Table 2.

Health system strengthening and policy capacity.

	Health system strengthening
Analytical capacity	At the national level, Commissions and health forums influenced policy shift and ideas for reform, notably reinforcing universal health coverage. Two health accords were signed to improve wait times, primary care, and drug coverage. Primary healthcare became a main focus of reforms (AB, MB, ON, QC).
	Following Commission recommendations, the federal government invested in specific programs. The Health Transition Fund and Primary Health Care Transition Fund influenced primary care strategies (AB, MB, ON, QC).
	At the provincial level, Commissions and consultations helped generate information to support decision-making and expand policy options, with influence on the content of reforms, notably primary care and physician engagement (Health and Social Service Centres and family medicine groups in Quebec, primary care networks in Manitoba and BC). MCHP data and information helped frame policy questions (120119_002). Alberta’s “Putting People First” consultation (2010) fed the “Becoming the best” (2012) 5-year action plan and Patients First Strategy (2015).
	Commission or advisory body recommendations also influenced structural changes in health reform (move from regionalization to centralization through consolidation of Health Authorities) to improve coordination and consolidate decision-making (AB, SK, NS)
Political capacity	Various stakeholders participated in formulating policy and reform strategies by providing informed opinion and identifying practical difficulties. Citizens were included in system and organization improvement efforts Health Quality Councils supported patient engagement in CQI (BC, AB, SK) and public consultations informed strategic direction (NS: The Renewal of Public Health in Nova Scotia: Building a Public System to Meet the Needs of Nova Scotians).
	More collaborative and participatory relations with stakeholders served to define priorities together and co-design and co-deliver health services. Partnerships often involved reaching out to patients and communities. Efforts were made to reinforce connections with communities and citizens (SK, MB, ON, NS).
	Conflicts were managed through partnerships or agreements with professional associations: FMGs in QC were an innovation developed collaboratively by government and the union of GPs; Alberta Health partnered with Strategic Clinical Networks; the tripartite agreement between the AMA, AH, and RHAs helped establish the Primary Care Initiative (PCI) to encourage physicians to implement PCNs.
	Leaders spread a strategy from an organization to a whole province: RHA leader with experience in Lean became DM and drove development of province-wide Lean capacities (SK).
	Provincial agencies and health networks established partnerships: in ON’s HQO/LHIN agreements, medical leadership was actively involved in planning and quality improvement, and, HQO worked hard with the “O’s and A’s” (organizations and associations) to “focus our resources on their gaps” (HQOWM2). In AB, the Primary Care Initiative provided incentives for physicians to develop Primary Care Networks as an 8-year plan in collaboration with RHAs
Operational capacity	Health system redesign efforts sought to establish a more comprehensive primary health care system: GACOs and Super Clinics to reduce wait times and use of ER in QC; productive government relationships with primary (PCN) and specialist (SCN) physicians to partner in designing new models of care in AB; Health Links and LHINs in ON along with expanded access to multidisciplinary primary care with FHTs; shared care mental health, Physician Integrated Networks and My Health Teams in MB

LHINs: Local Health Integration Networks; HQO: Health Quality Ontario; MCHP: Manitoba Centre for Health Policy; FHT: Family Health Teams.