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Recent work on health system strengthening suggests that a combination of leadership and policy capacity is essential to achieve transformation and improvement. Policy capacity and leadership are mutually constitutive but difficult to assemble in a coherent and consistent way. Our paper relies on the nested model of policy capacity to empirically explore how health reformers in seven Canadian provinces address the question of policy capacity. More specifically, we look at emerging representations of policy capacity within the context of health reforms between 1990 and 2020. Based on the exploration of the scientific and grey literature (legislation, annual reports of Ministries, agencies and organizations, meeting minutes, press, etc.) and interviews with key informants (n=54), we identify how policy capacity is considered and framed within health reforms A series of core dilemmas emerge from attempts by each province to develop policy capacity for and through health reforms. [ABSTRACT FROM AUTHOR]

In publicly funded health systems, reform efforts have proliferated to adapt to increasingly complex demands. In Canada, prior research (Lazar et al., 2013, Paradigm Freeze: Why is it so Hard to Reform Health Care in Canada?, McGill-Queen's Press) found that reforms at the end of the 20th century failed to change the fundamentals of the Canadian system based on physician independence and assured universal coverage only for medical and hospital services. This paper focuses on reforms since the turn of the millennium to explore the transformative capacities developed in seven provinces within this system architecture. Longitudinal case studies, based on scientific and grey literature, and interviews with key informants, trace the patterns of reform in each province and reveal five objectives that, to varying degrees, preoccupied reformers: (1) address chronic disease, (2) align health system actors with provincial objectives, (3) shift from hospital to community-based care, (4) integrate physicians, and (5) develop improvement capacities. The range of strategies adopted to achieve these objectives in different provinces is compared to identify emerging pathways of reform and extract lessons for future reformers. We find significant cross-learning between provinces, but also note an emergent dimension to reforms, where multiple strategies aggregate through time to create unique patterns, presenting their own set of possibilities and limitations for the future. [ABSTRACT FROM AUTHOR]

Despite growing interest in urban resilience, there is a significant gap between discourse and the capacity to develop resilience in practice. This scoping review assembles and shares evidence and insights from empirical studies of attempts to implement urban resilience published between 2005 and 2017. More precisely, it seeks to identify enabling strategies, impeding factors and trade‐offs in the implementation of urban resilience. Findings are presented along the dimensions of urban resilience detailed in the City Resilience Framework (ARUP/Rockefeller Foundation): Health and Wellbeing, Economy and Society, Infrastructure and Environment, and Leadership and Strategy (which we present as a cross‐cutting theme). While some enabling and impeding factors in implementation are associated with a specific dimension, others are common to all three. Across dimensions, we find that transparent, inclusive and supportive governance reduces the risk of negative impact that resilience implementation will have on communities. Conflicting priorities of managing risk and meeting short‐term needs are found to diminish the potential for transformative resilience action. Integrating risk into planning appears as a promising strategy in all dimensions of resilience. Trade‐offs are found in resilience implementation, and range from adverse effects associated with infrastructure to power imbalances when the power to implement resilience privileges one system level over another. [ABSTRACT FROM AUTHOR]

In their 2016 article, Saltman and Duran provide a thoughtful examination of the governance challenges involved in different care delivery models adopted in primary care and hospitals in two European countries. This commentary examines the limited potential of structural changes to achieve real reform and considers that, unless governance arrangements actually succeed in penetrating organizations, they are unlikely to improve care. It proposes three sets of levers influenced by governance that have potential to influence what happens at the point of care: harnessing the autonomy and expertise of professionals at a collective level to work towards better safety and quality; creating enabling contexts for cross-fertilization of clinical and organizational expertise, notably through teamwork; and patient and public engagement to achieve greater agreement on improvement priorities and overcome provider/ manager tensions. Good governance provides guidance at a distance but also goes deep enough to influence clinical habits. [ABSTRACT FROM AUTHOR]