Regionalizing Canadian healthcare: the good--the bad--the ugly.

In their lead paper, Lewis and Kouri leave us with a revealing and perplexing picture of Canadian experience with healthcare regionalization. Take-home messages are that regionalization is riddled with dilemmas, saddled with problems and tasked to find solutions current incentives do not encourage. And yet this mode of restructuring healthcare endures through peaks and flows of reconfiguring and renaming exercises, rarely discarded completely and apparently making some positive differences. While this peer commentary shares many of the lead authors' perspectives, it suggests that if we want to better understand the role of regionalization as a structure supporting organizational change, then there is value in broadening some investigative spaces and some analytical frames when trying to understand this seemingly endless restructuring effort. The commentary begins by arguing that we should seek transferable lessons and lenses more widely and more often, as regionalization is neither uniquely Canadian nor solely healthcare oriented. The remainder of the paper revisits some of the Lewis and Kouri terrain, viewing in turn the good, the bad and the ugly aspects of regionalization and reflecting on how these characteristics influence change opportunities both in practice and for research.