An excellent article about the direction that the healthcare system needs to head if it is to remain sustainable.

1. clinical work is assumed to need aggregating into physical locations like hospitals, as that is, as they say, where the brains are, but this creates a self-fulfilling pull toward grouping services and care into these structures (see Foucault's Birth of the Clinic). No doubt we'll see serious disintermediation of expensive hospital infrastructure as precision medicine, AI/prediction models evolve, etc.
2. rich people like to donate money and hospital buildings are a favourite destination. It is said that the official bird of healthcare is the "building crane". Buildings drive a cycle of further service investment leading to service pull to drive further service requirements, without creating any new models of care.

Great article with some innovative ideas. I completely agree with the need to redesign the health system based on wellness and health instead of illness and acute care. I also believe there is great opportunity to reorient home care to focus on rehabilitation and a return to wellness as opposed to the last stop before long term care. We could actually build a system of hope alongside a system that treats acute episodes and disease as a brief detour from the wellness journey in a highly specialized and effective way. We also need to build on peoples' and communities' strengths in health care to change behaviours and outcomes. We can only have a sustainable system if we begin treating the root cause of health issues before they begin.

@ David Uzan - thanks for your kind words.

@ Mike - well said! Politicians can find votes when they cut ribbons for new hospitals. Building a network for wellness and prevention will not get votes.

@ Catherine Butler - thank you! I think we need people like you and we can start the movement. I would love for this idea to take shape and become a reality. We are a G-7 nation in 2017 - if Elon Musk can dream big and take us to space, we can dream big and create a wellness network that would work alongside acute care, but reduce the number of incidents and the dependency on acute care and emergencies. Your comments mucho appreciated :)

Interesting article that will continue to get people thinking "outside the box."

As healthcare moves in to the digital space of next-generation analytics, predictive modeling, simulation, and precision medicine, and healthcare institutions adopt "hospital at home" approaches, it will be interesting to note how much of this article transforms from vision to reality!

@ Andre D'Penha - thank you. You are absolutely correct - there is so much happening in the space of predictive modeling - layered with genetics - imagine how powerful it can be to keep the population healthy!! Is it too much to dream that most of the vision in this article transforms from vision to reality?

The time is more than right to change our approaches - we need a "health care" not a "disease management" system.

It is great to see the notion of "health" being brought to the foreground, my own contemplations have led me to understand health as a "personal complex-adaptive state", conceptualised by the somato-psycho-socio-semiotic model of health.

Making "personal health" the centre of the "health care system" would result in a very different health and social (and for that matter economic) system - in short a redesign (I have written a book on this which will be published in January). Reform is no longer going to work, reform means "tinkering at the edges" within the prevailing framework.

Thank you for promoting this discourse which ultimately needs to be a "whole of society" one.

Un-hospitalizing is the way to go, without a doubt! And I think we are, ever so slowly, trying to move toward this type of preventative medicine. But we are not moving fast, or on a scale that is large enough.

Our hospitals are responding to a global economy driven by the profitability of hospitalizing its people. The Wellness Network Team must include more than our conventional health care providers, because the social determinants of health are impacted by a broader group. It is going to need to involve the individuals of every industry, to ensure the responsibility for "wellness" belongs to everyone.

This a great article, and such food for thought. To all the professors out there, constructing a model for un-hospitalization would be a very neat assignment.

A great essay and a must read for all. Health and wellness is far greater than independent ambitions or election votes. As your essay suggests, true transformation requires a new and revolutionary mindset and strategy. It is imperative that health care moves well beyond its current standing of; stale protocols, outmoded agendas, incomplete strategies, forceful top down mandates, self-serving ambitions, and political quick fixes. I have witnessed and been part these insertions for a number of decades, and they fail to work.

Your essay calls for healthcare leaders to be gritty and to stand up against outdated systems and relationship patterns. They need to use their voice, influence and energy to break down and remove each and every component that obstructs health and wellness change.

Thank you all for your comments and support.

@ Joachim Sturmberg, S P and Hugh MacLeod : Your comments are very apt. I hope you will champion this change and continue the dialogue. Thank you!

This sounds a lot like the work CityBlock is beginning to undertake in NYC and may spillover into Toronto with the awarding of the Quayside development to Sidewalk Labs. An opportunity there to take your thoughts off of the paper and into a real life model.

Abhi - you're 'right on the money' - we definitely need to move more aggressively in this direction! We've been slowly chipping away at this through the introduction of digital health tools but we need policy and political will to realize this vision. Let's use the ringing in of 2018 to dig deep and get the momentum going....it goes beyond health care leaders...we need leadership in all spaces. Financial security, housing, we need a coalition to move this forward.

@ Josh Williams: Thanks! I would love to take my thoughts into the real world. The Quayside is a good idea- but may have its challenges. I was thinking more of a defined geographical area with a stable population to begin as a pilot and plan to succeed. If we have good (timely & accurate) data on each and every person in that area and use the data to monitor the individuals for good health and wellness - may be we can build a case to scale this model across Canada. I know I am a dreamer, but reading the comments, I believe I am not the only one! Thank you for your feedback and encouragement.

@ Karen Waite: Thank you for your insight. You are absolutely correct in your assessment that healthcare is a component of mental, physical, emotional and economic factors and "goes beyond health care leaders..." We are blessed to live in Canada where we can contemplate having a holistic approach to wellness. We need champions like you Karen, so please help keep the conversation going on this.

We need to think of hospitals less about the building rather the coalition of expertise. The hospital of the future will be less about people coming to the hospital and more about the expertise going to people enabled by technology.