In our lead article, “A Policy Framework for Health Systems to Promote Triple Aim Innovation,” we presented an aspirational view of provincial leadership in Canadian healthcare and practical policy recommendations directed towards the Triple Aim (Verma and Bhatia 2016). The insightful and learned responses (Affleck 2016; Bryan and Donaldson 2016; Gray and Jani 2016; Lowi-Young and Dubois-Wing 2016; Noseworthy et al. 2016) that we received from health policy experts stimulate a nuanced and critical analysis of this essential topic: How can health systems foster innovation to promote better health and healthcare? 

The results of the recent federal election in Canada make this discussion all the more timely. The incoming Liberal government has promised to negotiate a new Health Accord with provinces and territories. They have promised new investments in healthcare, including a commitment to support pan-Canadian collaboration on health innovation. Renewed federal interest in healthcare represents an opportunity for provinces and territories to implement evidence-informed, system-level reforms to promote health innovation. However, this interest will be tempered by budgetary constraints at both the provincial and federal government levels. Thus, a common approach to both prioritize and evaluate innovative healthcare delivery approaches will be critical, particularly when resources are scarce. The Triple Aim is one such approach. 

We would like to address several key themes that emerge from the thoughtful replies to our paper. After reflecting upon the balance of this debate, we feel reaffirmed in our position that the Triple Aim is the right framework for health innovation in Canada and that, although they are imperfect actors, provincial and territorial governments, enabled by the federal government, are the agents best suited to the task of promoting system-level innovation. 

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