Spending time designing a health system that is entirely hypothetical can provide insight into how we shape the health systems we have in ways we wouldn’t have otherwise.
Theoretical exercises aren’t usually top of the list of what most leaders want to spend time doing. That presupposition might require some qualification.
Let’s start with a question: What If We Could Design Our Health System From Scratch?
This was the provocation that was put forth to a group of health-minded individuals at a recent Impact Talks event organized by Kindler & Company and the Sandra Rotman Centre for Healthcare Strategy at the University of Toronto. The event was titled Pictures of Health and offered up a chance for about 100 ordinary people from throughout the health ecosystem (myself, included) to imagine what we might do if we could (re)create the health system in Canada.
Setting the Stage
It was a beautiful Monday May evening in May as part of the Rotman School of Management’s Picture of Health event. The event was part of a series of Impact Talks, which were designed to bring diverse voices together to explore ideas about the health system. and brought together clinicians, healthcare leaders, health start-up innovators, investors, designers, and consultants working across the health sector to discuss and envision what a transformed system could look like if we started from scratch.
The aim was to provoke discussion and new thinking about what in our current system we could tackle to transform it from an underperforming system to one that delivers high-quality, timely, efficient, and effective health and care for all Canadians.
What framed the discussion were some sobering statistics that I’ve pulled together to illustrate (which could be a book on itself):
- Total health expenditures in Canada are projected to reach $399 billion in 2025, up from $372 billion in 2024 — roughly $9,054 per Canadian. Yet, the value for dollars spent remains low relative to other countries. (source: https://www.cihi.ca/en/national-health-expenditure-trends/nhex-trends-reports/nhex-trends-2025-snapshot#section7)
- Canada ranked 7th out of 10 high-income countries in the Commonwealth Fund’s 2023 international health system survey, and ranked last in access to primary health care. The proportion of Canadian adults with access to a primary care provider declined from 93% in 2016 to 86%. (source: https://www.cihi.ca/en/commonwealth-fund-survey-series)
- Canada ranked second last on access to care, fourth on care process, sixth on administrative efficiency, and sixth on health outcomes — remaining below the international average on many measures and at the bottom for timeliness. (source: https://cdhowe.org/publication/troubling-diagnosis-comparing-canadas-healthcare-with-international-peers/)
- As of late 2025, 5.9 million Canadians still lack regular access to a family doctor, nurse practitioner, or primary care team — down from 6.5 million in 2022, but still a significant gap. (source: https://www.cma.ca/healthcare-for-real/how-does-canada-rank-health-care)
- Forecasting models predicted a shortage of 60,000 nurses nationwide by 2022, and further predicted that would almost double to more than 117,000 by 2030. (source: https://www.macewan.ca/campus-life/news/2024/05/news-conversation-nursing-shortage-24/)
- The CMA’s 2025 National Physician Health Survey found 46% of Canadian physicians report high levels of burnout. In a 2024 survey of 5,595 nurses, 30% reported dissatisfaction with their career, and 40% intend to leave nursing or retire. (sources: https://www.cma.ca/about-us/what-we-do/press-room/five-years-onset-covid-19-canadas-physicians-still-suffer-high-rate-burnout and https://www.macewan.ca/campus-life/news/2024/05/news-conversation-nursing-shortage-24/)
As one speaker put it,
Our technology and tools for treatment are better than ever, while the system they—and the healthcare professionals who operate in it —are at their worst.
The Gathering & Crowd Insights
Four speakers kicked things off with some ideas about what our healthcare system might need.
It was interesting to hear the personal stories in each of the four presenters as they stood up and offered their take on the state of healthcare in Canada. These speakers represented different facets of healthcare leadership, advocacy, design, bio-pharmaceutical and startup innovation, research and futures thinking.
After the talks, the audience, which I estimated at 100 people, engaged in an interactive exercise facilitated in part by the firm Projectory, in which each of us wrote a single idea on a card that we thought would make a positive difference in the health system. (see above)
At the bottom were three spaces for a rating out of 10. In three waves, we were asked to trade our cards with others over the course of a minute so that the cards (and the ideas) circulated widely among the group. At the end of each minute, we were left with a new card and a chance to rate the idea on the card out of ten. We did this two more times, so at the end we had a card with three ratings out of ten. We tallied the total and discussed our ideas. The highest rated were 28 and 29 out of 30.
The ideas that gained the most traction among the group were, perhaps not surprisingly, tied to AI and data systems.
It got me wondering what the top rated issues would be if we had done the same exercise in the school of public health if we’d get a different response. Or what would it look like if we did it in a community setting? What about a care facility? What about a setting with new immigrants or migrants from other parts of the world? What if this was facilitating in a different language?
These were all constraints, yet the approach nevertheless offered a means to have a conversation about what we valued, what people thought the system valued, and
The Us in HealthCare
The evening’s presentations and discussions ran through a variety of overlapping issues, demonstrating the complexity of the situation we face. The term complexity was used often, alongside the contributors to some of this complexity: data. Data sovereignty, interoperability of electronic health records, data access and the quality of that data, AI, and the evolving nature of our technical systems were themes that ran throughout the talks.
But so was the need to consider the people at the centre of our system. We were encouraged to see ourselves in the system as users, citizens, and employers (both contributing through taxes and receiving benefits through our workplaces). We are also the executives, clinicians, and caregivers in the system, too.
Another theme was the reminder that one of the best ways to curb healthcare expenditures and limits is to reduce the demand on the system by focusing energy on upstream thinking. This means talking about and taking definitive steps toward prevention, early intervention, and different models of care at a population level.
What I felt was missing was the us. Who are the humans in the system? What is the system there for? What are our needs, wants, preferences, and capacities that are not represented in or supported by technical systems?
These are design questions that the format and structure didn’t allow us to get into. This is not a criticism of the event, rather a reminder that the opportunity to envision new systems invites bigger questions about what the point of what we do is. To that end, the event was a success.
Photo by The 77 Human Needs System on Unsplash