By Sara Allin

It is increasingly apparent to researchers and the public alike that Canada’s healthcare systems need urgent action to deal with some critical challenges. Even before the COVID-19 pandemic, the strains were already there. A growing and aging population with inadequate long-term and acute care across the continuum. The increasing burden of chronic illness and multi-morbidity. Inequitable access to high-quality care. A workforce struggling to meet the demand. Now, those strains have reached the breaking point, affecting all parts of our healthcare systems, including hospitals and the people who work in them.

While change is hard, it’s clear we can’t keep doing things the way we always have.  Continuing to invest more in health but not changing the way we finance, govern and deliver healthcare won’t solve the problem. We can learn from the experiences of the pandemic to find new ways to create more sustainable and resilient healthcare systems.

On November 16, we released our report – Sustainability and Resilience in the Canadian Health System – as part of a new research initiative with the Partnership for Health System Sustainability and Resilience (PHSSR), a global collaboration between academic, non-governmental, life sciences, healthcare and business organizations. Using a framework developed by the London School of Economics, and with input from an expert panel of health system decision makers, leaders and researchers across Canada, the report identifies the strengths, weaknesses, opportunities and risks of Canada’s healthcare systems across seven key domains.

None of the findings will surprise anyone who works in Canada’s healthcare systems or who has had any interaction with them. The report recognizes the huge sums of money that governments spend on healthcare every year and a Conference Board of Canada forecast that spending must continue to increase in real terms over the next decade to ensure our health systems are adequately funded. But strengthening Canada’s ailing healthcare systems needs more than just money. That’s why the report makes a series of focused recommendations for systemic changes that could be implemented rapidly if all healthcare partners work together and collaborate.

Several recommendations relate directly to hospitals, but there are also others, such as reforming primary and long-term care that, if implemented, would help ensure patients receive care in the most appropriate setting. The report calls on governments to implement a Pan-Canadian Health Data Strategy that would support the effective creation, exchange and use of critical health data for the benefit of Canadians and the health systems they rely on.  And it stresses the importance of adopting interoperable, integrated electronic patient records systems to support the shift from provider-centric to patient-centric data. A strengthened data infrastructure across Canada is critical to improving health system planning, including of the workforce, and in monitoring and improving performance.

A key issue for ensuring the long-term sustainability and resilience of Canada’s healthcare systems is how to support health workers and deal with shortages, burnout and other challenges. Recognizing the increased stresses caused by understaffing and the additional burdens created by COVID-19, the report recommends improving working environments and increasing access to mental health support services. It also calls for action to combat systemic discrimination and racism in the health system, and to strengthen education pathways for health workers from Indigenous, racialized and low-income communities to address inequities in the system.

It notes that, despite calls from experts and health workers alike, there is no Canada-wide approach to long-term workforce planning. Instead, workforce data and planning remain at the provincial or territorial level and vary significantly among jurisdictions and health professions. The report calls for strengthened integrated health human resource planning and evaluation, with enhanced workforce data infrastructure across occupations, sectors and jurisdictions, which could be supported by a pan-Canadian agency or body.

The report also examines governance within the healthcare system, calling for increased transparency in decision making and public reporting of health system performance at both the system level and the organization or practice level, including hospitals. Public reporting, enabled by high quality data across all parts of the system, may help inform and empower patients and communities. It can also strengthen the accountability of governments to the public for the how their tax dollars are spent, and the accountability of providers and organizations for the value they provide with those investments.

The report also looks at how to strengthen care in the community to keep people out of hospitals as much as possible, with a particular focus on primary care and home care. The report calls for scaling up innovative strategies and inter-professional team-based models of primary care, prioritizing underserved communities and optimizing the available workforce. It recommends taking a life-course perspective to plan for and invest in high-quality long-term care across the continuum of services and supports, along with improving the working conditions, education standards and full-time employment opportunities, with benefits and adequate wages, for aged care workers including unregulated workers.

In all, the report makes 29 recommendations across seven domains for improving the sustainability and resilience of Canada’s healthcare systems. The hope with this project is that the practical and action-oriented recommendations will be seriously considered by governments and health sector stakeholders. Their implementation will require a concerted effort by all involved.

Our healthcare systems have failed to evolve to meet the needs of Canadian patients and the healthcare professionals who care for them.

We know we need to do things differently.

We know it won’t be easy.

We also know that, if we don’t make some changes, we will not be ready for the next crisis and will never build the sustainable and resilient healthcare systems Canadians need and expect.

To read the full Canadian report, please visit: https://www.phssr.org/findings

Sara Allin is Associate Professor, Institute of Health Policy, Management and Evaluation, University of Toronto; Director, The North American Observatory on Health Systems and Policies; and lead researcher, Sustainability and Resilience in the Canadian Health System