Between 2022 and 2024, Canadian nursing regulators significantly reformed licensure pathways for Internationally Educated Nurses (IENs) to address worsening workforce shortages. Since then, pathways have continued to evolve, illustrating a dynamic policy area. The objective of this article is to examine factors shaping changes to IEN licensure policy discourse and pathway design between 2024 and 2026. A comparative qualitative policy analysis of six nursing regulators across four provinces was conducted using publicly available grey literature, guided by the 3I + E framework and the READ approach. The findings suggest that IEN licensure reforms continue to be shaped by ongoing labour mobility, political, and economic pressures. Regulatory pathways increasingly emphasize substantial equivalence pathways with increased verification and competency oversight measures. Despite an increased supply of licensed nurses, ongoing integration challenges indicate that licensure is only one component of the solution. Findings also highlight the need for adaptive and coordinated policy responses across interconnected workforce, immigration, education, and healthcare systems.
This article examines the evolving internal governance dynamics of Canadian hospitals, with a focus on the triangular leadership relationship between the Board of Directors, Chief Executive Officer, and Chief of Staff. Drawing on research from seven eastern Ontario healthcare institutions, it identifies three distinct governance interaction models and highlights how, post-pandemic, there has been an accelerated shift toward more integrated, collaborative leadership. Key findings include persistent gaps in non-financial delegated authorities, sub-optimal Chief of Staff performance management, and succession planning, and reinforcing that trust and transparency between the Board Chair, Chief Executive Officer, and Chief of Staff remain the ultimate foundational pillars of governance effectiveness.
Hospitals must maintain essential services during disasters, although routine funding rarely covers the staff, supplies, backup systems, and regional coordination required for readiness. This article examines emergency preparedness as a leadership and financing responsibility. A narrative review considered Canadian, United States, and international policy documents and research on hospital resilience, emergency management, coalitions, supply continuity, and preparedness investment. Preparedness requires recurring expenditures that compete with operating priorities, while benefits often extend beyond the hospital that pays for them. Leaders can strengthen readiness through governance, budgeting, lifecycle planning, workforce decisions, regional agreements, risk monitoring, and emergency spending authority. Public support remains necessary for shared capabilities and extreme events. Sustainable readiness combines hospital financing for core capability, regional arrangements for shared resources, public investment where community benefits are broad, and rapid access to funds when demand exceeds normal capacity.
The purpose of this article is to introduce the Social Dynamics of Change (SDoC), a framework for institutional transformation, and examine the Canadian Medical Association’s (CMA) 2024 Apology to the Indigenous Peoples of Canada as a case study in institutional reconciliation. Converging social, political, and institutional forces exposed the CMA’s maladaptive relationship with Indigenous Peoples. Through the SDoC framework, reconciliation involved movement from crisis through denial, resistance, exploration, and commitment. Progress required relational accountability, trust, co-design, and sustained engagement between Indigenous and non-Indigenous leaders. The case highlights the importance of Indigenous leadership in senior governance, as three authors in distinct leadership roles helped create the enabling environment that supported the CMA’s reconciliation journey. The CMA case suggests that meaningful institutional reconciliation is achieved when relational alignment precedes transactional milestones. The SDoC framework helps explain how healthcare organizations navigate change and translate reconciliation commitments into lasting shifts in governance and culture.
Since the transfer of federal health programs to the First Nations Health Authority (FNHA) in 2013, First Nations Health Directors have played a central role within British Columbia's evolving health governance landscape. Health Directors are community health leads who oversee programs and service development in First Nations health centres and work with health partners to address community health needs. This mixed-methods study draws on a province-wide survey of Health Directors and five sharing circles to examine how Health Directors engage in reconciliation work through their everyday decision-making and relationship-building. Findings demonstrate that this daily community and governance related work contributes to incremental shifts that drive long-term system change, while persistent funding constraints, workload-related burnout, and anti-First Nations racism continue to shape and constrain these efforts.
Internationally Educated Healthcare Professionals (IEHPs) represent a significant part of Canada’s health workforce, yet limited evidence exists on vaccine attitudes in this group. This study examined vaccine perceptions among IEHPs in Canada and their roles in promoting vaccination within their communities. Semi-structured interviews were conducted with 22 IEHPs and analyzed using thematic analysis through an intersectional lens. Participants generally expressed strong pro-vaccine attitudes and believed that gender/sex, religion, ethnicity/race, and employment precarity, particularly in relation to vaccine mandates, influence vaccine attitudes, and decision-making. Participants viewed IEHPs as ambassadors who can promote vaccine uptake, especially among culturally and ethnically similar populations. IEHPs demonstrated overall support for vaccination and identified themselves as contributors to vaccine promotion in communities historically underserved by public health. These findings highlight their potential role in culturally tailored vaccine communication and public health outreach in Canada as well as in policy development and implementation efforts.
The Truth and Reconciliation Commission of Canada released its Calls to Action in 2015, including the seven health-related Calls. Progress has been variable and slow, including in the health-related Calls to Action. Drawing on our combined experience as Indigenous health leaders, we propose new leadership competencies for supporting Indigenous health workers and emerging Indigenous leaders. We envision these competencies as uniquely necessary to advance antiracism and decolonization approaches that will move the dial from interim progress to meaningful differences in Indigenous health and health workforce outcomes.
In 2025, University Health Network expanded its annual influenza and COVID-19 vaccination campaign by integrating nursing Clinical Externs (CEs), nursing students working as paid unregulated care providers, to administer the injections under delegation. This case study describes the program implementation and how education and competency validation were structured. The program was grounded in adult learning principles and Benner’s Novice to Expert Theory. CEs completed surveys assessing confidence, comfort, and preparedness for intramuscular injection administration. Post-intervention surveys reported a 71% increase in extreme confidence, 71% increase in high comfort, and 56.6% increase in being very prepared. CEs supported high-volume clinic workflows and administered 1,575 vaccinations across multiple hospital sites, enabling OHS nurses to focus on clinical oversight and more complex occupational health assessments. Integrating CEs into immunization delivery built learner competence and expanded vaccination capacity. This program can offer a scalable model for hospitals seeking cost-effective workforce solutions for immunization campaigns.
Healthcare contributes to environmental harm, with Hemodialysis (HD) among the most resource-intensive treatments. Intravenous (IV) iron sucrose is routinely administered by infusion in HD units despite product monographs permitting direct ("push") administration. IV infusion generates avoidable plastic waste. We conducted a quality improvement initiative across a regional kidney program in Canada to switch IV iron sucrose to push administration. A literature-informed safety and workflow review, supplemented by peer experience and prospective time trial on nursing time guided implementation. Safety events, nursing feedback, and consumable waste were evaluated. The pilot period prevented 36 kg of consumable waste, with estimated annual reduction of 1,548 kg. Consumable supply costs decreased by 75% following program-wide implementation. Transitioning iron sucrose from IV infusion to IV push is safe, feasible, and well accepted in HD settings, while substantially reducing waste and costs. This initiative demonstrates how evidence-based changes to practices can support environmentally sustainable kidney care.
Although chronic pain education programs are widely recommended, evidence of their effectiveness remains limited. This may be partly due to a focus on short-term, quantitative outcomes rather than longer-term exploration of patient experiences. This qualitative study explored how individuals with lived experience of chronic pain perceived and applied pain education over time, focusing on factors that may inform program evaluation and quality improvement. Thirteen interviews were conducted with adults in British Columbia who had participated in chronic pain education within the past 10 years. Participants described education as an adaptive process, developing individualized "pain management toolboxes" rather than following prescriptive approaches. Thematic analysis identified three relational factors that shaped program experience: validation of lived experience, building trust, and perceived control over care. Findings suggest that relational aspects of patient experience are critical to program impact. Incorporating qualitative evaluation and patient-reported experience measures may support quality improvement and person-centred care.
Burnout among Canadian Family Physicians (FPs) is a significant concern, as is their lack of capacity and skillset in supporting patients' mental health conditions in clinics. This article reports evaluation results of an 8-week group-based mental health skills program delivered virtually to 698 physicians in British Columbia with the dual objectives of (1) providing skills physicians can use to support patients experiencing mental health concerns and (2) supporting physician wellness. A mixed methods approach was employed. Professional Fulfilment (PF), Burnout (BO), and resiliency outcomes were assessed at pre-, post- and 1-year follow-up using the Stanford Professional Fulfillment Index and the Brief Resiliency Scale (resiliency). An anonymous survey was administered upon completion of the program, and again at 1-year follow-up to assess learning outcomes and program value. Twelve participants provided additional feedback through focus groups and interviews. Participants were primarily family physicians working in urban settings. Pre- to post-paired t-test results showed improvements for professional fulfilment (P < .001), burnout (P < .001), and resiliency (P < .001), with no loss in gains at 1-year follow-up for professional fulfilment (P = .202) and resiliency (P = .184), and further improvements in burnout (P = .016). Participants agreed that the program energized them in their work and that they would recommend the program to colleagues. Most were actively using the mental health skills in their professional and personal lives at 1-year follow-up. The CBT Skills Mental Health Physician Groups Program is effective at supporting physicians' personal and professional well-being and mental health upskilling, with participants highly valuing the program.
Nova Scotia Health aims to strengthen continuous professional development, leadership growth, and patient care through a structured physician assessment framework grounded in CanMEDS roles and Equity, Diversity, Inclusion, Reconciliation, and Accessibility (EDIRA) principles. We evaluated multisource (360-degree) feedback tools to support voluntary, confidential, and formative professional development across diverse practice settings. Five commercially available platforms (Pulse 360, MCC 360, Trakstar, SurveySparrow, and 15Five) were compared for alignment with CanMEDS competencies, usability, flexibility, cost, and capacity to support leadership development. Pulse 360 and MCC 360 demonstrated the strongest alignment with guiding principles. Pulse 360 was favoured for its customization, efficiency, benchmarking capability, integrated coaching resources, and overall cost-effectiveness. We recommend adopting Pulse 360 in 2- to 3-year cycles, beginning with a pilot implementation at a medium-sized institution to support scalable physician leadership development and organizational improvement.
Health leaders operate in systems where small disruptions can cascade rapidly across clinical care, staffing, technology, facilities, and supply chains. Traditional risk management often emphasizes preventing failure; however, in complex and tightly coupled systems, some failures are difficult to predict or fully avoid. This article introduces the concept of operational rupture discs as a practical leadership framework for healthcare resilience. Borrowed from manufacturing and engineering safety, a rupture disc is a designed weak point that releases overpressure before a larger system failure occurs. In healthcare systems, rupture discs are intentional buffers, escalation triggers, decision rules, redundancies, and recovery pathways that allow leaders to absorb disruption before it becomes catastrophic. This article presents a four-part framework for designing rupture discs in healthcare: sensing pressure, creating controlled release points, protecting critical functions, and learning after activation. Implications for health executives seeking to build safer, more resilient systems are discussed.
As demand for homecare services continues to rise, homecare worker retention remains a critical issue for the sector which impacts access to care and operational efficiency. To design evidence-based retention policies within a fiscally constrained context, it is important to understand the sector-specific costs of turnover. Using data from a large homecare provider organization in Ontario, Canada, we have developed the first known homecare Personal Support Workers (PSWs) cost of turnover estimate. We estimate a turnover cost of $22,000 (CAD 2024) per homecare PSW, based on an employer-level homecare-specific model. The primary driver of turnover costs was opportunity costs from reduced capacity; other more direct costs such as recruitment and training were smaller contributors. Decision-makers at both the organizational and broader health system level can use this estimate in considering the cost-benefit ratio and return on investment of interventions designed to promote the retention of homecare PSWs, such as enhanced training, benefits, and preceptorship programs.
Burnout among healthcare workers in Canada remains a critical challenge with implications for workforce retention, patient safety, and system sustainability. Traditional responses have often emphasized individual coping strategies rather than structural change. This article argues that Artificial Intelligence (AI) might offer new opportunities to address some of the organizational drivers of burnout. We outline three domains where AI may provide value: (1) enhancing the measurement and understanding of burnout, (2) strengthening workforce planning and operational decision-making, and (3) mitigating workplace risks through process redesign and automation. By shifting attention from “fixing workers” to “fixing work,” AI might be part of the “solution” to support healthier, more sustainable healthcare environments.
Long-Haul Truck Drivers (LHTDs) have been identified as a high-risk population for chronic conditions. Health promotion programs have largely focused on individual behaviours, with less emphasis placed on the broader environmental factors. However, there is growing evidence that effective strategies must consider both individual and environmental factors. Through a social-ecological lens this mixed-methods study explored how the mobile work environment impacts health and health behaviours amongst LHTDs on the Canadian Prairies. Data were collected through semi-structured interviews with 13 participants, diet and activity logs, and a mobile work environment assessment of the Trans-Canada Highway between Manitoba and Alberta. Individual, occupational and policy level influences on the health and health practices of LHTDs were identified. Leaders in health policy are in a key position to build inter-sectoral, collaborative relationships and advocate for the necessary policy changes to create a healthy work environment for LHTDs.
Diabetes disproportionately affects Indigenous populations in Canada, reflecting the enduring impacts of colonialism, structural inequities, and systemic barriers within healthcare. The "Walking Together in the Same Direction" project developed a community-driven, culturally rooted diabetes prevention framework with ten First Nations communities across South Vancouver Island, British Columbia. Through circle discussions, communities did not simply share experiences-they co-created a 13 Moons framework grounded in Indigenous ways of knowing. This cyclical model reflects a holistic understanding of health across physical, emotional, mental, and spiritual domains, aligned with seasonal teachings and community life. It represents a critical shift from adapting Western models toward centring Indigenous knowledge as the foundation of care, demonstrating community-led design, self-determination beyond consultation, and tangible Indigenous-led outcomes. This work highlights the importance of moving from linear, biomedical approaches toward relational, culturally grounded models that privilege trust, continuity, and holistic wellness.
Health reports about First Nations in Canada continue to perpetuate systemic and structural racism in Canada. While the acknowledgment of First Nations Peoples' inherent right to own, control, access, and possess information about them and their territories is increasing in Canadian health data systems, the operationalization of such principles continue to live ambiguously. First Nations Health Data Sovereignty is an ongoing, reciprocal, and intersectional process requiring clear governance principles, well-defined structures, and sustained resources to ensure that Nation-based sovereignty is meaningfully embedded in everyday health data operations. In British Columbia, the First Nations Health Authority, working within the governance pathways assigned by Chiefs and leadership undertook research on the topic of First Nations Health Data to articulate key principles that can equip policy and operations across health data systems. These principles aim to reorient First Nations health data away from western accountability frameworks toward Nation-based self-determination and self-governance.
Principle 4 of the Pan-Canadian Health Data Charter calls for common standards to enable interoperability, access, and portability of health data. Yet clinically meaningful information, particularly nursing documentation, remains largely unstructured and siloed across care settings. This article argues that nursing data represent a critical but under-leveraged asset for improving patient safety and continuity of care, as it captures early indicators of deterioration, functional decline, and social context often absent from structured datasets. While traditional approaches to standardization have relied on behavioural change, emerging Artificial Intelligence (AI) tools offer a practical alternative by translating narrative documentation into standardized, interoperable formats. Drawing on institutional examples and current evidence, the article examines the possibilities and potential benefits of leveraging AI to fully realize the promise of common standards in practice without creating undue burdens for clinicians.
Principle 5 of the Pan-Canadian Health Data Charter highlights the importance of maximizing public benefit from reusing health data with minimizing harm, focusing on quality, security, privacy, and reliable governance. This article brings together findings showing that Canada's fragmented and non-interoperable data landscape, along with inconsistent governance, leads to reduced clinical safety, slower research and innovation progress, and significant economic setbacks. Moreover, prioritizing privacy above all can unintentionally hinder valuable data sharing. Our recommendations are to mandate data sharing with protective safeguards, implement national interoperability standards, shift towards stewardship models, and create culturally grounded health data governance for Indigenous and equity-seeking groups.
