"We're sinking": a qualitative interview-based study on stakeholder perceptions of structural and process limitations to the Canadian healthcare system

Jeanna Parsons Leigh; Stephana Julia Moss; Sara J Mizen; Cynthia Sriskandarajah; Emily A FitzGerald; Amity E Quinn; Fiona Clement; Brenlea Farkas; Alexandra Dodds; Melanie Columbus; Henry T Stelfox

doi:10.1186/s13690-024-01279-4

"We're sinking": a qualitative interview-based study on stakeholder perceptions of structural and process limitations to the Canadian healthcare system

Arch Public Health. 2024 Apr 25;82(1):56. doi: 10.1186/s13690-024-01279-4.

Affiliations

¹ School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada. j.parsonsleigh@dal.ca.
² School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada.
³ Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.
⁴ Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
⁵ O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.

Abstract

Background: Despite longstanding efforts and calls for reform, Canada's incremental approach to healthcare changes has left the country lagging behind other OECD nations. Reform to the Canadian healthcare system is essential to develop a higher performing system. This study sought to gain a deeper understanding of the views of Canadian stakeholders on structural and process deficiencies and strategies to improve the Canadian healthcare system substantially and meaningfully.

Methods: We conducted individual, ~ 45-minute, semi-structured virtual interviews from May 2022 to August 2022. Using existing contacts and snowball sampling, we targeted one man and one woman from five regions in Canada across four stakeholder groups: (1) public citizens; (2) healthcare leaders; (3) academics; and (4) political decision makers. Interviews centered on participants' perceptions of the state of the current healthcare system, including areas where major improvements are required, and strategies to achieve suggested enhancements; Donabedian's Model (i.e., structure, process, outcomes) was the guiding conceptual framework. Interviews were audio-recorded, transcribed verbatim, and de-identified, and inductive thematic analysis was performed independently and in duplicate according to published methods.

Results: The data from 31 interviews with 13 (41.9%) public citizens, 10 (32.3%) healthcare leaders, 4 (12.9%) academics, and 4 (12.9%) political decision makers resulted in three themes related to the structure of the healthcare system (1. system reactivity; 2. linkage with the Canadian identity; and 3. political and funding structures), three themes related to healthcare processes (1. staffing shortages; 2. inefficient care; and 3. inconsistent care), and three strategies to improve short- and long-term population health outcomes (1. delineating roles and revising incentives; 2. enhanced health literacy; 3. interdisciplinary and patient-centred care).

Conclusion: Canadians in our sample identified important structural and process limitations to the Canadian healthcare system. Meaningful reforms are needed and will require addressing the link between the Canadian identity and our healthcare system to facilitate effective development and implementation of strategies to improve population health outcomes.

Keywords: Access; Canada; Healthcare; Interviews; Quality; Reform; System.