It has been 10 years since the Advisory Panel on Healthcare Innovation Report (Advisory Panel on Healthcare Innovation 2015) recommended patient engagement and empowerment as one action to enhance the quality and sustainability of healthcare in Canada. Since that time, patient engagement has become internationally recognized as a key component toward improving healthcare systems. In this article, the author highlights how organizations across Canada have engaged patients in healthcare and health research planning, design and governance activities, and discusses three key areas wherein improvements are needed to leverage the potential of patient engagement: leadership and infrastructure, diversity and representation and power structures/imbalances.

According to Manns et al. (2025), Canada struggles to turn good ideas into routine care because functions for evidence, funding, procurement and delivery are fragmented. In the UK, these functions are, in part, connected within a tax-funded service free at the point of use. This commentary maps the architecture, linking research translation, independent assessment, regulation, procurement, adoption support and data and explains how evidence moves into practice through principles aligned with the nonadoption, abandonment, scale-up, spread and sustainability framework, which addresses nonadoption, abandonment, the challenges of scale-up, spread and sustainability. Two worked examples, placental growth factor testing and stroke imaging artificial intelligence, show that national assessment, adoption support and procurement enabled rapid adoption at a national scale. Practical implications for Canada include a single repeatable pathway from promising evidence to routine use, conditional adoption with evidence generation, national frameworks that reduce transaction costs, investment in implementation capability and secure data environments for real-world evaluation.

Ten years ago, the Advisory Panel on Healthcare Innovation, chaired by C. David Naylor, gave its prescription to strengthen Canada's healthcare systems. Unfortunately, the report fell victim to politics and shifting government priorities. This commentary argues that key barriers to healthcare improvement in Canada - particularly siloed structures that prevent collaboration, a lack of political will to challenge the status quo and a myopic federalism paradigm - continue to bedevil Canada's health systems, and that the recommendations of the Naylor panel, particularly the proposed healthcare innovation fund and federal healthcare innovation agency, are as relevant today as they were in 2015.

Federal Health Minister Rona Ambrose created the Advisory Panel on Healthcare Innovation, asking them to identify five priority innovation areas that would improve accessibility, quality of care and health spending. Their 2015 report found fragmented systems, a lack of collaboration across jurisdictions to share learnings and best practices and undercapitalized technological advancements, among other barriers to spreading successful innovation. Ten years later, we review the report's main recommendations and examine progress in the key areas identified for action. Progress on many of the recommendations is lacking. The panel's main recommendations - creation of a $1-billion innovation fund to enable sustainable changes in care delivery and a national healthcare innovation agency - have gone largely unanswered. We illustrate the need for an innovation agency that spans all provinces using several examples, including ones where digital health innovation is required, including central intake and triage for specialist referrals. We discuss the conditions needed for successful implementation: An interoperable digital solution, changes to models of care and funding flows, leadership and a patient-centred culture within the health system. We also highlight how local innovation hubs enable the development of new technologies and identify the key local, provincial and national factors for success that should be considered for a new federal agency.

In December 2024, Santé Québec (SQ), a province-wide agency overseeing health and social services delivery, was launched. Denis's essay offers an insightful and valuable lens to analyze the reform's underlying assumptions and to reflect on the opportunities and challenges ahead. SQ aims to separate policy making and planning from service delivery, a distinction that may prove difficult in practice. Moreover, the infrastructure for meaningful decentralization might be lacking, given Quebec's health system legacy of extensive structural integration. Nonetheless, existing assets - such as health regions, population-based responsibility and local health and social services networks - could prove to be valuable tools for stakeholder engagement and innovation.

Over the last several decades, Alberta has led Canadian provinces in waves of healthcare system reform: first to regionalize, first to replace regions with a province-wide health authority and, in 2024, first to blow up such an authority for a new combination of functionally based organizations. Yet behind the flux in organizational forms lies a consistent set of storylines. On the surface, reforms have continually tried to find ways to facilitate the transfer of resources from the acute care sector to other components of the health system. Less openly, changes from the Klein government onward appear to be intended to facilitate greater political control over health bureaucrats and professionals, and to pave the way for an expanded private sector role.

Health governance is political as it is tied to goals specific to individual health systems. The best health governance is context-specific. Health governance is a collective practice that involves stakeholders across levels and sectors. The universality of health governance offers great opportunities for learning across jurisdictions. The view across borders is best at inspiring self-reflection about what is good enough health governance in one's health system. Health governance affords political and administrative crafts(wo)manship, drawing on in-depth knowledge of one's health system, excelling at collaboration and being open to experiences from other jurisdictions as a tool of self-reflection.

Canada's public healthcare system grapples with persistent challenges, including long waiting times and limited coverage for essential services. Fierlbeck and Berman propose a "third way" for Canadian healthcare, which involves a greater role for private service provision and private insurance, alongside improved price controls and efficiency measures. While they provide many sensible policy ideas, several critical issues require clarification, particularly the definition of private insurance, the scope of services it would cover and the potential financial impact on low-income populations. Rather than leaning heavily on private insurance and market-based solutions, expanding the public benefits package and reinforcing regulatory frameworks for integrating private capacity would be more equitable and sustainable paths forward.

Should oral healthcare be part of Canada's universal healthcare system? If so, how? To effectively deal with oral healthcare within broader healthcare policy, we must first gain clarity on what comprehensiveness and access should mean for oral healthcare. To do this, we will need a fair process of deliberation to determine what Canadians think is a reasonable level of oral health and what oral healthcare services go alongside it, irrespective of how that ultimately becomes organized, financed and delivered.