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Changing how we educate our health experts will improve our health system

A version of this commentary appeared in the Toronto Star, the Huffington Post and Hill Times

Canada has a mismatch between the world class quality of research we produce on health every year and how that research is implemented into our healthcare system.

Canadians can be proud that our doctoral graduates are among the most productive and respected researchers in the fields of health services, health policy and health economics — and Canadian universities are often in the global top 10 for these areas of study.  Yet our own health system continues to under-perform.

Where’s the disconnect?

The Commonwealth Fund ranks comparable health systems around the world on a number of quality performance indicators and continually places Canada as one of the worst performers across a number of categories, such as timeliness, safety and efficiency of care. Only the United States routinely performs worse than Canada, sitting at the overall last place in the rankings.

It would be easy to point to healthcare funding as the culprit, but it’s largely not the case.

Canada spends roughly 10.4 percent of its GDP on health, more than the United Kingdom New Zealand and Australia which rank 1st, 4th and 7th respectively, in the same rankings, well ahead of Canada’s dismal 10th place finish.

So if funding isn’t the primary issue, it must mean management is to blame. The truth is, we often don’t manage our health system well.  But the good news is that there is much that can be done to lift Canadian healthcare out of its current poor standing.

Over the last several decades, a wide number of studies from experts inside and outside of Canada have pointed out the gap between the current performance of our system and the level of performance we should be able to expect.

In what ways can the system improve?

There are the landmark reports from Manitoba and Ontario showing that a patient’s likelihood of getting needed surgery depends heavily on where they live.  Multiple studies have shown a huge gap between what we know to be effective and appropriate care and what people have actually received. And a study from over a decade ago shows that nearly one in 13 hospital visits resulted in adverse health events with nearly nine percent of these ending in preventable death; a follow-up study last year shows that little has changed over the last decade.  We can do better.


Health system changes require greater input by people trained to create and use evidence to design, implement and evaluate them. That’s not happening right now in Canada.

Every year funders in Canada invest more than $3.5 million in supporting the training of healthcare-related PhDs, but for the majority of them, the likelihood of academic employment is low and declining over time.  In fact, the vast majority will go on to work in health services and management related fields and not academia.  Yet our doctoral programs in health sciences do not prepare them for such work.

An extensive interview-based study found that our recent health PhDs in Canada are not having the impact they could have on the health system — the sort of impact that many of our most advanced graduates with PhDs see as the goal of their careers and the reason for their training. While well prepared in academic terms, they lack preparation in the types of managerial and leadership skills necessary to make tough decisions based on evidence with a relentless commitment to evaluation and improvement across the system.

We can change this — and we’ve started to.

Over the past two years, the Canadian Health Services and Policy Research Alliance has worked with experts from across the country to improve the impact of Canadian PhDs on the quality and sustainability of our health system — by changing the training and preparation they receive.

It’s time to move health research out of the academy and into the community.

We now provide experiential learning opportunities during and after PhD training, where individuals get the opportunity to work with hospitals, government agencies and other healthcare providers in the community — to apply their skills and findings directly in the service of health system improvement.

We are building an open source curriculum to teach health PhDs in Canada essential managerial and leadership skills that they will need to make sure their expertise gets translated into better decisions across our health care system.

Discussions about healthcare funding will always be important, but we need to make sure that we have the personnel needed to make the health system better, regardless of the dollars transferred between levels of government.

We have a great resource in the university-based training programs in health services across the country and PhD graduates who want to make a difference. Now we need to make sure that they have the opportunity to do so.


Adalsteinn Brown is an expert advisor with EvidenceNetwork.ca, the Director of the Institute of Health Policy, Management and Evaluation and the Dalla Lana Chair in Public Health Policy at the University of Toronto. Prior roles include senior positions in the Ontario government. 

Stephen Bornstein is Director of the Centre for Applied Health Research and a Professor at Memorial University. Prior roles include senior positions in the Ontario government.

November 2016


This work is licensed under a Creative Commons Attribution 4.0 International License.