Those are really good questions.
In terms of the competency-based question, we actually have a grant in to the Canadian Institutes of Health Research to try to study this some more. What we want to try to do is map the dimensions of care and the indicators particularly in primary care to competencies, because we know that nurses and even medical office assistants can help to move towards timely access to care. That should not all be an accountability attributable only to physicians. It's really a team-based approach that we need.
What we're trying to do is to move towards performance measurement and monitoring to have a system whereby we can actually look at creating information systems for the indicators and then to also map the competencies on. That would take working with the different regulatory bodies.
In terms of your other question, I think William Tholl talked about the fact that Dr. Ivy Bourgeault, is heading up the Pan-Canadian Health Human Resources Network. They are actually collecting best practices across the country. To be able to then take that a step further would be to try to really assess those that could be scaled up.
We have to get away from thinking that each province is so different and each context is so different and try to figure out how we can learn from each other. I think the initiative, the strategy for patient-oriented research and the primary and integrated health care innovations networks, should try to do some of that where we can try to create a continuous learning environment whereby we learn from each other and scale up those innovations that work and actually get rid of the ones that don't work early on; so turf them sooner rather than later, rather than let years and years go by.