Healthcare Management Forum

The Pan-Canadian Health Data Charter (the Charter) provides a strong foundation for Canada’s strategy to building a trustworthy and adaptable health information ecosystem. A key requirement is to ensure that governance mechanisms are informed by the views of the public, raising important questions about what constituencies make up “the public” and what inclusion looks like in practice. In this article, we use health data justice as the theoretical basis to justify the importance of centring equity in inclusionary efforts and outline key considerations for involving diverse members of the public, patients, and communities in advising health information systems and policy. We suggest that engagement should be fit-for-purpose, marrying the methods and selection of participants with overarching goals, and multi-modal, employing multiple methods to facilitate wider participation from individuals with varying needs. We also recognize the importance of long-term partnerships between civil society organizations, policy actors, and researchers to ensure that the needs and preferences of structurally marginalized groups are prioritized in engagement initiatives and downstream policy decisions.

Scalable, interprofessional care models are needed to support chronic disease management and improve access to speciality services. A community hospital heart function clinic expanded from a single-site, nurse practitioner–led model to a two-site interprofessional program over 4 years. The objective was to examine program growth, service utilization, and operational strategies supporting sustainable expansion. A retrospective review assessed annual encounters, visit types, and provider activity across nursing, pharmacy, supportive cardiology, and community partnerships. The Consolidated Framework for Implementation Research guided analysis of implementation and scalability. Annual encounters increased from 1,562 to 4,623, with unique patients rising from 566 to 854. Registered Nurse telephone follow-ups expanded substantially, with additional growth in Nurse Practitioner and pharmacy visits. The second site accounted for nearly 10% of visits, improving regional access. Interprofessional collaboration and distributed care supported sustainable growth and improved access to specialized heart failure services.

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.

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.

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.

Health data are essential for improving care, guiding decisions, and shaping health policy, but many people in Canada lack the knowledge needed to use them effectively. This article suggests that health data literacy, understanding what data are, why they matter, and how they should be used, is a critical foundation of a well-functioning health system. Without a shared level of literacy across the public, healthcare providers, decision-makers, and researchers, even advanced systems may result in fragmented care, poor decisions, wasted resources, and reduced public trust. Currently, there is no consistent definition of comprehensive approach to measure or improve health data literacy in Canada, and existing efforts are limited. Evidence shows significant gaps across all groups from low public awareness to challenges among clinicians and policy-makers in interpreting and using data effectively. A coordinated approach to define, measure, and improve health data literacy is needed to strengthen Canada’s health system.

Pan-Canadian Health Data Charter Principle 6 envisions health data that are timely, accessible, meaningful, and comprehensive. This paper examines three dimensions of this principle: what is envisioned for health data, for whom, and for what purposes. Comprehensive data include publicly funded care, privately paid services, patient-reported outcomes, and social determinants. To be meaningful, data require standardization and quality assurance. Timely access ranges from real-time clinical use to dependable research access. Accessibility depends on interoperable systems and secure environments. Current practices fall short across all dimensions, with fragmented, incomplete, and delayed data limiting timely access and effective use. Access and coverage remain uneven, reflecting structural and policy barriers. Despite these challenges, there are promising initiatives such as efforts to enhance national data stewardship. Advancing Principle 6 will require involvement of all interests in health data, including data stewards, policy-makers, providers, data users, and members of the public.

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.

In Long-Term Care (LTC), many residents live with dementia, a chronic and progressive disease that is often complicated by behavioural and psychological symptoms. A changing context, including the COVID-19 pandemic, health human resource challenges, and increasing medical complexities, has led to greater reliance on medical management of dementia, with risks to residents’ health and quality of life. In response, we have developed a regional LTC program that integrates quality, clinical practice and education, research, and nursing specialist expertise to enhance the ability of care teams to provide evidence-based, person-centred dementia care. This strategy includes dedicated quality improvement supports; innovative non-pharmacological approaches, such as optimizing care-in-place with virtual care; and collaborative research opportunities. We describe these strategies and promising results to date, which include shifting the culture of care to support the holistic physical, social, emotional, and spiritual needs of residents living with dementia.

The Canadian healthcare landscape’s deep fragmentation of service-centric data silos is causing harm to patients, providers, and the overall healthcare system. This article examines Principle 1 of the Pan-Canadian Health Data Charter: Person-Centric Health Information Design (PCHID). Unlike traditional models, PCHID creates a technical architecture organizing data around individuals to ensure continuity of information across the care continuum. Canada can realize significant gains in health equity, clinical safety, and population health and innovation by moving from an “ego-centric” system of institutional data control to an “eco-centric” model of shared stewardship. This article outlines pathways for health leaders to operationalize PCHID. These include governance and public engagement, harmonized policies and legislation, investment in health data literacy, culture change, and embedding Indigenous data sovereignty. Ultimately, PCHID serves as the foundational blueprint for a trusted, integrated health ecosystem that prioritizes the well-being and agency of all people in Canada.

The rapid emergence of Artificial Intelligence (AI) has unveiled the clinical, public health, and economic value of Canada’s health data assets. However, the Canadian industry developing technologies to improve the standard and quality of Canadian healthcare has limited, and often dysfunctional, access to data. The eighth principle of the Pan-Canadian Health Data Charter calls for data-driven social and technological innovation through partnership, invention, discovery, value creation, and international best practice. Trustworthy and efficient innovation data access is essential for realizing a data ecosystem that improves the health and clinical outcomes for Canadians. This article examines the innovation data access landscape in Canada and identifies structural and cultural challenges. It proposes governance mechanisms in the context of current legislation to address challenges and promote trust in ethical data use while looking internationally for inspiration, and reinforces that achieving the eighth principle is structurally dependant on addressing the other nine in turn.

Health systems across Canada are increasingly committing to support First Nations, Inuit, and Métis data sovereignty and Indigenous-led data governance frameworks. However, many organizations struggle to translate these commitments into practice. Uncertainty regarding Indigenous data governance, combined with concerns about misusing Indigenous data or violating emerging sovereignty principles, has produced a “freezing effect,” where Indigenous data are collected but under-analyzed, under-reported, or avoided altogether. This hesitation can perpetuate the invisibility of anti-Indigenous racism and inequities in care. This article provides a brief overview of Indigenous data sovereignty and its grounding in Indigenous rights frameworks, including the United Nations Declaration on the Rights of Indigenous Peoples. Drawing on the experience of Providence Health Care in British Columbia, the article describes how Indigenous-led governance structures, data stewardship, and improvements in Indigenous self-identification processes can enable the ethical use of Indigenous health data to monitor inequities and inform quality improvement in health systems.

The Pan-Canadian Health Data Charter advocates for new legal institutions, that would empower organizations to steward health data for future use. We propose three potential legal mechanisms to realize this vision: (i) data stewards as fiduciaries, (ii) licensed data stewards, and (iii) licensed data trusts. These mechanisms would enable representative decision-makers acting on behalf of affected communities and publics to make binding choices about whether proposed health information uses respect applicable norms. This would help to foster public trust in health sector use of information. It would also enable data stewards to base their decisions on data re-use upon actionable feedback from affected populations regarding their preferences in balancing competing norms, which these institutions would produce. Our proposals hope to move the literature beyond narrow debates about the benefits of increasing or reducing regulation, towards an actionable vision of adaptive data governance in practice.

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.

Ethical health data use in Canada is often reduced to compliance with privacy requirements, limiting its role in governance and decision-making. This article reframes ethical data use as a relational practice that supports trust, transparency, participation, and shared accountability across institutions, patients, and communities. Grounded in Principle 7 of the Pan-Canadian Health Data Charter, it examines tensions between risk-averse data protection and the need to enable responsible data use for care, research, and system improvement, arguing that this divide constrains both innovation and public benefit. Trust and social licence are positioned as foundational to participation, data quality, and legitimacy, underscoring the need to redistribute decision-making power to patients and communities. Relational governance offers a practical pathway to move beyond compliance and support ethical, effective, and publicly trusted health data use in Canada.

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.

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.

Health innovation involves reducing silos, bringing together interdisciplinary teams, and supporting person-centerd care, particularly for mental well-being. Indigenous youth in Newfoundland and Labrador report having poor mental health, with few options for support in their home communities. How can Integrated Youth Services and traditional modalities of healing support clinical care to improve mental health outcomes for Indigenous Youth?

COVID-19 has created a unique context for the practice of leadership in healthcare. Given the significant use of the LEADS in a Caring Environment capabilities framework (LEADS) in Canada’s health system, it is important to document the relevancy of LEADS. The authors reviewed literature, conducted research, and reflected on their own experience to identify leadership practices during the pandemic and related them to LEADS. Findings are presented in three sections: Hindsight (before), Insight (during), and Foresight (post). We profile the issue of improving Long-Term Care to provide an example of how LEADS can be applied in crisis times. Our analysis suggests that while LEADS appears to specify the leadership capabilities needed, it requires adaptation to context. The vision Canada has for healthcare will dictate how LEADS will be used as a guide to leadership practice in the current context or to shape a bolder vision of healthcare’s future.