an underfunded healthcare system. By analyzing the intersection of physical and mental suffering, the text challenges health system utilitarianism and the artificial segregation of pain. Ultimately, it calls for rigorous evidentiary standards in healthcare policy, emphasizing the system's fundamental obligation to protect vulnerable patients and prioritize comprehensive care over expedited assisted death.
This paper describes how the Huron Perth and Area Ontario Health Team implemented a multi-partner, single-survey accreditation collaborative across independently governed organizations. By reframing accreditation as a system-level integration strategy, the collaborative aligned governance, policies and quality improvement efforts across sectors. Key lessons highlight the importance of shared governance, trust, continuous improvement and coordinated leadership. Evidence shows reduced duplication, improved policy consistency and enhanced system-level risk visibility. The model demonstrates how collaborative accreditation can strengthen integration, support leadership capacity and advance high-quality, patient-centred care in complex health systems.
Individuals with mental health and substance use (MHSU) conditions account for a disproportionate share of hospital and emergency department (ED) service use in Canada. This analysis draws on three Canadian Institute for Health Information indicators: 30-day readmissions, repeat hospitalizations and frequent ED visits for help with MHSU. Results show that rates across all indicators remained persistently elevated and, in 2024-2025, were approximately 8-9% higher than those in pre-pandemic baseline years. Higher rates are consistently observed among individuals living in lower-income neighbourhoods, adults aged 25-44 years and those with substance use-related conditions. Taken together, these indicator results point to recurring patterns of acute care use that reflect gaps in continuity, access to community-based care and integration across services. Strengthening transitions of care, expanding community-based supports and improving integration for individuals with complex and co-occurring conditions are critical to reducing avoidable acute care use.
The life sciences industry, and specifically the pharmaceutical sub-sector, is a major funder of private sector research and development. Canada's life sciences industry reinvests less of its revenues in research and development (R&D) activities than those in peer countries, which hinders innovation, creates supply risks and contributes to Canada's poor productivity growth. Traditional approaches to incentivizing reinvestment, including tax incentives, direct funding and public research spending, have failed. As an alternative, transforming Canada's health data systems would enable faster and more comprehensive secondary use, making R&D investments safer and more productive. Our peers are already pursuing this strategy, meaning Canada risks being left behind unless we act.
Direct service funding is re-shaping Canada's developmental services sector and beyond, increasing individual choice while introducing new ethical challenges for providers. This paper examines one organization's transition to Ontario's needs-based autism program, where families receive direct funding to purchase services. Although the model enhances choice, it raises concerns about equity, two-tiered access and non-recommended service requests. In response, the organization used an ethics decision-making framework and developed nine ethics principles. These principles now serve as a compass that guides organizational decision-making for relevant ethical dilemmas. Sharing this experience aims to support others navigate ethical complexities associated with direct service funding.
Canada's healthcare system faces increasing strain as patients who could be managed in alternative levels of care (ALCs) occupy acute hospital beds. The small house model (SHM) offers an opportunity to alleviate the growing burden on hospitals and long-term care facilities while supporting environmentally sustainable care. This case study quantifies the greenhouse gas (GHG) footprint of two facilities in Hamilton, Ontario. Annual emissions were 1,612 kg CO2e/bed and 512 kg CO2e/bed, respectively, with travel contributing significantly to emissions. Our study provides a baseline GHG footprint of the SHM, allowing for comparison to traditional methods of ALC.
Mental health and substance use-related emergency department visits are increasingly common among youth (ages 12-24 years); however, there are no standards or guidelines for providing quality care and referral to appropriate services. Based on existing evidence and insights from a technical committee of 14 Canadian experts (youth, caregivers, service providers and decision-makers), we outline four key priority areas for improving care in emergency department settings and recommendations for implementation. This includes improving the care environment; appropriate and timely mental health and substance use assessment; treatment based on youths' goals, needs, preferences and circumstances; and referral to appropriate services.
Pharmaceutical spending is increasing, and many Canadians are facing challenges with drug affordability. The Pharmaceutical Data Tool (PDT) (CIHI 2026) is a public interactive dashboard launched in 2024 that provides novel insights about drugs that are driving costs. To provide analytical insights on why pharmaceutical spending is increasing, the Canadian Institute for Health Information updated the PDT in January 2026 with 2024 calendar-year data. The PDT provides information on factors that can reduce costs such as biosimilars and formulary coverage. This paper summarizes key findings from the PDT and aims to provide pharmaceutical information users with analytical insights to inform better decision-making.
Healthcare systems are struggling to keep pace with growing populations and their complex social/medical needs. Most believe that integrated care closer to home, not hospitals, is the answer, but this requires a shift in our mental models. In establishing a distributed health network for the Northern York and South Simcoe regions of Ontario, Canada, we realized the need for a measure that reflects the magnitude of the challenge ahead and the new thinking required to get there. Population avoidable days combines four commonly used measures of unnecessary hospital utilization into a single absolute value that can help achieve these objectives.
Academic and healthcare conferences often default to professional expertise, leaving patients and caregivers at the margins. In this commentary led by patient and caregiver partners, we reflect on our experiences co-designing and participating in the 2024 North American Conference on Integrated Care (NACIC24). From waived registration fees and quiet rooms to shared chairing and plenary roles, we highlight tangible steps to creating inclusive conference design processes, spaces and experiences. In reflecting on the successes and areas for additional opportunities, this article provides tangible recommendations to advance patient and caregiver inclusive engagement based on our key learnings from the NACIC24.
Currently, most healthcare organizations in Canada lack the capacity to identify products on hand, track their locations or link product use in the delivery of healthcare to patient outcomes. These digital blind spots are associated with delayed product-recall responsiveness, compromised patient safety and a limited ability to make data-driven decisions during supply disruptions. This study presents a co-design strategy supported by the Supply Chain Advancement Network in Health (SCANH) community of practice to define a digital supply chain strategy that will ensure that health systems have the supply chain capacity to deliver quality and safe care to Canadians. Using Delphi methodology and roundtable consultation among diverse health system stakeholders (n = 35), four system-level strategies are described to advance a digitally enabled supply chain within and across Canadian health systems, including: (1) the key features of a clinically integrated, digitally enabled healthcare supply chain; (2) defined data sources and data content to strengthen product traceability (e.g., unique product identification; location data; utilization at point of care); (3) integration of global product data standards to strengthen accuracy and consistency of supply chain management; and (4) interoperability of product data across Canadian healthcare systems. Project findings leverage current federal, provincial and territorial data modernization efforts, such as the Canadian Institute for Health Information's Pan-Canadian Health Data Content Framework strategy and Canada Health Infoway's interoperability initiatives. The results of the co-design strategy offer a strategic path forward to advance a digitally enabled healthcare supply chain across Canada, illustrating how access to standardized product data empowers proactive, evidence-based supply chain decisions that protect patient safety and improve system resilience.
Our most recent issue of Healthcare Quarterly was entirely dedicated to the theme of integrated, people-centred care, and was developed in partnership with the International Foundation for Integrated Care - Canada. This theme seemed to resonate quite strongly with both readers and contributing authors, with broad consensus that we must improve how we coordinate across health and social care to meet the growing complexity of care needs in our population. Given the strong response to our call for papers, we will continue publishing articles that illustrate leading practices in integrated care in this and future editions.
Despite knowledge mobilization efforts between academic researchers and health system decision-makers, the evidence-to-action gap persists. Given that the learning health system is a cycle of knowledge to action to knowledge, the implementation of embedded health service researchers within host health system organizations is a promising approach to bridge the evidence-to-action gap. The contributions of embedded researchers to quality improvement (QI) and evaluation research capacity for integrated health systems are promising areas that warrant investigation. This paper describes the roles and contributions of embedded researchers to QI and evaluation research capacity within the context of nine Ontario Health Teams.
Canada's healthcare systems continue to experience multiple and lengthy supply chain disruptions, compounded by limited digital infrastructure and a lack of real-time visibility into risks of supply disruptions. Despite growing awareness of health supply vulnerabilities, there is no standardized tool currently to assess the risks of supply shortages for patients or the health workforce. This study introduces a healthcare supply chain risk assessment tool, co-designed through a national Community of Practice representing over 60 organizations across healthcare, industry and government. Using a participatory, evidence-informed co-design process, the risk assessment tool was developed to quantify both the probability of disruption and its impact on patient care, to enable proactive decision-making to mitigate risks to patients and the health system workforce. Pilot testing with 11 organizations demonstrated that the risk assessment tool enables prioritization of high-risk products, strengthens cross-sector collaboration and embeds risk intelligence into procurement decisions and supply management. The tool offers a scalable solution to enhance supply chain resilience, bridge gaps in data visibility and support health system modernization in Canada.
Alberta has become a leader in opioid use disorder (OUD) treatment within provincial corrections. Correctional Health Services developed an innovative opioid agonist therapy (OAT) program over the last decade. A more recent partnership with the Virtual Opioid Dependency Program has resulted in immediate asynchronous virtual assessment for an OUD diagnosis and OAT treatment for inmates who meet the OUD screening criteria on admission. Since the program's launch, there have been several quality improvement initiatives undertaken that have eliminated waitlists for OAT initiation, and there have been reductions in drug overdose mortality, both within correctional centres and after release.
Care models integrating geriatrics into primary care are emerging across Ontario. Referred to as Primary Care Integrated Geriatric Teams (PCIGTs), their evidence-based approaches improve access to specialized care and support for older adults. Seven Ontario models were highlighted through webinars held in spring 2025, attended by nearly 200 participants. Presenters and participants identified promising design features, key learnings and supports needed to advance goal-aligned care for older adults. Relevant to primary care transformation, health system redesign and policy efforts in Ontario and beyond, PCIGTs can support primary care attachment, reduce pressure on acute services and promote aging in place.
