A study by The Institute for Education Research (TIER) at UHN and the Centre for Advancing Collaborative Healthcare & Education (CACHE) explores how health care leaders can balance short-term initiatives with the need for longer-term transformational change.
Primary care in Canada, the backbone of its universal health care system, is facing significant challenges. Notably, improving access to primary care remains a top and daunting, priority. Access can be even harder for equity-deserving groups, such as Indigenous peoples, recent immigrants, and low-income households.
The nationwide Team Primary Care (TPC) initiative, a funding proposal co-led by the College of Family Physicians of Canada and the Canadian Health Workforce Network, focused on addressing these challenges by promoting interprofessional team-based approaches to comprehensive primary care as a key solution. In team-based primary care, different types of health care workers (e.g., family physicians, nurse practitioners, and social workers) work collaboratively to provide the right care at the right time and place to those who need it. TPC was guided by core principles including social accountability, truth and reconciliation, psychological health and safety, equity, diversity, inclusion, accessibility, and interprofessionalism.
A key partner in the TPC initiative was the Centre for Advancing Collaborative Healthcare & Education (CACHE), a strategic collaboration between the University of Toronto and the Toronto Academic Health Sciences Network, with UHN as the lead hospital. CACHE works with local, national, and international partners to advance education, practice, research, systems, and policy to improve care. As part of TPC, CACHE provided professional development and coaching across the country in an effort to enable emerging and experienced teams to optimize their collaborative practices.
To pursue meaningful change, the team at TIER and CACHE used Principles-Focused Evaluation (PFE) to examine how the TPC principles were interpreted, applied, and adapted while delivering on CACHE’s commitments to TPC.
Findings from this evaluation indicated that leaders working on health care reform need to balance two competing goals: the need to meet immediate project deadlines while fostering meaningful, long-term change. These competing goals require a delicate balancing act between fast and optimal.
To mitigate this challenge, the study recommends an approach coined “organizational critically reflective practice.” This method encourages teams to continuously learn, balance key values, and adapt, continually re-grounding in guiding principles for the work.
This practice involves recognizing knowledge gaps and challenging harmful practices through the following steps:
● Understanding how principles are interpreted by all team members early on
● Reflecting on current practices and including perspectives that may be overlooked
● Determining shared goals and regularly reassessing the potential harms of haste during the process
“We hope that organizations undertaking major health care reforms will use these insights to prioritize early and ongoing critical reflection and learning, ultimately leading to more meaningful and lasting improvements in the health care system,” says Dr. Stella Ng, senior author, Director of CACHE and Scientist at TIER.
The first author of this study is Dr. Tavis Apramianis, a Clinician-Investigator in the Department of Family & Community Medicine (DFCM) at the University of Toronto and Scientist in the DFCM’s Office of Education Scholarship. Dr. Apramian is also a Wilson Centre scholar.
The authorship team consists of CACHE team members as well as contributors who joined specifically for the TPC initiative.
Senior author Dr. Stella Ng is also an Associate Professor at the University of Toronto.
This work was supported by Employment and Social Development Canada, the Foundation for Advancing Family Medicine, and UHN Foundation.
Apramian T, Karim A, Parker K, Sinclair L, Ladak Z, Ku C, Gregor S, Winnebota L, Ponte D, Ng S. How national healthcare change initiatives balance emergent and deliberate change: A principles-focused evaluation. Healthc Manage Forum. 2024 Sep 12:8404704241279501. doi: 10.1177/08404704241279501. Epub ahead of print.
Toronto General Hospital Research Institute (TGHRI) recently held its annual Research Day, highlighting some of the latest findings from its talented scientists and trainees.
The event, held to a full house at the MaRS Centre on October 30, featured talks from TGHRI Principal Investigators, trainees, and staff, divided across three sessions: Cardiovascular, Collaborative Centres, and New Investigator Highlights. Julie Quenneville, the CEO of UHN Foundation, also addressed the group, sharing how the UHNITED campaign is advancing research innovation through philanthropy and inviting everyone to participate in the We Walk UHNited event on May 31, 2024.
The day began with opening remarks from Institute Director Dr. Myron Cybulsky and a welcome message from Executive Vice President of Science and Research, Dr. Brad Wouters. Kyla Kumar, UHN’s Vice President of Communications & Brand Strategy, also surprised the attendees, announcing the winner of UHN’s Week of Gratitude contest for Taylor Swift concert tickets.
Keynote speaker Dr. Burkhard Ludewig, Head of the Medical Research Center at the Kantonsspital St. Gallen as well as Translational Cardioimmunology at the University Hospital Zurich, discussed his research on the mechanisms behind myocarditis, an inflammation of the heart that can reduce its ability to pump blood.
The day also included 11 Flash Presentations from top-ranked poster submitters, where the presenters had 90 seconds to give an “elevator pitch” of their research and to invite the attendees to visit their poster for further details.
In the poster session, trainees shared their projects and engaged in discussions on their research. Awards were given to six presenters and included the Murray Krahn Award for Excellence in Health Technology Assessment (HTA). In addition, six postdoctoral researchers were awarded.
The day brought together researchers, trainees, and leaders to celebrate innovation and collaboration. From thought-provoking talks to interactive poster sessions, the event highlighted the vibrant and supportive community at TGHRI.
Congratulations to all the winners and to everyone who presented their work.
TGHRI Research Day was made possible through support from UHN Foundation, Novo Nordisk, and Bristol Myers Squibb.
Earlier this fall, Pride in Patient Engagement in Research (PiPER) hosted its second PiPER Research Day to highlight its goals and achievements in improving health outcomes by engaging people with lived experience in research. The event welcomed over 203 registrants, including individuals with lived experience and representatives from various research fields, and was a resounding success.
PiPER is a transformative research initiative at the University Health Network (UHN) that was launched in 2022. Its mission is to actively engage persons with lived experience (i.e. patients), families, and caregivers as part of research teams, ensuring that their voices are integral to improving health outcomes and enhancing the quality and relevance of research outputs.
The Research Day was held on October 9 at the Guild Inn Estate in Scarborough, where attendees could enjoy outdoor spaces and light-filled meeting rooms, setting the stage for a day of collaboration, learning, and inspiration.
Dr. Brad Wouters, Executive Vice President of Science and Research at UHN, kicked off the event by highlighting PiPER’s history, role within Research at UHN, achievements to date and future role within UHN. Maureen Dunne, a neurodivergent business leader, delivered a keynote presentation titled, "Embracing the Neurodiversity Paradigm: Turning Differences into Strengths," that urged attendees to rethink neurodiversity and view these differences as strengths that drive innovation. Another keynote speaker, Stephanie Lurch, an educator and physiotherapist, followed with her compelling talk, "Manifesto of a Critical Consciousness." She called for a deeper understanding of anti-racism, equity, diversity, and inclusion, emphasizing the importance of transformative change across all systems.
The event featured workshops, story sharing sessions, oral presentations, and posters that brought together people with lived experience, researchers, trainees, and health care leaders. These sessions and presentations focused on integrating patient voices into research. Highlights included stories on real-world impact, posters, and an art exhibit that showcased innovative projects and enabled researchers and people with lived experience to connect and collaborate on future initiatives.
PiPER Research Day delivered a compelling and urgent message: creating a more inclusive and effective learning health system is not only necessary but possible, particularly through engaging people with lived experience in research. PiPER Research Day reinforced that institutions like UHN must lead the way by embedding the voices and perspectives of patients at the heart of our research.
Thank you to the Research Day Planning Committee, volunteers, speakers, and attendees who made PiPER Research Day possible. Beyond Research Day, PiPER continues collaborating with TeamUHN to develop new policies, processes, resources, and research methods that support the implementation of transformative research experiences, driving collective impact toward a healthier world.
For more information on PiPER, click here or email piper@uhn.ca. Follow PiPER on X and LinkedIn.
PiPER Research Day was made possible due to the support of our partners: The Ontario SPOR Support Unit (OSSU), UHN’s Research IDEA (Inclusion, Diversity, Equity, Accessibility, and Antiracism), PiPER, and the North American Conference on Integrated Care (NACIC), who supported the attendance of people with lived experiences. NACIC also supported two PiPER Research Day presenters (Adeife Akingbade and Vishma Sookdeo) to present at NACIC 2024 in Calgary.
Three research projects at UHN have received a combined total of over $4 million to support research on increasing the number of suitable donor lungs for transplantation, building innovative MRI technology for neurological disorders, and understanding muscle health and the mechanisms of osteoarthritis.
The Ontario government has invested more than $92 million across the province in research projects at universities, colleges, research institutes, and research hospitals through the Ontario Research Fund.
The recipients of this funding include the following UHN Researchers:
●Dr. Ian Connell, Affiliate Scientist at KITE Research Institute, and Dr. Taufik Valiante, Senior Scientist at Krembil Research Institute, received $1.9 million from the Research Excellence program to develop advanced MRI technology for neuromodulation therapy—the use of implanted devices to precisely treat neurological disorders. They are partnering with medical device company Synaptive Medical to transform care for conditions like epilepsy and Parkinson disease. Dr. Connell is an Assistant Professor in the Department of Medical Biophysics at the University of Toronto (U of T). Dr. Valiante is also a Professor of Surgery at U of T.
● Drs. Shaf Keshavjee and Bo Wang, Senior Scientists at the Toronto General Hospital Research Institute (TGHRI), received $2 million from the Research Excellence program to develop advanced technologies to increase the availability of life-saving donor lungs. They will use artificial intelligence (AI) to find solutions for human lung preservation and assessment. Dr. Keshavjee is also a Professor of Surgery at U of T and Dr. Wang is an Assistant Professor in the Departments of Computer Science and Laboratory Medicine and Pathobiology at U of T.
●Dr. Andy Kin On Wong, Scientist at TGHRI and Schroeder Arthritis Institute, received $275,000 from the Small Infrastructure Fund. This funding will go toward the Sarcopenia and Musculoskeletal Interactions (SaMI) Collaborative Hub. Dr. Wong will study how knee osteoarthritis is related to muscle strength, activity, and balance by using functional testing equipment. His team also aims to broadly investigate the interaction of muscles, bones, and fat using imaging to better understand joint health and pain during stair climbing. This project was co-funded by the Canada Foundation for Innovation (CFI) through the John R. Evans Leaders Fund (JELF). Dr. Wong is an Assistant Professor in the Epidemiology Division at the Dalla Lana School of Public Health and the Rehabilitation Sciences Institute at U of T.
This funding will help institutions cover the costs of their research operations and facilities, including building, renovating, and equipping research facilities with state-of-the-art equipment and laboratories.
“When we invest in research, we invest in our province’s future,” said Nolan Quinn, Minister of Colleges and Universities. "These critical investments will ensure Ontario’s researchers can continue making discoveries that drive key sectors, create good-paying jobs, and improve the lives of all Ontarians.”
Congratulations to all recipients at UHN!
To read the announcement, click here. To see a full list of funded projects in 2024, click here.
Across science, education, and health care, our future success begins with the connections we make today.
UHN’s Krembil Research Institute stands at the forefront of exploration, redefining possibilities in science and medicine to pave the way for A Healthier World.
This year’s Krembil Annual Report, Making Connections, highlights innovative discoveries from Krembil’s three research institutes: Krembil Brain Institute, Schroeder Arthritis Institute, and Donald K. Johnson Eye Institute.
At Krembil, we are forging transformative connections—not only among people and institutions, but among diverse disciplines and ideas. These connections are driving discoveries that redefine our understanding of health and disease while bringing hope to millions of people facing life-altering conditions.
In this year’s report, we feature some of our recent scientific achievements, including:
● Developing a potential therapy for glioblastoma that may extend patient survival
● Identifying molecular markers of ankylosing spondylitis to improve disease detection and treatment
● Determining how cells migrate and connect within the retina, paving the way for treatments to combat certain forms of vision loss
The report also highlights our outreach activities, which connect Krembil scientists, clinicians, staff, and trainees with communities worldwide. This year, we reached over 2,800 students through an educational webinar celebrating the International Day of Women and Girls in Science. We also launched the third season of our acclaimed podcast, Your Complex Brain, and introduced a new mentorship program to help staff and trainees explore career paths beyond traditional research and academic settings.
“We are driven by a shared vision of a healthier future and inspired by the knowledge that, when we come together in purpose and passion, we can make a profound difference,” says Krembil Director Dr. Jaideep Bains.
UHN was ranked number one on the 2024 list of Canada’s Top 40 Research Hospitals by Research Infosource Inc. and has held the top position since the inception of the list in 2011.
The annual rankings compare research hospitals across Canada based on research spending data. Funds considered include grants, contributions, and contracts from internal and external government and non-government sources during the previous fiscal year.
UHN’s research spending totalled $539 million in the 2023 fiscal year. Within the "Large Hospital" category (total hospital spending exceeding $1 billion), UHN ranked second for research hospital intensity, defined as the percentage of research spending relative to total hospital spending.
Dr. Brad Wouters, UHN’s Executive Vice President of Science and Research, comments, “UHN's top rank year after year is a reflection of our steadfast commitment to health research. From fundamental discoveries to education, clinical innovation, and medical rehabilitation, we are one team relentlessly focused on a shared goal of improving the lives of patients and communities globally."
This short video celebrates the people, places, and passion driving UHN’s continued success as Canada’s top research hospital.
“These achievements are fueled by the unwavering support of many individuals and institutions including our financial supporters, The Princess Margaret Cancer Foundation, UHN Foundation, and the West Park Foundation, government, industry, and other charities. We are part of a global leading research community in Toronto with the University of Toronto and many other academic hospitals that work together to accelerate discovery and impact. We are also strongly supported by our many patient partners that work with us every day towards our goal to create A Healthier World.”
Research Infosource Inc. reports on research activity across Canada. Click on the following links to view the complete list of Canada’s Top 40 Research Hospitals and a Spotlight on Hospital Research Activity within the Large Hospital category.
Alzheimer disease (AD) is marked by pathological changes in the brain, collectively known as Alzheimer disease neuropathological change (ADNC). Typical ADNC is defined by a build-up of amyloid-beta proteins (called amyloid plaques) and tau proteins (called neurofibrillary tangles). Despite advances in research, defining subtypes of ADNC and predicting related patient outcomes remain significant challenges for clinicians and scientists.
A recent study, co-led by a team at the Krembil Brain Institute at UHN offers new insights into how we could overcome this challenge. The study identified distinct genetic and clinical features across ADNC subtypes, focusing on a newly proposed subtype called amyloid-predominant ADNC (AP-ADNC).
The team found that AP-ADNC has unique genetic traits that may be protective against tau build up and influence disease progression differently compared to other ADNC subtypes. Previously, this subtype was thought to be a separate condition unrelated to Alzheimer disease. By recognizing AP-ADNC as part of the ADNC continuum, the researchers highlighted an opportunity to redefine how these subtypes are classified and understood.
The findings not only expand the understanding of ADNC diversity but also lay the groundwork for more personalized approaches to care. Subtypes like AP-ADNC may require different diagnostic and therapeutic strategies, reflecting their distinct pathways of progression.
These results emphasize the need to further explore the links between ADNC subtypes and cognitive decline. The ultimate goal is to predict patient outcomes more accurately and develop tailored treatments based on specific subtype characteristics.
As researchers delve deeper into the complexities of ADNC, studies like this bring the medical community closer to personalized care for individuals with Alzheimer disease. Recognizing the diverse pathways underlying the condition is essential for improving patient outcomes and advancing therapeutic approaches.
The first author on this study is Dr. Gabor Kovacs, a Senior Scientist at Krembil Brain Institute and Professor in the Department of Laboratory Medicine and Pathobiology at the University of Toronto.
Dr. Shelley Forrest, Senior Scientific Associate at Krembil Brain Institute, also contributed to the study.
The senior author of this study is Dr. Peter Nelson, Professor in the Department of Pathology at the University of Kentucky.
This work was supported by the National Institutes of Health, National Institute on Aging (NIH-NIA), and UHN Foundation.
Kovacs GG#, Katsumata Y#, Wu X, Aung KZ, Fardo DW, Forrest SL; Alzheimer's Disease Genetics Consortium; Nelson PT. Amyloid-β predominant Alzheimer's disease neuropathologic change. Brain. 2024 Oct 17:awae325. doi: 10.1093/brain/awae325. Epub ahead of print.
#Contributed equally
Research conducted at UHN's research institutes spans the full spectrum of diseases and disciplines, including cancer, cardiovascular sciences, transplantation, neural and sensory sciences, musculoskeletal health, rehabilitation sciences, and community and population health.
Learn more about our institutes by clicking below:
