Across Canada, governments are confronting a deepening healthcare crisis. Many have turned their attention to primary care, focusing on increasing “attachment” to providers. Because attachment matters. And we’ve seen the value of trusted primary care relationships reflected in efforts across British Columbia, Ontario, and Nova Scotia.
But attachment also raises a harder question that we have avoided for too long: what exactly are we attaching people to if the system around that provider remains fragmented, siloed, and structurally unable to support the whole person? And more fundamentally, is attachment itself the right measure of success? Or is it or simply a starting point?
What exactly are we attaching people to if the system around that provider remains fragmented, siloed, and structurally unable to support the whole person?
For people with complex needs, attachment alone does not guarantee continuity, coordination, or care that reflects their lived reality. Without a system that can work together around that patient and provider, attachment risks becoming a promise the system cannot keep.
The Reality for Canadians Navigating Healthcare Systems
Too many Canadians are left to navigate a confusing network of disconnected services. A parent supporting a child with complex needs, an older adult managing multiple chronic conditions, or someone dealing with poverty or unstable housing is often forced to act as their own case manager, navigator, and advocate.
They repeat their story again and again, hoping the next provider understands what the last one did. Information does not flow easily and there is no simple, trusted way for providers across organizations and sectors to see the full picture or coordinate their efforts.
No single health or social service professional, no matter how skilled or committed, can meet all the needs of a person or family. Care is inherently a team effort, yet our systems are still organized to the contrary.
The Real Barrier in Health Systems: Structure Before Culture
In most cases, this problem is not anyone’s fault. It is the result of how systems have been structured over decades.
Health and social systems have been shaped by funding, accountability, and governance models that reward organizations for optimizing within their own mandates rather than collaborating toward shared outcomes. These structural conditions give rise to cultural challenges among system partners—defensiveness, risk aversion, and fragmentation—not because people resist collaboration, but because the system makes it hard to sustain.
Scarcity does not only limit resources. It limits possibility. It reinforces siloed behaviour and undermines the trust and shared ways of working required to deliver care that is comprehensive, coordinated, continuous, and accessible. Instead of incentivizing connection, we unintentionally incentivize protectionism. Instead of rewarding integration, we reward compliance with siloed mandates.
Beyond Attachment: Toward Connected Care Ecosystems
Universal attachment to care is not the same as universal continuity or coordination. Attachment alone cannot ensure that care follows people across life stages, sectors, and settings.
The next evolution of care in Canada must move beyond attachment toward connection. Connection to an integrated, local ecosystem of health and community supports working together to improve health, mental health, and social wellbeing.
We instinctively know that health does not live only in clinics or hospitals. It is shaped by where we live, how we work, what we eat, the relationships we rely on, and the supports available in our communities. Yet healthcare, housing, income supports, education, child and family services, and community organizations continue to operate under different mandates, accountabilities, and funding structures. When these systems remain disconnected, people fall through the cracks—even when they have a primary care provider.
Recent investments in digital health transformation, including Ontario’s efforts to modernize and connect health information systems, create an important opportunity to advance the work of a more connected health system. But technology alone will not deliver integration. Digital tools must enable relationships, coordination, and shared decision-making across providers and organizations. If we digitize fragmented systems without changing how they work together, we risk making fragmentation more entrenched, rather than making care more connected.
Health Neighbourhoods: A Local Model for Connection
A Health Neighbourhood is not a single model or structure. It is a locally grounded way of working where health, social, and community partners coordinate around shared outcomes with clear governance, trusted data-sharing, and practical delivery rhythms.
Health Neighbourhoods look different in different places. They’re shaped by local context, assets, and needs, but they share a commitment to connection and coordination over fragmentation.
Trust. Capability. Connected Care.
One of the most persistent myths in system transformation is that integration is primarily a strategy challenge. The harder challenge is building the capability to work differently across organizations and sectors.
Integrated care in Canada depends on capabilities that many systems struggle to develop at scale—shared governance, collaborative decision-making, relationship management, community engagement, cross-sector planning, and continuous learning. These capabilities cannot be mandated into existence through policy alone. They are built through practice, trust, and repetition.
Trust is particularly important. Sustainable integration rarely emerges from compliance-based approaches or transactional partnerships. It emerges when organizations develop confidence in one another’s intentions, capabilities, and commitment to shared outcomes. Building that trust requires time, transparency, and delivery structures that create opportunities for partners to solve problems together.
Connection is ultimately a human act. Technology, governance and funding matter, but lasting integration depends on people and organizations developing the capability and trust required to work as part of a connected system, rather than a collection of independent organizations.
From Coordination to Mission
Across the country, promising efforts such as Ontario Health Teams, Primary Care Networks in BC, and emerging Health Home models point in the right direction. Still, these initiatives are often fragile, dependent on individual champions, or difficult to sustain at scale.
What we need is more than coordination. We need a shared mission that reshapes how health and social services systems work together.
Mariana Mazzucato’s work on mission-oriented transformation offers a useful lens. Rather than optimizing programs in isolation, a mission sets a unifying goal that aligns public, private, and community actors around a collective purpose.
Imagine this mission: by 2030, every Canadian is supported by a connected Health Neighbourhood that measurably improves health, mental health, and social wellbeing.
A mission reframes the work. It shifts focus from fixing fragmented parts to strengthening the relationships between them. It demands new approaches to governance, funding, and accountability. And it requires ways of working that reflect how people actually experience services—across systems, not within them.
Importantly, a mission provides a shared focus on outcomes that matter to people and communities. These outcomes may include improved physical and mental health, greater ability for seniors to age safely in place, reduced avoidable emergency department visits and hospitalizations, improved access to preventative and community-based supports, better experiences navigating services, and stronger overall wellbeing. While the specific priorities may differ by community, the principle remains the same: organizations align around the outcomes people experience rather than the services they individually deliver.
Turning Mission in Practice
A mission only matters if it translates into action. That means governance that enables shared accountability rather than compliance, delivery models that replace organizational defensiveness with trust, and operational plans grounded in frontline realities.
We have seen what’s possible when systems align around a shared purpose. During the COVID-19 vaccine rollout, progress came not from any single organization, but from unprecedented collaboration among public health, community organizations, private partners, and local leaders. Similar lessons have emerged from integrated care work across Canada, including in Ontario, municipal health partnerships in Burlington, and large-scale social service transformation efforts in Nova Scotia.
In each case, success depended on leaders and organizations working differently—sharing ownership, aligning decision-making, and building delivery capability across boundaries.
Our Role
At Davis Pier, our role in the health and wellbeing space is to help create the conditions where this kind of collaboration can take root and endure. We work close to frontline realities, helping partners articulate shared missions, design governance models that support coordination, and translate ambition into operational plans that can be delivered, adapted, and measured.
We act as conveners, translators, and connectors. And, we build trust across organizations while grounding strategy in lived experience and practical delivery. Integration is not something we design and walk away from—it is something we help systems build the capability to do themselves.
An Invitation
The work ahead is not simple. It requires letting go of scarcity thinking, questioning long-standing assumptions, and embracing shared accountability for outcomes no single organization can achieve alone. It also requires humility—recognizing that no single model fits every community, and that local context must shape how integration shows up in practice.
This is an invitation to co-create a Mission Charter for Integrated Care in Canada. One that sets shared milestones, establishes governance principles rooted in partnership, and supports community-led Health Neighbourhoods that deliver care and positive outcomes for people and communities.
Matthew Rios is a Partner at Davis Pier and co-leads the firm’s Health & Wellbeing practice. Matthew is an activator known for his ability to bring structure and momentum to challenging initiatives and for balancing strategic thinking with a deep understanding of operational realities.
