Shift: Conversations on Changing Canadian Health Care

In this episode Kyla sits down with Sonali Sharma, author of The 90% Code: Rewriting Power for the AI Era, for a wide-ranging conversation about power, leadership, and how we might build systems that run on the intelligence and agency of the many rather than the authority of the few. 

Using Bill Sharpe’s Three Horizons model as a guide, they start with Horizon One: the “hero model” of leadership, which Sonali argues is dying for both moral and functional reasons, and which AI is now undermining by distributing knowledge and expertise to the edges. 

They move to Horizon Three, which Sonali calls distributed abundance, powered by collective intelligence, with examples from Buurtzorg, Mondragon, and Spotify, and a reminder that “distributed doesn’t mean disconnected.” Along the way, they explore the ancient roots of these ideas, from the Haudenosaunee Confederacy’s Seven Generations principle and the role of clan mothers to Vedic traditions of deliberation and Ayurveda’s focus on prevention. 

The conversation lands in Horizon Two, “where your Monday morning happens,” with a look at why we keep treating symptoms instead of the systems that produce them, from poverty and climate to emergency department wait times. Sonali closes with reflection practices any leader can start tomorrow.

Resources & links

•    The 90% Code: Rewriting Power for the AI Era, frameworks and tools: the90code.com

•    Get the book (also available on Amazon, Indigo, Barnes & Noble, and Bookshop, and as an ebook on Kobo and Kindle)

•    Kirkus Reviews: The 90% Code

•    Sonali Sharma on LinkedIn

•    Related SHIFT episode: Reimagining Home Care: The Buurtzorg Way, with Jos de Blok

•    Related SHIFT episode: A Three Horizons Conversation with Andy Wilkins

•    Also mentioned: Bill Sharpe’s Three Horizons framework; Peter Senge, The Fifth Discipline; Jim Collins, Good to Great; Mondragon Corporation; the Haudenosaunee Confederacy and the Seven Generations principle; Arundhati Roy

In August 2026 Kyla sat down with Dr. Clare Morrison, Director of Engagement and Change at Healthcare Improvement Scotland, and Diana Hekerem, Associate Director of Transformational Change, to talk about the Scottish Approach to Change — a national framework for change that launched across Scotland's health and social care system in November 2025. 

Built around five enablers and eight steps, and deliberately never abbreviated to protect its meaning, the approach was shaped by years of engagement, an expert reference group, real-world pathfinder sites, and a deep collaboration with the Human Learning System movement. 

Clare and Diana talk candidly about what it took to build something that belongs to everyone rather than an expert few, what happens when a pathfinder site tells you the whole plan needs to change, and why they believe transformation is fundamentally relational work.

Resources

• Scottish Approach to Change — overview
• The Framework — 5 enablers & 8 steps
• Using the Scottish Approach to Change
• Scottish Approach to Change launch coverage (Nov 21, 2025)
• Healthcare Improvement Scotland
• Human Learning Systems (Professor Toby Lowe's work)
• Realistic Medicine (Scotland)
• Near Me — NHS Scotland video consulting service
• The Health Foundation podcast: "What we can learn from Scotland's approach to change"
• Get involved / Learning Community: [email protected]

In 2009, a keynote from Don Berwick changed the course of my career. Seventeen years later, with privatization pressures, looming strikes and dual practice in Alberta, his question feels more urgent than ever: What do we really, really want from our health care system, and what are we willing to give up to get it?

In this episode, I share why that speech has been coming back to me recently, and why I keep thinking about the tragedy of the commons: individuals making reasonable choices for themselves can slowly use up a resource they all share. Our public health care system is a commons. I also share the hopeful part of the story. Elinor Ostrom won a Nobel Prize for showing that communities can care for their commons when they build trust and decide together.

To Find Squirrel and all Don Berwick's other speeches click HERE

Kyla sits down with Dr. Michelle Pavloff, a registered nurse and researcher at the University of Saskatchewan, to talk about how she built a mental health network for Saskatchewan farmers and ranchers almost entirely from the ground up. Michelle's path started in a rural emergency room, where she was often the only nurse in the building, and where she began to notice that farm culture — distinct from both rural and urban culture — wasn't being served by either. When she set out to research farmer and rancher mental health, her patient partners threw out her plan for a survey and insisted on something slower: showing up at the farm, fixing fence, and earning trust before ever asking a  question. That decision shaped everything that followed, from a heifer auction that raised over $20,000, to a therapy network staffed entirely by counsellors who are farmers themselves, to a recent provincial funding commitment putting the network on stable footing. It's a story about what patient-oriented research looks like when you actually hand it back to the people who built it.  

Resources

Sask AgMatters Mental Health Network

• Website: https://www.saskagmatters.ca/
• Donate: https://www.saskagmatters.ca/donate
• Free counselling services: https://www.saskagmatters.ca/freeservices
• Farm Stress Line: https://www.saskagmatters.ca/farm-stress-line
• Background/vision: https://www.saskagmatters.ca/vision

Saskatchewan Farm Stress Line — 1-800-667-4442,  

Canadian Centre for Agricultural Wellbeing

• : https://ccaw.ca/
• National Farmer Crisis Line: https://ccaw.ca/ 

Saskatchewan Centre for Patient-Oriented Research (SCPOR) — https://www.scpor.ca/

Saskatchewan Health Research Foundation (SHRF) — https://www.shrf.ca/

What happens when you stop managing nurses and start trusting them? In this episode, Kyla sits down with Jos de Blok — the Dutch nurse-turned-founder of Buurtzorg, the neighbourhood care organization that rebuilt home nursing in the Netherlands around self-managing teams instead of hierarchy. Jos started as a community nurse in the 1980s, watched that model get dismantled when the system shifted to task-based, regionalized care in the '90s, and spent the next two decades building something better.

In 2006, Jos and a colleague founded Buurtzorg (Dutch for “neighbourhood care”) on a simple idea: if you give nurses real autonomy, keep the back office as small as possible, and build trust instead of surveillance into the system, both quality and cost will take care of themselves. Ten teams became hundreds within a few years. Today Buurtzorg employs roughly 15,000 people across the Netherlands — and the country's total volume of home care delivered has dropped by half, even as outcomes improved.

Jos and Kyla talk about what nurses lose when hierarchy and task-based care takes over, why he believes multidisciplinary teams are often treated as a solution when they should be a last resort, and what it would actually take to bring a model like this to Canada. It's a conversation about trust, autonomy, and what becomes possible when a health system is built around relationships instead of routines.

• How Buurtzorg Works
•  Buurtzorg in action (video) - 

•     Buurtzorg International — official site

•     Jos de Blok's personal website

•     Buurtzorg Nederland — Wikipedia overview

•     World Economic Forum: “Buurtzorg — The Dutch word that could revolutionize healthcare”

•     Corporate Rebels: The 7 Self-Managing Team Roles of Buurtzorg

•     Academic case study: “Buurtzorg Nederland: A Global Model of Social Innovation, Change, and Whole-Systems Healing”

•     Euronews: “Buurtzorg — the Dutch proximity health care revolution”

•     The 90% Code

To open this new season, Kyla sits down with retired registered nurse and author Cathy MacNeil to talk about her book Dying to Be Seen: The Race to Save Medicare in Canada. Over fifty years in the system — bedside nursing, ICU, hospital administration, and long-term care management — Cathy watched Canadian Medicare go from a hard-won, world-admired achievement to a system she believes is being deliberately dismantled. They trace the story from Tommy Douglas and the birth of Medicare in Saskatchewan, through the devastating cuts of the 1990s, to today's privatization pressures in provinces like Alberta and Nova Scotia — and close with Cathy's concrete ideas for what governments and individuals can do about it.

Resources & links

-       Book: Dying to be Seen: The Race to Save Medicare in Canada by Cathy MacNeil, or through the FriesenPress bookstore

-       Film: Bitter Medicine, Part One: The Birth of Medicare — National Film Board of Canada documentary on the 1962 Saskatchewan doctors' strike and the founding of Medicare

-       Canadian Health Coalition

-       Canadian Doctors for Medicare

-       Friends of Medicare (Alberta)

-       BloodWatch.org 

-       Cathy MacNeil on LinkedIn

This is the episode where all five flaws converge. When you don't plan your workforce, don't budget for results, follow rules instead of outcomes, and never track data — you end up funding the emergency and starving the prevention, year after year, until the safety nets all break at once. 

How it All Broke Report

Kelly Lamrock Interview

How It All Broke Videos

This episode is about what happens when governments collect data but never act on it, measures inputs but never outcomes, and substitutes the phrase "we are committed to continuous improvement" for an actual plan.

How it All Broke Report

Kelly Lamrock Interview

How It All Broke Videos

A domestic violence survivor loses her benefits if she stays with her parents for a tenth month. A person with a disability turns down a job offer because taking it means losing housing support. A senior is denied a taxi voucher to a clinic and ends up in a hospital bed at ten times the cost. This episode is about a system organized around rule-following rather than results — and what that looks like for the people on the other side of the desk.

How it All Broke Report

Kelly Lamrock Interview

How It All Broke Videos

Human Learning Systems as a method for Reimagining Government

Every year, government sets a budget for social programs. But almost nobody asks what those numbers are supposed to produce — or checks whether they did. This episode follows Lamrock's team as they ask the Department of Finance some very basic questions about its 2023 budget: what will this money do, for how many people, and how will you know if it worked? The answers — or the absence of them — will make you shake your head.  

How it All Broke Report

Kelly Lamrock Interview

How It All Broke Videos