Changing the culture means changing the approaches taken by the system's healthcare organizations and its leaders. EXTRA participants - who are selected based on a rigorous evaluation process - are mid-career nurses, physicians and health service executives in senior management positions who are able to influence change in their organizations.

"In my role as a physician leader, an evidence-based approach is rarely used," says Dr. James Worthington, vice-president of medical affairs at the Ottawa Hospital. "The EXTRA fellowship provides an opportunity to develop a similar evidence-based approach for management practice in collaboration with others from across Canada, as well as the chance for personal growth."

Dr. Worthington is among the first cohort of fellows, announced in May 2004. Twenty-four fellows will be selected annually over the program's 10-year course. Joining Dr. Worthington are nine nurse leaders, five other physician leaders and nine health service executives from every part of the country. They completed their first residency session in August 2004. The residency sessions (held at the Banff Centre in Alberta and at La Sapinière in the Laurentians) are one of five components that make up the program's structure. The others are an intervention project conducted at the fellow's home organization; educational activities between the residency sessions; network-building (facilitated by a state-of-the-art Internet-based desktop system); and post-program support and activities.

These five elements come together to create a blended learning experience where fellows are able to apply what they learn in the classroom directly to the issues they face daily in their workplaces. This is particularly true of the intervention project. Fellows design their project as a way of engaging their home organization in a change strategy with support from their senior management.

Lindsay Campbell is the director of rural health in the Cape Breton District Health Authority and an EXTRA fellow. Her intervention project aims to reduce the rate of hospital admissions through better prevention and management of chronic diseases. She was drawn to the program because of its focus on applying research-based evidence to change management activities.

"The creation of an ongoing network of healthcare leaders committed to the use of research-based evidence in decision-making is a real benefit of the program," says Campbell.

That network is a key benefit of EXTRA; fellows have opportunities both at home and during the residency sessions to collaborate with colleagues, work with mentors and learn from EXTRA's top-flight faculty. This integrated system of support reflects the adult-learning philosophy upon which EXTRA was created. Participants are encouraged to become active in a dynamic community of like-minded professionals who advocate knowledge transfer and evidence-based decision-making.

Established with a $25-million investment by the federal government in the 2003 budget, EXTRA is supported by a group of partnering organizations: the Canadian Health Services Research Foundation; the Canadian College of Health Service Executives; the Canadian Nurses Association; the Canadian Medical Association; and a consortium of 13 Quebec partners, represented by the Agence des technologies et des modes d'intervention en santé. The Canadian Health Services Research Foundation is responsible for the overall management and delivery of the program.

The government's investment will be money well spent as Canadian health system leaders learn to manage change effectively. EXTRA will help them develop the skills to shift the way they approach decision-making and, ultimately, stronger decisions will lead to a stronger health system.

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