Family doctors and specialists play vital roles in managing chronic illnesses like diabetes, but power imbalances can make collaboration challenging. A study from The Institute of Education Research at UHN explores how clinical practice guidelines shape these dynamics and the implications for collaboration and patient care.
While power imbalances between family doctors and specialists are common in health care settings, little is understood about how clinical practice guidelines influence these dynamics. Using diabetes care as a case study, the research team reviewed clinical care and management guidelines that define the roles of family doctors and specialists. They then interviewed 15 clinicians at the University of Toronto about their experiences collaborating in patient care.
Key findings revealed that the language and structure of guidelines often create a hierarchy, positioning specialists as primary decision-makers while family doctors are placed in a supporting role. Written communications, such as consultation letters, further reinforce these imbalances, limiting open discussions and hindering the sharing of valuable insights into the best care for patients.
Acknowledging these power imbalances and promoting a more balanced approach—where the contributions of both family doctors and specialists are equally valued—can improve provider satisfaction and patient outcomes.
Dr. Rene Wong, the lead author of the study, is an Educational Investigator at The Institute for Education Research at UHN. Dr. Wong is an Associate Professor in the Department of Medicine at the University of Toronto.
Dr. Cynthia Whitehead, senior author of the study, is a Senior Scientist at The Institute for Education Research at UHN. She is also the Director and a Scientist at The Wilson Centre, as well as a Professor in the Department of Family and Community Medicine at the University of Toronto.
This work was supported by UHN Foundation and the Royal College of Physicians and Surgeons of Canada.
Wong R, Whitehead CR. Exploring how structural forms of power shape the training of intraprofessional collaboration between family physicians and specialty physicians in outpatient workplace settings. Med Educ. 2025 Jan 15. doi: 10.1111/medu.15607.
In Canada, marginalized populations face many barriers to accessing the health care they need, which can lead to poor outcomes. Researchers at UHN’s Toronto General Hospital Research Institute (TGHRI) and Social Medicine program have demonstrated that mobile health clinics (MHCs)—providing primary care, harm reduction, and mental health services at convenient locations within a community—can alleviate these barriers to care.
Despite Canada’s universal health care system, socioeconomic factors still contribute to disparities in health outcomes. As a solution to this inequity, MHCs have been deployed in cities across the country. These clinics are designed to be present in convenient locations within communities while offering a wide range of services, including prevention, primary care, support with income assistance applications, harm reduction, and mental health services.
MHCs provide care to clients who are poorly served by the traditional health care system due to financial, geographic, or cultural barriers, as well as previous negative experiences in health care settings. However, little is known about the impact of MHCs in countries with universal health care like Canada and the characteristics of the clients they serve.
In 2021, Parkdale Queen West Community Health Centre, TELUS Health for Good, and UHN’s Gattuso Centre for Social Medicine partnered to launch a nurse practitioner-led, community-based MHC in Toronto. The MHC currently serves approximately nine locations in downtown Toronto including shelters, community centres, high-density buildings, and encampments.
To better understand the impact of MHCs on the community, the team surveyed and conducted interviews with clients after they had received care. Most clients reported being homeless (61%) and 37% stated that without the MHC they would have accessed care at an emergency department, while 18% would not have sought care at all.
The team also identified factors that improved care experiences and access: client-centred approaches to communication, inclusive environments, reducing barriers such as cost and transportation issues, and connecting clients to other health and social services within the community.
This work highlights how MHCs help deliver care to those who face challenges accessing health care and can help inform the best ways to reach underserved communities. Although MHCs are often thought of as an alternative form of health care, these findings indicate that MHCs serve as an entry point to and a connection with the health care system.
The first author of this paper is Meghan O’Neill, former Epidemiologist and Evaluation Specialist for the Population Health Analytics Lab and a Research Officer with the Dalla Lana School of Public Health at the University of Toronto (U of T).
Dr. Andrew Boozary is the senior author of the study. Dr. Boozary is a Clinician Investigator at TGHRI, Executive Director of the Social Medicine and Population Health Program at UHN, and Assistant Professor at the Dalla Lana School of Public Health at U of T.
This work was supported by the Gattuso Centre for Social Medicine Innovation at the University Health Network and UHN Foundation.
O'Neill M, Redelmeier RJ, Michalski C, Macaraeg R, Gans M, Schoffel A, Diemert LM, Ogbaselassie L, Rosella LC, Boozary A. Implementation and evaluation of a novel community-based urban mobile health clinic in Toronto, Ontario. Can J Public Health. 2025 Jan 13. doi: 10.17269/s41997-024-00962-x. Epub ahead of print.
Patient safety incidents provide critical learning opportunities. However, many health care organizations struggle to turn these incidents into lasting improvements. Researchers from The Institute for Education Research at UHN examine the challenges of learning from patient safety incidents and identify factors that create barriers to effective learning.
Researchers conducted 15 in-depth interviews with staff members and physicians involved in patient safety incidents at a large academic health science centre. The interviews provided valuable insights into the investigation process and the broader factors that shape how information is shared and applied within the organization.
Key findings indicate that although incident investigation and follow-up procedures are thorough and well-defined, several factors hinder effective learning. Decisions on how to classify incidents are often influenced by differing professional perspectives and institutional priorities. This can cause non-physical incidents—like emotional distress, which can impact patients but are harder to track—to be overlooked during learning and improvement efforts. Additionally, privacy policies often remove key contextual details from reports to create a safe space for disclosure. However, this makes it more challenging to transfer learning across different cases.
To enhance organizational learning, health care organizations should have a more collaborative approach between patient safety teams and learning experts. By integrating their strengths, organizations can address not only the technical aspects of incident investigations but also the underlying social and political dynamics. Ultimately, this can transform incident reports into actionable insights to improve patient care.
Dr. Paula Rowland is the lead author of the study and a Scientist at The Institute for Education Research at UHN. At the University of Toronto, Dr. Rowland is a Wilson Centre Scientist in the Office of the Vice Dean Medical Education at the Temerty Faculty of Medicine, an Associate Professor (status only) in the Department of Occupational Science and Occupational Therapy and an Associate Professor at the Institute of Health Policy, Management, and Evaluation.
Melissa Lan is a co-author of the study and a Patient Safety and Quality Improvement Specialist at UHN as well as an Adjunct Lecturer at the Institute of Health Policy, Management, and Evaluation at the University of Toronto.
Cecilia Wan is a co-author of the study and a Patient Safety and Quality Improvement Specialist at UHN.
Laura Pozzobon is a co-author of the study and a Manager of Quality, Safety, and Clinical Adoption at UHN as well as an Adjunct Lecturer at the Lawrence S. Bloomberg School of Nursing at the University of Toronto.
This work was supported by UHN Foundation.
Rowland P, Lan MF, Wan C, Pozzobon L. Why is learning from patient safety incidents (still) so hard? A sociocultural perspective on learning from incidents in healthcare organizations. J Health Organ Manag. 2025 Jan 14. doi: 10.1108/JHOM-08-2024-0334.
On March 11, 2020, the world changed. The World Health Organization declared COVID-19 a pandemic, launching an unprecedented global health crisis. At UHN, researchers, clinicians, and scientists rapidly mobilized, applying expertise and innovation to understand, combat, and ultimately shape the future of pandemic preparedness.
"COVID-19 reinforced what we have always known—scientific discovery, collaboration, and innovation are our best defences against global health crises. This is true for both the challenges we are aware of today and those that will continue to develop. At UHN, we are not just responding to pandemics; we are building the future of health care." — Dr. Brad Wouters, EVP of Science and Research, UHN.
As we mark the fifth anniversary of this defining moment, we reflect on the extraordinary contributions of UHN’s research teams and the lasting impact of this work on global health.
Responding to a Global Crisis
The urgency of the pandemic demanded swift, coordinated action. UHN experts stepped up as leaders in public health strategy, ensuring data-driven decisions that would save lives. Dr. Beate Sander’s data modelling provided critical insights to policymakers, shaping Ontario’s response and resource allocation. Meanwhile, UHN researchers played a key role in Canada’s $53-million Variants of Concern Strategy, identifying and tracking emerging threats such as the Delta variant. These contributions ensured that UHN was not just responding to the crisis but actively shaping the scientific and public health response at both the national and international levels.
Transforming Research into Action
Clinical trials at UHN adapted in real time, ensuring research could continue without compromising patient safety. The launch of STOP-CoV, UHN’s first fully virtual clinical trial demonstrated the power of remote participation in medical research. Innovations such as electronic consent and virtual monitoring redefined how trials were conducted, setting a new standard for accessibility in clinical research. A first-in-the-world trial led by Atul Humar and Deepali Kumar, has provided critical evidence on the effectiveness of third-dose COVID-19 vaccines for transplant recipients. Additionally, a recent study, co-authored by Peter Wu and Moira Kapral, provides further information about nirmatrelvir-ritonavir's role in reducing the risk of hospitalization for COVID-19, while highlighting key limitations for patients and health care providers. These findings are reshaping global vaccination strategies, ensuring that immunocompromised individuals receive optimal protection against emerging variants.
Driving Scientific Discovery
The pandemic also catalyzed game-changing discoveries at UHN. Dr. Eleanor Fish’s research on interferon-α2b showed its potential to reduce COVID-19 viral load, offering a new avenue for treatment. Meanwhile, computational modeling by Dr. Donald Weaver identified furosemide as a promising candidate for mitigating severe infections, reinforcing the power of fundamental science in pandemic response. These discoveries highlight how UHN’s scientific infrastructure is positioned to pivot quickly when new global health threats emerge, ensuring that research remains one step ahead of the next pandemic.
Protecting Mental Health and Frontline Workers
Beyond virology and clinical breakthroughs, UHN recognized the deep mental health impact of the pandemic. The development of UHN CARES initiative provided tailored mental health support, reinforcing UHN’s commitment to holistic well-being in health crises. The pandemic reinforced the need to integrate mental health support into frontline care environments, ensuring that those who dedicate their lives to protecting others receive the care they need to sustain their own well-being. To further this commitment, UHN continues to develop innovative mental health programs and digital solutions that support resilience, ensuring that health care workers have access to the resources they need, both during crises and in everyday practice.
Building a Future on Innovation and Collaboration
The pandemic underscored the necessity of an integrated approach to health care, research, and public policy. UHN’s response exemplified a One Team mindset, uniting experts across disciplines to address urgent challenges. As we move forward, the lessons learned will shape the next generation of pandemic preparedness — enhancing surveillance, refining rapid response frameworks, and advancing digital health solutions. Strengthening global collaborations and investing in pandemic prevention measures will be critical to mitigating the impact of future outbreaks before they escalate into crises.
UHN’s vision of A Healthier World is more than an aspiration; it is a commitment. The advanced research and innovations developed in response to COVID-19 will continue to drive progress, ensuring that global health systems are more resilient, responsive, and prepared for the challenges ahead. The fight against infectious diseases is ongoing, but with science, collaboration, and a relentless pursuit of excellence, TeamUHN is leading the way forward.
UHN is pleased to unveil its new Research Strategic Action Plan, Bold Resolve: Science for Society, setting an ambitious course for the future of research at Canada’s largest research hospital. Science for Society is about conducting research with purpose—ensuring discoveries lead to real benefits for patients, communities, and the broader health care system. This bold approach reinforces UHN’s unwavering dedication to driving scientific excellence and breakthroughs to create A Healthier World.
“As science continues to transform the way we understand and treat disease, UHN’s research community remains steadfast in its resolve to pushing the boundaries of scientific discovery and innovation,” says Dr. Brad Wouters, Executive Vice President of Science and Research at UHN. “This plan articulates how we will work as one team to enhance health research, improve patient care, and lead innovation at a national and global scale.”
The Research Strategic Action Plan outlines three key strategic directions that will shape the future of Research at UHN:
● Transformative Experiences – Empowering TeamUHN—researchers, trainees, technical experts, and persons with lived experience—by fostering an inclusive, diverse, and collaborative research environment that drives innovation.
● Solutions Beyond Boundaries – Accelerating the development and application of cutting-edge technologies, policies, and innovative health solutions.
● Alignment for Impact – Strengthening UHN’s leadership role in health research by integrating discovery into patient care and advancing team science initiatives.
Developed in alignment with UHN’s broader Bold Resolve Strategic Plan, this research plan is a call to action for researchers, learners, technical experts, and administrators—along with UHN’s academic, government, philanthropic, and industry partners—to join in the collective effort to drive meaningful change in health care research and innovation.
With over 6,000 members in its research community, UHN continues to lead advancements across a broad spectrum of health disciplines, from artificial intelligence and genomics to clinical trials and health policy. This strategic framework provides the foundation for continued excellence and positions UHN as a leader in transforming scientific breakthroughs into real-world solutions.
To learn more, download the full Research Strategic Action Plan here.
Caregivers play a crucial role in the success of individuals recovering from cardiovascular events, providing support such as transportation to medical appointments, emotional encouragement, and medication management. Despite their critical role, many caregivers struggle to navigate complex health challenges without proper education or training. Researchers from UHN’s KITE Research Institute explore the needs of caregivers and highlight the importance of tailored support programs to improve patient recovery and caregiver well-being.
In a two-part study, the research team surveyed 86 caregivers about their background, quality of life, and caregiving experiences. The online survey revealed that while caregivers have a moderate to high level of understanding of cardiovascular disease, most have never received any formal training and report challenges in accessing reliable information and resources.
To gain deeper insights, the team conducted 16 in-depth interviews. These conversations uncovered four key themes, highlighting the support and education needed by caregivers—forming the acronym H.E.L.P.
● H: Helpful resources – more practical resources to handle everyday challenges.
● E: Empowerment – support and empowerment through direct access to health care professionals.
● L: Lived experience network – connection with peers who have similar experiences.
● P: Psychological support – managing stress and maintaining personal well-being.
These findings reveal the diverse needs of caregivers and the importance of tailored educational programs that offer social and emotional support. By addressing these gaps, these programs can enhance patient recovery and caregiver well-being, ultimately improving cardiac rehabilitation outcomes.
Ana Paula Delgado Bomtempo is the first author of the study and a former international trainee from the Federal University of Juiz de Fora.
Dr. Gabriela Melo Ghisi is the senior author of the study and an Affiliate Scientist at the KITE Research Institute. Dr. Melo Ghisi is also an Adjunct Professor in the Department of Physical Therapy at the University of Toronto.
This work was supported by UHN Foundation.
Bomtempo APD, Ghisi GLM. Educational Needs of Informal Caregivers in Cardiac Rehabilitation: a Mixed-Methods Study. Eur J Cardiovasc Nurs. 2025 Jan 7. doi: 10.1093/eurjcn/zvaf001.
I am the new Indigenous Educator in the Department of Research Strategy and Development. In this role, I develop arts-based curricula and workshops about Indigenous health for people working in research and clinical settings.
I view my work as a form of translation. Visual art captures powerful narratives that are sometimes inaccessible with text alone. The images I create illuminate the beauty and resilience of Indigenous Peoples.
There is an element of this art in health research. To conduct research effectively, we must envision and reimagine it in various ways. It is a beautiful feeling to witness the work of scientists and clinicians unfold artistically as they begin to view themselves differently in their research journey.
I use image-based workshops to educate health care providers and researchers about the colonial barriers Indigenous patients navigate in the current health care system. By using art in the Indigenous continuum of passing knowledge through images, I strive to bring light to these barriers and humanize health care for Indigenous patients.
UHN has supported my work to advance health research by providing an arts-based learning space at the Toronto Rehabilitation Institute. This space allows for creative, educational opportunities and offers privacy for people who have questions about cultural safety.
As an educator, I facilitate workshops, lunch-and-learns, office hours, and scheduled individual meetings for people interested in learning and creating art. Additionally, I make myself available on Wednesdays for office hours if people have questions or need more time to create artwork.
I am also a children’s author and illustrator of We Dream Medicine Dreams and I Will See You Again, where I share Indigenous teachings about death, grief, and healing. In 2022, We Dream Medicine Dreams won the First Nation Communities READ PMC Indigenous Literature Award.
I imagine a world where all research and institutions have inclusive arts-based learning spaces for researchers, staff, and trainees to drop-in and explore their creativity. The work created in these spaces will be uplifting and designed to ensure social change from an individual to a global level, resulting in culturally safe research and health care systems.
How to Participate in You @TeamUHN
You @TeamUHN is a campaign to highlight the important scientific contributions that research lab staff, trainees and learners, administrative staff, core facilities staff, Research Solutions & Services staff, and volunteers make towards A Healthier World through discovery and innovation. If you’re interested in sharing your story, we invite you to complete this form here (Open to UHN staff, trainees and volunteers).
Research conducted at UHN's research institutes spans the full spectrum of diseases and disciplines, including cancer, cardiovascular sciences, transplantation, neural and sensory sciences, musculoskeletal health, rehabilitation sciences, and community and population health.
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