The Need for Bold Thinking

Amol Verma and Sacha Bhatia's (2016) paper presents policy recommendations that merit serious consideration on a system-wide level. While they make compelling arguments about why provincial governments are ideally suited to adapt Triple Aim innovation, we are concerned that the current health system climate limits this possibility. In our commentary, we present our thoughts about the authors' admittedly aspirational goals and the realities of the pan-Canadian healthcare system. We commence our commentary by confirming our agreement about the potential inherent within the Triple Aim framework. Second, we argue how important progress can take place that may not reflect a provincial-wide system. Next, we maintain that a learning health system is an essential ingredient to advancing Triple Aim and other health system-wide improvements. Third, we wonder whether the stewardship role of government is real and possible. Finally, we question the concept of our current health system's readiness for system change. While we have raised some questions about Verma and Bhatia's thinking around provincial adoption of the Triple Aim, we applaud their ideas. We believe that transformation in provincial health systems requires bold thinking.