Shrinking budgets, population growth, diversity and aging, new technologies, unexplained variations in clinical practice, and demands for greater accountability are all forcing changes in healthcare delivery, organization, and financing across Canada (Pink, et al., 1996). Most healthcare policy analysts feel that the status quo is not sustainable. In Ontario, there is an emerging and growing momentum to create Integrated Health Systems (IHS). The impetus for change comes from the Health Services Restructuring Commission, from proposals to create IHSs from community and provider organizations and groups, and from within the Ministry of Health. The most commonly accepted definition for an integrated system is "a network of organizations that provides or arranges to provide a coordinated continuum of services to a defined population and is willing to be held clinically and fiscally accountable for the outcomes and the health status of the population served" (Shortell et al., 1994). The challenge in the development of integrated systems will be to achieve improved health for the population and better health outcomes for the patients treated while maintaining or reducing the cost of the overall health system.

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