Yes, they are a partner inasmuch as it is teams within their provinces who are working on these innovations and working to share them; hence it's the labour of the people in these institutions who are making the changes. In that way the provinces are indeed assisting greatly. Where I don't feel we are where we ought to be is in ensuring an understanding of how you move from, say, across the country 52 long-term care homes doing this and then the work that we have to do as a kind of intermediary, which is really to do the convincing work to put that information before provincial people to say, “Look how this has spread”.
That happened in Manitoba. After the first personal care home used a different approach to dealing with long-term care residents with dementia who had been over-prescribed antipsychotics, the province, looking at that, said, “Okay, now we're going to spread it all across Winnipeg, and now we're going to work on spreading it across the province”. Similarly in B.C., in another very interesting project that reduced the time for a patient between seeing a GP and seeing a specialist, they are now working on spreading that across the province.
Provinces are key in taking up the innovations in health care delivery. Our challenge in what we do, in working with people across the country, is then also working with them in their provinces and moving things along. Why doesn't it happen? People get used to doing things a certain way, and they continue doing them a certain way. The economists call it path dependency, and that's what we see operating all the time.