Contextualizing evidence in Canadian healthcare

This chapter discusses Canada's Executive Training for Research Application (EXTRA) program, which can in some ways be seen as a Transition Program avant la lettre. It presents system innovation that entails the transformation of intervention development and implementation in health organizations, challenging both the "trial-and-error" approach of many health practices as well as the "evidence-based medicine" (EBM) approach of the knowledge production system. The chapter highlights the broad structure of the Canadian health system and its challenges, and provides specific insight into components of the Canadian health system which are closely linked to the long-term objective on change: publicly funded innovation, healthcare professionalism and evidence-informed decision-making (EIDM). It also presents a discussion of what those engaged in the theory and management of system innovation and transitions could learn from the practical experience in Canada, as well as what transition management theory might offer governments wishing to support long-term transformative change in healthcare.