Case Study

Challenge

Vancouver Coastal Health’s core challenge wasn’t a lack of strategy, it was converting strategy into consistent behavior across a vast, union-dense, geographically dispersed system in ways that reliably improved patient outcomes and quality of care. With 30 000 employees across 120+ locations—from tertiary hospitals to remote coastal clinics—execution was strained by siloed decision-making, overlapping accountabilities, and uneven manager capability. In a multi-union environment, complex change processes slowed adoption of best practices; region-by-region realities (clinical, cultural, Indigenous, rural/remote) produced variability in care pathways, quality metrics, and follow-through on safety actions. The result: local pockets of excellence but inconsistent operating routines, psychological safety that varied by site, and an unreliable line of sight from enterprise priorities to frontline care conditions that can elevate critical-incident risk (handoff failures, escalation delays, near-misses) and blunt system learning. Organizational health was thus the rate-limiting factor for performance: without sharper decision rights, shared clinical/operating norms, and a visible rhythm of review and improvement, the system could not consistently scale improvements, sustain innovation, reduce adverse events, or translate transformation programs into measurable gains in patient safety, experience, and outcomes.