Two big hairy audacious goals for Canadian health care

Canada’s opioid crisis and rapidly aging population pose challenges that have stretched our health care system to its limits. To meet these challenges, and to be ready for new obstacles like the COVID-19 pandemic, we need to innovate. In Vancouver, we hope that the new St. Paul’s Hospital will be a catalyst for innovation and help us prepare for the future. 

To that end, Dr Zayna Khayat recently gave a presentation about the “Future of Healthcare” to the Providence Health Care (PHC) Health Authority leadership and community, which is partly responsible for designing the new St. Paul’s Hospital. In her presentation, Dr Khayat presented “10 big ideas” about innovation. Of the 10, the two ideas that most inspired us were her emphasis on the importance of building capacity for innovation and creating clinical entrepreneurship programs. We turned those two ideas into big hairy audacious goals (BHAGs) and explored how we can achieve them.

BHAG #1: Build capacity for innovation by teaching it

In Dr Khayat’s presentation, she defined innovation as generating completely new ideas or “doing things that no one else is doing.” The degree and pace of change in innovation exceeds that of the traditional schools of thinking within health care, such as quality improvement, which focuses on incremental changes to the status quo, and evidence-based medicine, which focuses on identifying the gold standard of evidence through rigorous, but time-intensive, randomized control trials. Moreover, innovation has a unique set of methodologies,[1] such as design thinking and design sprints. Hence, overapplication of the word innovation can actually dilute[2] the concept and detract from its goal of completely novel thinking.

Recognizing the value of true innovation work, several academic institutions in Canada have developed innovation centres, such as the Alberta Health Services Design Lab and plans for a Health Innovation Campus at the new St. Paul’s Hospital in Vancouver, BC. These centres offer tremendous opportunities for the health workforce to nurture innovation skills through engagement with projects, integration with existing coursework for students, and potentially even certificate programs or degrees. 

Our BHAG #1 is to include innovation education in the curricula for all who are in training (i.e., medical school and residency) as well as for early-career physicians. Initially, this could involve elective opportunities for engagement in projects with innovation methods, as opposed to purely research or quality improvement, which would then pave the road for widespread curricular integration[3] in health professions education. As underscored by the Topol report,[4] innovation and fluency with digital health technologies will be of critical relevance to future generations of physicians practising in a digital world.[4] Innovation projects also provide opportunities for physicians to engage in interdisciplinary teams, which include patients, and which can strengthen a culture of teamwork and collaboration in health care.

BHAG #2: Create and support clinical entrepreneurship programs

After innovation comes entrepreneurship and commercialization. Dr Khayat emphasized that we can help move innovative ideas from the drawing board to real-world impact by supporting clinical entrepreneurs. Clinical entrepreneurs are frontline health care workers who leverage their unique understanding of the challenges in health care to be entrepreneurs and develop and commercialize innovative technologies. She highlighted the NHS England Clinical Entrepreneurship Training Program as an effective program that provides health care workers with the commercialization skills, knowledge, and experience needed to successfully develop and spread innovative solutions to the challenges facing the NHS.

Inspired by Dr Khayat’s advice, our BHAG #2 is to develop a Canadian clinical entrepreneurship training program. This program, ideally a national initiative like the Creative Destruction Lab, with a variety of local sites across Canada, would foster clinical entrepreneurship by giving health care trainees and workers institutional support to develop and pursue entrepreneurial projects. In practice, health care trainees and professionals could participate in a part-time 8-month program in which they would learn a made-in-Canada version of the Stanford Biodesign Process and work with teams of biomedical engineering students and MBA students to innovate, commercialize, and build a healthier world.[5] A Canadian clinical entrepreneurship program could be built in collaboration with existing programs like Hacking Health, Physician Innovator, Halo Health, or Joule Innovation Grants, which already foster and support Canadian clinical entrepreneurship. 


Dr Khayat’s closing message was that health care organizations need to develop BHAGs and articulate a vision for the future of health care. Health care organizations should adopt the BHAGs we have set out so that future Canadian health care providers are fluent in innovation methodologies and have institutional support to participate in clinical entrepreneurship training programs and commercialize their innovations. 

These BHAGs work in tandem; the first aims to develop widespread capacity for innovation work, while the second aims to develop leaders who will scale innovation projects and products to a national or international scale. We believe that adoption of these two BHAGs is a key ingredient to building a future-focused and patient-centred health care system that will respond to the challenges of the future, and that all Canadians can benefit from and be proud of.
—Philip Edgcumbe, MD, PhD
Resident Physician, Department of Diagnostic Radiology, Faculty of Medicine, UBC
—Nadia Khan, MSc, MD
Professor and Head, Division of General Internal Medicine, Faculty of Medicine, UBC
—Brandon Tang, MD
Resident Physician, General Internal Medicine, Faculty of Medicine, University of Toronto 


1.    Gerber N. What is innovation? A beginner’s guide into different models, terminologies and methodologies [blog]. 20 August 2018. Accessed 12 November 2021.
2.    Ansari S. During times of massive disruption, you need to plan for every possible outcome. MaRS. 15 July 2020. Accessed 12 November 2021.
3.    Aungst TD, Patel R. Integrating digital health into the curriculum—considerations on the current landscape and future developments. J Med Educ Curric Dev 2020;7:2382120519901275.
4.    UK National Health Service. The topol review. Preparing the healthcare workforce to deliver the digital future. Accessed 12 November 2021.
5.    Schwartz JG, Kumar UN, Azagury DE, et al. Needs-based innovation in cardiovascular medicine: The Stanford Biodesign process. JACC Basic Transl Sci 2016;1:541-547.

This post has not been peer reviewed by the BCMJ Editorial Board.

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