Working a Complex Challenge as a Portfolio

The province was ready to push on patient flow and community-based care. Political backing was real. Operational appetite was real. What hadn't been worked out was where to start, how to test, or how to scale anything that worked.

The institutional terrain was full of overlap and constraint: multiple partner organizations, overlapping governance, misaligned policies, different charting systems, and hundreds of stakeholders who each held a piece of the puzzle. The work would need to find the right threads to pull, build prototypes, test them under real conditions, and design pilots that could become the basis for scaling without crushing under their own weight.

We worked the challenge as a portfolio across the full arc. Prototypes built and tested. Pilots designed from what survived. Scaling system built alongside, so the work could move from validated pilot to operating practice without losing fidelity. Three structural moves sat at the centre of the scaling design:

• A shared spine of tools and language. A Service Delivery Framework, a Playbook with pathways and protocols, and a Core vs Adaptable framework that told every partner what had to stay constant across sites and what was theirs to shape locally.
• Minimum viable pilot design instead of full-scale rollout. We narrowed implementation to five essentials the system could actually absorb at go-live, protecting the pilots from being crushed by their own ambition.
• A scaling engine designed before the pilots launched. A three-wave roadmap, Peer Learning Summits as the codification mechanism, developmental evaluation with monthly insight briefs, and a Leader Partnership Table to keep cross-partner policy moving.

The reframe underneath all three: the pilots were not the destination. They were the first load test of a system designed to scale.

The Playbook now operates as working infrastructure at both pilot sites, with its pathways, protocols, and handoff procedures in active use. The Core vs Adaptable distinction travels with the model to every new site conversation, giving partners a shared way to hold fidelity and autonomy at once. Peer Learning Summits function as the spread mechanism connecting pilot learning to the next wave.

“first time we're all thinking the same thing.”

— Stakeholder · mid-engagement

The language stuck because the structure underneath it made it true.