Anyone who's been in a hospital lately knows Canada's health system is stretched thin. Staff are burnt out, emergency rooms are either packed or closed, and patients face some of the longest waits in decades.

Year after year, good ideas that could improve healthcare fail to move beyond the trial stage.

This isn't a new problem. More than 30 years ago, former health minister Monique Bégin warned Canada had become the “land of perpetual pilot projects.” Today, her words still ring true.

Pilot projects – or small test runs of new ideas – are valuable in healthcare, but their impact is limited unless they can expand widely.

Perpetual pilot projects: how did we get here?

Part of the problem is that governments and health systems often judge pilots by their immediate cost rather than their long-term value. A project might lead to healthier patients, fewer hospital visits, and less pressure on the system, but if it doesn’t fit neatly into the current budget, it rarely gets the green light to grow.

But cost isn’t the only barrier. Canada also lacks a national framework to spread proven innovations. There’s no clear way to evaluate what works, share lessons across provinces, or provide stable funding to turn pilots into permanent programs. As a result, ideas are tested and re-tested in different regions, while patients wait for solutions that already exist.

The opportunity cost is high. When we fail to scale innovation, patients face avoidable delays, poorer outcomes, and inequities in access to care. Health workers waste time repeating projects instead of improving care. And public money is spent on experiments that go nowhere. In today’s economic climate, when every dollar and every worker counts, we can’t afford to keep going in circles.

True value in healthcare should be measured more broadly. It’s not only about what can be saved on the balance sheet this year. It’s about long-term impact – earlier diagnoses, better quality of life, fewer hospital visits, and keeping people healthy and able to contribute to the workforce. These outcomes help people live better lives while also making the health system and the economy more sustainable.

Viable solutions involve collaboration across the healthcare ecosystem

We’ve seen glimpses of what’s possible when collaboration allows innovation to grow. For instance, a recent partnership between UCB and Toronto’s University Health Network (UHN) - was created to tackle delayed diagnosis in axial spondyloarthritis, a chronic inflammatory condition often mistaken for common back pain. The model brings specialty trained physiotherapists and rheumatologists together in team-based care, supported by referrals from family doctors. The partnership has led to shorter diagnosis times, earlier access to treatment, slower disease progression, and better quality of life for patients. The program is now being used in Ottawa, Thunder Bay, and Quebec.

Other countries provide examples of how investment in innovation can be done at a system-wide level. In the United Kingdom, through the NHS Innovation Accelerator successful innovation proposals are placed on a three-year acceleration pathway. Since 2015, the program has supported over 100 innovations with critical funding, guidance, and connections, helping them move from small pilots into tools used across the country.

That kind of national effort not only improves care at home, but it also puts a country ahead on the world stage. Canada has a real chance to do the same right now, as the global science and research landscape shifts.

We could attract talent, investment, and innovation, but only if we have the structures in place to scale and sustain what works.

That means moving beyond endless pilots toward a system that can spread proven solutions: national frameworks to evaluate and share results, dedicated funding streams to support scaling, and a mindset that measures success by long-term patient outcomes rather than short-term costs. Without that shift, we risk watching good ideas fade away.

Canada has the ideas. What we need now is the follow-through. It’s time to move from being the land of pilot projects to the land of lasting solutions.

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