Health System Reform: Lessons from the West

Monday, May 13, 2019 – Michelle Holden

Sharing stories is part of what makes us human. In the case of health system reform in Canada, these stories can provide unique learning opportunities. With their pulse on what’s trending in healthcare, Longwoods recently hosted a Breakfast with the Chiefs session to offer insights into Ontario’s Health Teams, based on the lived experience of two diverse leaders.

Brendan Carr, President and CEO of William Osler Health System, and Arden Krystal, President and CEO of Southlake Regional Health Centre, were on hand to share key takeaways from the integrations they’ve seen throughout their careers.

As a partner of Longwoods, bringing leadership together and being a part of this important conversation is critical to HIROC’s vision – partnering to create the safest healthcare system.

Carr and Krystal shared valuable learnings from their experiences with integration – most notably during their time in British Columbia. Here are a few of the highlights from their talk. 


In Carr’s experience, healthcare geography really matters – it’s about local assets and issues. “The most effective integrations across Canada,” said Carr, “have been those with a clear understanding of populations and subpopulations.”

Understanding the population that flows into Southlake is also important to Krystal who meets with mayors of the surrounding municipalities on a regular basis to talk about areas of overlap and their role in creating healthy communities.


While consolidation can create challenges in terms of funding a variety of agencies, it can also streamline certain key areas. Krystal spoke to back-office processes like analytics, finance and payroll.

Krystal also spoke about improved communication. She offered an example of a measles case where a patient had made contact with different areas across the region before seeking treatment. Because the tracing area had to cover multiple regions, it was helpful from a communication standpoint to have one big umbrella organization to work within. 

Krystal is interested in seeing how consolidation of funding will play out. She commented on certain models that tend to remove the incentive to do innovative efficiency work when there’s a concern that running a surplus may mean losing funding in the following years. “What I like about the idea for the Ontario Health Team model is it does create more incentive,” she said.  


When it comes to integration and doing it right, “It’s hard to force it, it really does require time,” said Carr. This is one thing that both leaders reiterated to the packed house. Part of that time is needed to develop a structure that can make the organization stronger. “Expecting a central agency and one leader to be the expert of all things is not a reasonable expectation,” said Krystal. One way Krystal believes this can be shifted is by considering giving clinical agencies more autonomy under the larger umbrella.

And while these agencies may have more autonomy, there still needs to be a well-understood structure. “You do need to have an anchor or backbone organization,” said Carr who added that there needs to be clarity around how that backbone organization is not necessarily the leader. Both Krystal and Carr referenced the importance of partnership when it comes to developing strong relationships between agencies and organizations.

While funding and time are essentials, the talk really was underpinned by how critical it is to connect with the communities and the people we serve. As Ontario moves forward, this will be something to keep our eye on.

Both leaders reiterated that they and their teams are watching with optimism and are keen to be part of the solution.

To watch the full Breakfast with the Chiefs, visit To hear more from Brendan Carr on his diverse leadership experience and the importance of connecting communities, download episode 7 of HIROC’s Healthcare Change Makers podcast.

Michelle Holden is Communications and Marketing Specialist, HIROC