Insights from Working in the Healthcare Sector

Across engagements with community health centres, healthcare professional associations, unions, and organizations working to address barriers to healthcare access, we have seen firsthand the pressures these organizations face. They are being asked to collaborate, to modernize, and to move toward more integrated and equitable models of care while navigating workforce shortages, burnout, and the slow pace of systems change.

Across the healthcare sector in Canada, there is no shortage of agreement that change is needed. Researchers and health policy bodies have consistently called for a shift toward team-based care. Professional associations have long advocated for preventive and upstream approaches as essential to a sustainable system. Federal and provincial strategies alike name collaboration and integration as priorities. 

In our work, we have witnessed similar trends. There is commitment to change, and at the same time, the entrenched structures, governance constraints, and the ways of working that shape the sector can make it hard for that commitment to fully take hold.

In this blog, we explore what we have observed through our work in the healthcare sector across five areas: team-based care and professional identity, collaboration in practice, trust and measurement, systems change, and the relationship between healthcare and broader social systems.

Team-Based Care and Professional Identity

Team-based care (where multiple health professionals work together to provide coordinated care) is often positioned as a practical response to workforce shortages, burnout, and the growing complexity of patient needs. There is belief in its potential though progress remains slow.

A core reason is that team-based care requires a redistribution of power, not just tasks. That redistribution runs directly into questions about scope of practice. Who is authorized to do what, under what conditions, and with what level of autonomy are questions that are actively debated, negotiated, and regulated across professions. 

This is true across the spectrum of healthcare professions. Allied health professionals have long advocated for their scope of practice to be recognized and resourced rather than treated as supplementary to physician-led care. At the same time,  family physicians and other medical practitioners describe concerns about their scope being diluted or made interchangeable in ways that don't reflect the breadth of their training. 

These are different concerns, but they point to the same unresolved question: how do existing scope of practice frameworks need to evolve to support integrated models of care, and how does that happen in a way that works across professions? 

How roles are categorized and described (whether framed as preventive, diagnostic, technical, therapeutic, or clinical) shapes funding, influence, and whose clinical voice gets heard. When team-based models ask people to work across these lines without answering those questions, resistance is less about reluctance to collaborate and more about the absence of a clear and fair framework for doing so.

Collaboration: Goal Vs. Reality

Across the sector, we see organizations serving similar populations, tackling similar problems, while operating largely in silos. Despite a narrative of collaboration, incentive structures, funding models, and regulatory environments tend to reward and reinforce separation. This, again, is a reflection of system design rather than a failure of willingness to collaborate.

Organizational collaboration takes many forms in healthcare —  formal partnerships between organizations, shared referral networks, cross-sector initiatives. Each of these involves coordination across different mandates, funding streams, and professional cultures. That work is complex, and the conditions for it are rarely fully in place before organizations are expected to deliver on it.

This is especially true when collaboration is driven by structural reform rather than built organically. Government-driven restructuring requires organizations to work together, potentially before the conditions for doing so are in place. In BC, the consolidation of regulatory colleges under the Health Professions Act is one example. The BC College of Nurses and Midwives (BCCNM), formed through two successive amalgamations of nursing and midwifery regulators, has reflected on what that process surfaced — questions about how smaller designations would maintain their voice, how professional identities would be preserved, and how long it takes to build shared culture across professions with different histories and scopes.

The work of finding common ground, rather than defaulting to the lowest common denominator, falls to the organizations left to make it work, and that deserves more support than it typically receives.

Making Change in a System Under Strain

Change in healthcare is inherently slow, and many of the organizations we work with are confronting challenges that look remarkably similar to those they faced five years ago. Funding instability remains a constant pressure, even for essential services. Payment models frequently lag behind the realities of team-based and relational care, leaving practitioners feeling undervalued and under compensated.

Preventive and upstream care continues to be widely recognized as critical, yet remains consistently under-resourced. Some technical systems-change efforts have stalled following the rapid adaptations seen during COVID-19. While privacy and risk considerations are real and necessary, leaders question why barriers that were once quickly removed have since become fixed again.

Trust, Feedback, and What Gets Measured

Practitioners across the sector describe working in environments where trust, between professions, within organizations, and with the systems meant to support them, is fragile. Many practitioners do not feel they have clear or meaningful channels to provide feedback on the services and supports intended for them, contributing to disengagement and frustration.

Measurement compounds the problem. Standard metrics often fail to capture what truly matters about how professionals work and what they contribute. The conditions that allow for good care — attachment (an ongoing relationship between a patient and a consistent provider) and continuity of care (seeing the same provider or team over time) — depend on a stable, supported workforce. Yet the effort required to build and sustain those conditions tends to be invisible in how performance is tracked. Progress is slow, often invisible in traditional data frameworks, and that invisibility has consequences for how professions are resourced, valued, and heard.

Healthcare is Not a Standalone System

Healthcare does not operate in isolation. Its effectiveness is deeply intertwined with housing, employment, transportation, and other social systems, especially for people facing multiple barriers. Integrated and wraparound models continue to demonstrate what is possible when care is designed around real lives.

Questions about how to fund, coordinate, and sustain these approaches are far from settled, even in better-resourced urban settings. Rural and remote communities face these same challenges with the added constraints of smaller workforces, greater distances, and more limited infrastructure, making the implementation gap even more pronounced in places where integrated care may be needed most.

What This Means for Change Efforts

The challenge facing the healthcare sector is not a lack of ideas or commitment. It is the difficulty of reshaping entrenched structures, rebuilding trust, and aligning incentives in a system that is stretched thin and deeply fragmented, and doing so within regulatory and governance environments that were not designed with rapid adaptation in mind.

For organizations and leaders working within this environment, progress depends less on introducing new frameworks and more on investing in the slow, often uncomfortable work of engagement, advocacy, and collaboration. 

Have thoughts on what we have described in this blog post? We would love to hear from organizations and practitioners doing this work.