How We Will, Not Whether We Can: Improving Health and Healthcare.

When students lose hope, we're in trouble.

I recently had the pleasure of visiting a university where I met with a group of smart, inquisitive and engaged students. Our conversation touched on many topics, but one of their questions has stayed with me. We were talking about a policy direction recently confirmed by government. The specifics don't matter – suffice it to say that it's a direction with broad public support but one that will be complex to implement, as so many meaningful health policies are.

I was asked whether I thought that it was possible for the change to be made within 5–7 years. Many were skeptical. They had been told – or in some cases personally experienced – that change does not happen that quickly in the health sector.

It's true that it doesn't always. But it can, and it should, and it must.

To illustrate, I offer five varied examples of recent progress:

The rate of in-hospital deaths following a heart attack is falling steadily, reflecting broad-based improvements in cardiac care (CIHI n.d.);

Since 2012, scope of practice expansions in all provinces mean that pharmacists can adapt/manage prescriptions (CPA n.d.);

Use of electronic medical records in primary care in Canada is more than twice what it was in 2009 (CIHI 2016);

Smoking rates are at the lowest level since measurement began (PROPEL: Centre for Population Health Impact n.d.); and

Hospitalizations for rotavirus-related acute gastroenteritis in children have fallen significantly since a vaccination program was introduced in 2011 (Wilson et al. 2016).

So it's time to change the conversation. Instead of asking whether progress can happen, let's focus on asking how. How do we build a case, construct a coalition and sow the conditions for change? And to go further, we also need to understand the opportunities and barriers to demonstrating, evaluating, scaling and spreading approaches that deliver real and sustained value for individuals, communities and the health system.

Real change is rarely about quick fixes. In an environment as complex as the health system, transformation often requires leadership and complementary actions by a variety of stakeholders. It may involve substantial culture, policy and/or practice change.

This context is as much a challenge for researchers as it is for policy makers, healthcare leaders, clinicians and individuals. We need to understand more about how progress happens and how to speed it up so that the benefits reach everyone, not just the lucky few who happen to be connected with early adopters or policy innovators.

In this issue of Healthcare Policy/Politiques de santé, authors tackle a range of substantive issues, as well as methods such as collaborative learning, qualitative description and performance measurement that may help inform future change efforts. I hope that you will find their insights useful for accelerating improvements in health and healthcare.