Leveraging Collaborative Networks to Adopt and Adapt Complex Interventions – the Example of HealthPathways in Canada

Background: Ontario Health Teams were introduced by the Government of Ontario, Canada, in 2019 to transform the delivery of healthcare by creating a more integrated, person-centered system. Their core mandate is to advance population health and equity, develop integrated care pathways, improve chronic disease management, and strengthen primary care. In 2024, three Ontario Health Teams—Burlington, Greater Hamilton Health Network, and Middlesex London—came together to implement HealthPathways an internationally established care pathways methodology and digital platform that serves as a “one-stop shop” to support primary care providers and other clinicians in delivering up-to-date, evidence-informed, standardized, and locally contextualized care.

 

In less than one year the three OHTs undertook a shared procurement and contracting process; engaged and trained clinical editors (family physicians and nurse practitioners) and subject matter experts; and validated, localized and disseminated 46 care-pathways, with an additional 54 pathways expected by March 2026. The adoption and implementation of HealthPathways—the first in North America—required adaptive and systems leadership, the leveraging of collaborative networks, continuous learning, innovation and improvement, and a commitment to equity and diversity.

 

Audience: Integrated care leaders, implementers, evaluators, policymakers, and researchers.

 

Approach: This interactive workshop will function as a “living lab” where participants will work through the 4 stages of a complex implementation – Exploration, Preparation, Implementation, Sustainment (EPIS, Moullin et al, 2019). Theory and key concepts from network theory, adaptive and systems leadership will be intermixed with real-world case studies that illustrate implementation challenges, solutions, and lessons learned. Participants will be presented with opportunities for individual reflection, small group discussion, and action planning to promote knowledge exchange, practical learning and application to their own contexts.

 

Timing (90 minutes):

- Introduction (15 min) – Framing the problem: challenges within Ontario’s health system from the perspective of patients, providers, and health system leaders with a focus on access, navigation, and equity.

- HealthPathways Overview (10 min) – Presentation on methodology, design, and global outcomes.

- Ontario Implementation Experience and the EPIS framework (50 min) – Brief theoretical and case-based presentations highlighting planning and implementation, adaptation, and early outcomes intersected with breakout discussion where participants will explore potential enablers, barriers, and strategies for local adoption in their own regions.

- Lessons Learned – Spread, Scale, Sustain (10 min) – Facilitated reflection and co-creation of an approach for scale and spread to other jurisdictions.Outcomes

 

Outcomes: - Reflect on the balance needed between standardization (i.e. fidelity to model) and adaptability to local context in healthcare system implementation.

- Identify and prioritize key barriers (e.g., governance challenges, clinical engagement issues, equity gaps, technical integration hurdles) and enablers (e.g., adaptive leadership, collaborative networks, continuous learning) in the Canadian HealthPathways implementation process and reflect on applicability to other complex intervention implementations.

- Describe and assess how shared governance structures and pooled resources across the three OHTs facilitated the adoption and adaptation of HealthPathways in Ontario.