Who’s Missing?: Equity Informed Health and Health Services with Erin Beckwell

Recorded just twenty-four hours before Prairie Harm Reduction (PHR)—formerly known as AIDS Saskatoon—officially closed its doors on April 9, 2026, this episode features a deep dive conversation with social worker and advocate Erin Beckwell.  Erin shares her decade-long history with AIDS Saskatoon, starting from its roots as a community-led response to the HIV crisis to its evolution into a vital institution that provided life-saving services in the community.  As you will hear, Erin and her co-workers were doing Relational Service long before it even had a name.  

In this timely conversation, we explore what it means to lead with a health equity lens, the frustrations of working in a huge bureaucracy, and the opportunity to do change approaches when we think outside the health care box. 

Resources 

Prairie Harm Reduction (formerly AIDS Saskatoon)

Wellness Wheel Clinic (Regina)

University Health Network Housing Model

Video: How Public Policy Creates Poverty with Colleen Christopherson-Cote

This Week's Shift Shout Out:

Trillium Heath Partners AI Challenge

Transcript

SPEAKER_01 0:11

Hey everyone, welcome to the podcast. Today I have with me Erin Beckwell. Erin and I grew up in the same small town and have been friends for as long as I can remember. When I launched this podcast, she was one of the first people I reached out to. Erin is a social worker, academic, and fierce advocate whose commitment to equitable care has shaped her work for years. I knew she would bring a clarity and courage that's worth sharing. We recorded this episode on April 8th, and we didn't know it at the time, but within 24 hours, Prey Harm Reduction, a supervised injection site that grew out of AIDSkatoon, announced it would be closing. Erin spent 10 years at AIDSkatoon, and those experiences deeply informed her thinking about health and system change. In our conversation, she walks through those formative years and how they guide her approach today. If you have time, check out the show notes for a video interview with Colleen Christofferson-Cote. She uses a bathtub analogy that helps explain our current model, scooping out water out of a bathtub instead of turning off the tap. It's a helpful compliment to this episode and highlights what happens when community-based services, also known as the buckets, are underfunded or removed. Erin also shares practical examples of equity in action and invites listeners to consider how their organizations can do the same. You'll find links to those resources in the show notes as well. At the end of this episode, I'll introduce a new segment called Shift Shout Out, where I highlight an individual team or organization in Canada that's moving the system forward. Stay tuned for that. Here's my conversation with Erin Beckwell. Well, let's talk about where we met, Erin, because whenever I say, Do you know Erin Beckwell? Everyone goes, she's great. And I'm like, I know she's great. And I've known her since I was a baby.

SPEAKER_00 1:58

So how do we know each other? You tell me. Well, I mean, I think most notoriously we rode the school bush. Your mom from the time you were in kindergarten and my mom drove the bus, which was for a time our station wagon.

SPEAKER_01 2:13

That's right, with a backward-facing backseat.

SPEAKER_00 2:15

Yes, I was a backseat rider in our station wagon school bus for years in you know, Cabury School. That's right. Yeah, middle southwest Saskatchewan.

SPEAKER_01 2:25

I know, and I'm so proud to know you because I think you're like such a change maker, and I'm just so proud that we grew up together and that I get to know you and that I get to say, yeah, I grew up with her.

SPEAKER_00 2:37

Well, I feel the same.

SPEAKER_01 2:38

Oh, that's nice. Okay, so how did you get from the backward-facing school bus um station wagon to becoming a social worker?

SPEAKER_00 2:48

Um, it was a bit of a journey, actually. And so I graduated from high school wanting to become a physician. That was the plan. I was going to med school, and um, I was the first person in my family to go to university. And so, you know, it was like high stakes and lots of expectations. But I'd been a kid who had tons of health issues, spent a lot of time in hospitals and at doctor's appointments, and and I'd seen great physicians and terrible ones. And I wanted to be a great physician. And like, and by great, I meant person-centered, like relentlessly patient-centered. Because when I saw physicians who felt like bad healthcare providers, it was when they weren't focused on me. And as a child, of course, that experience really shapes who you are and what you think about the world. And so I went away to university to become a doctor, realized my first semester that hard sciences and stats was not my jam, and um wandered around a bit and thought about being a teacher. I thought about being um a nurse. I actually got accepted into a nursing program. And then I had a friend in social work and he said, Why don't you come take this elective with me, just as a general, like a general elective for your degree? And I was like, All right, I don't know what my degree is at this point, but sure. And I took this social work class and it felt like I found my people. And it was so interesting to me. I just found it the most engaging and riveting content. Um, I just wanted more and more and more. And so after that class, I applied to the Bachelor of Social Work program. And interestingly, when I applied, um, the class sizes were tiny, like nine to 12 people accepted in Regina and Saskatoon each year. And so I didn't think I had a shot. Um, it was really competitive. I was young, and I was so lucky to be offered a spot in the program. And um, yeah, the rest is kind of history. Picked up a graduate degree along the way and became an academic and did a bunch of different jobs that got me really fascinated in why some people end up healthy and why some people don't.

SPEAKER_01 5:13

Yeah.

SPEAKER_00 5:14

And um, yeah, um, I think that interest in medicine was maybe because I just didn't know what social workers did.

SPEAKER_01 5:22

Yes. Yeah, yeah. Yeah.

SPEAKER_00 5:24

Or I thought they did child protection, right? Like that's what I thought. Right.

SPEAKER_01 5:28

Yes. And I now that you're a social worker, like I can't imagine you being anything else than a social worker. No, right.

SPEAKER_00 5:34

Like it is your perfect career. It's who I am. Yeah. And I didn't feel like it's a calling.

SPEAKER_01 5:40

I remember you from high school being one of the episodes I talked about rocking the boat. There's a saying about, you know, rock the boat, but don't fall out. And I just remember you rocking the boat in any way you could, even in a tiny little town. You were already pushing boundaries, already asking why this has to be. You were super embolden, um students against drunk driving, you were doing social movement kind of stuff even then. So it makes total sense. And I really want to highlight people that are brave. And I I mean, you still are gainfully employed. So I guess you've rocked the boat hard enough and still stayed in.

SPEAKER_00 6:22

Yeah, which it surprises me sometimes. I feel like I've been clinging to the edge a couple of times in my career, and now might kind of be one of those times where I'm not sure if I'm gonna be able to stay in the boat. And it's funny for today's podcast, I actually wore one of my favorite shirts that I feel encapsulates who I am. And so underneath this T, there's a t-shirt that says, being a shit disturber is an act of love.

unknown 6:49

Yeah.

SPEAKER_00 6:50

And I wear it around my family, I wear it to work. I wear, you know, and um quite famously am known for I wore it to teach a like upper level seminar, and um, the classroom got really hot. And so I took off my shirt over top and I had this, and the president popped by. Oh, and I'm sitting in class wearing this shirt, and he's like, Oh, you must be Aaron. Uh-huh.

SPEAKER_01 7:18

Yeah, yeah, I am. I think that's part of what people appreciate about you is that you're really willing to say what needs to be said when it needs to be said, where it needs to be said, and you're quite fearless in that way. Um, I recently listened to a podcast that you had done for the Social Work Association. And I was reminded the other place that we know each other from is you accrued me to be a board member on AIDS Askatoon. Yes, when you were working there. And we've had a few episodes on my podcast about relational design and relational services. And I wondered if you could share your experience and how formative that was for you. Because our conversation today is going to be based on equity. And I thought maybe that would be an experience that would be really interesting to people because I'm not sure. Now looking back, I see how special that place was. But even when I was there as a board member, I was like, I don't get this place. Like I come straight out of nursing school and I was like, this is not program planning and evaluation.

SPEAKER_00 8:18

Like it's just Google.

SPEAKER_01 8:23

Yeah, but you were so ahead of your time. So tell me about you and your work with AIDS Saskatoon.

SPEAKER_00 8:30

Yeah, it that job, which I was there for almost 10 years, and I started out there as a practicum student doing my undergrad degree in social work. And when I started as a student, I didn't realize until much later that we were on the cusp of something truly amazing. And so as an organization, Aid Saskatoon, I mean, had come out of crisis and chaos and struggle and had been created by community members who were like, we need more support than we can give each other informally. So they created an organization and got money and hired staff. And I was lucky enough to be brought along at a time when HIV was changing so much and it was shifting. You know, we had some treatments for HIV. People were living longer in many cases, but we were also seeing people who use substances, particularly injection substance use. Um, all of a sudden, it seemed this just happened. And it it certainly took longer than it wasn't all of a sudden in a fellow place.

SPEAKER_01 9:39

Like, was that in the 90s? Okay.

SPEAKER_00 9:42

Yeah. And um I was so lucky though, because during my major practicum, we sat down all the staff all the way up to the ED and said, things are changing. How are we gonna change? And I knew in those moments that I was in a place that I fit because that's how I respond to challenges is okay, how are we gonna adapt and change? Not how are we gonna dig our heels in and force people to fit into the way we do things. So that organization had, you know, a social worker who met with people by appointment, who did support groups, um, always scheduled though, with pre-registration, you know, all the typical stuff. Yeah. And within about two years, we had completely flipped our services to include a drop-in center. Um, to, and I mean, that just happened organically. It was wild because um people started dropping in and we didn't know what to do. Like people know where to go now, and we aren't used to this. So we actually started creating a sort of impromptu pop-up drop-in center. Um, we moved our library out of the front. We had a front office kind of resource library. We moved that and that became their first drop-in center. And we started running food programs. We had a kitchenette that had like half a sink, and we were running food programs out of there. And we started really learning about how do you serve people who are struggling with the very basics of life, who are in survival mode constantly. And when we moved up to the space that you probably remember, that was a big turning point for us because it was a purpose-built drop-in space. And we were able to bring in things like washer and dryer and um, you know, amp up our food programs, and we offered freezer meals and people could work in exchange for meals. Um, and and just such real relationships. And I think that's what I learned there is that when you build relationships with people, you can do wildly amazing things. I loved being down on the drop-in floor and spending time with people, just have a coffee with somebody. And it keeps you grounded, but it I mean, it made me a way better social worker, but it made me better human. And I still sometimes talk like I still work there because of how profoundly impactful that work was and the way we did it. Um, we had people with lived experience who worked for us. Um, we provided really flexible employment opportunities that people felt mattered because sometimes people wanted to give back. Sometimes people needed a little extra cash. And we could do that, and it benefited us too, not only in the capacity it brought, but in the relationships it brought. Um, and it really broke down some of the barriers between whose staff and whose client, right? Right. And um, that always stuck with me is just how radical that actually is. I mean, we work with people who were often under the influence of a lot of substance. Yes, like every day. That was just our daily. And um, while a bit different, I think, maybe significantly different than the reality today. And I want to make that clear that I don't know if we could do it the same now.

SPEAKER_01 13:19

Yeah.

SPEAKER_00 13:20

And I think that's been a challenge for the organization as it's kind of grown is how do we keep that spirit alive when the issues have changed? I mean, toxic drug supply has actually, you know, created such chaos. But we didn't ban people if their behavior was inappropriate. We also didn't require people to be sober to come in because we'd probably have a pretty empty drop-in center, which was really the reason why we're like, we can't prevent people from coming in or we'll see nobody. So um we had basically a code of conduct that was co-written with clients, and it was about like how do we behave when we're around each other? What is our expected sort of behavior? And it was really basic, like respect the space and the people in the space. And if you can't do that, then you're gonna get a break for maybe hours, maybe overnight. But tomorrow's a new day and we're gonna try again.

SPEAKER_01 14:16

Right.

SPEAKER_00 14:17

And I think that just giving people opportunities to try again is so important. And I'm just so glad that was my first, one of my first social, because it set the template for what was possible everywhere else.

SPEAKER_01 14:34

So when I reached out to you, I said, Was there anything you'd want to talk about on my podcast? And you were like, I would love to talk about equity. And I said, Yes, 100%. Let's talk about equity because equity seems to be a bit of a new or like the latest buzzword or the latest thing that everybody's kind of intrigued by, or it comes up in so many things where you have to apply an equity lens to this project. And I think even for me, sometimes I struggle with keeping it straight and understanding it in the bigger context. So, could you give us a bit of a rundown of what equity means in the context of health or health care?

SPEAKER_00 15:15

So when I was in a role in the health system here where I was pretty much my job was to talk about equity, I used to explain it this way that equity can be about people's access to care. Who has access? And so we would ask ask questions of providers like who's missing? And they'd be like, I don't know, how do we tell who's missing? But there are ways to do that. But always remembering the people who show up are often the ones with the most privilege, the most resources, the most motivated, the most supportive. And so the access changes when you don't have those things. And then there's equity in experiences of care. So looking at what does your care experience actually look and feel like as a patient, and what does it look and feel like as a provider? And so being able to think about do we treat people differently? And I think there's been a narrative around equality that actually has people kind of tripped up with this, okay, where equity asks us to actually understand individual but also population level needs and respond according to those, not respond according to what works for everyone else. And it's about, and I think it fits well with some of the stuff that people are also talking about right now, around like really like sort of customizing care. An equity-informed approach actually fits that pretty well. Um, that you know, looking at how do we actually relate to people from diverse backgrounds who may face multiple barriers getting access to care? And then how do we provide care to them in a way that feels affirming, it feels safe enough, it feels helpful, um, it feels relevant. And then on the sort of outcome side is, and this is where I first got into doing equity work in the health system, was looking at health outcomes, right? And we can see when we go population level, that there are very clear um connections between social determinants to health and health outcomes, right? Specifically around housing and income. And then we add in education level, right? And it's like the more education you get, the more stable your house, the better your income is, the healthier you will be. Yeah. And so, how do we try to address the realities for the people who aren't in those sort of top health groups, the top housing groups, the top income groups, right? And and so what do we do about the people who are falling through cracks, who are, you know, their primary care provider is the emergency room, right? And so, how do we actually see that as a predictable and very clear pattern?

SPEAKER_01 18:06

Yeah, and they often call it postal code health, yes, where it's like you can predict your life expectancy based on your postal code of where you're born or where you live.

SPEAKER_00 18:16

When you look at a map of Saskatoon divided by income, and then you overlay health outcomes on there. I'm sorry, if people's minds aren't blown by that, I I like I was just like, okay, so we know this and we're doing what about it? Yeah, yeah. And people were like, yeah, some things, but not a lot.

SPEAKER_01 18:34

That was my master's thesis was doing um immunization uptake by neighborhood in Saskatoon. And I think it was maybe one of the first neighborhood analysis that was done, and it was like a bullseye in terms of like 30% immunization rates for measles, mumps, and rubella in the core of the city. And then as you went out, it went up to like 100% in the suburbs. Yeah. And the number one indicator of that was access to transportation. So if you had a car, you could get to the immunization appointment, which are multiple over the first couple of years of life, and you have to make an appointment and you had to call in and you had to do all these things. And it really shifted, I think, public health's thinking about access to immunization programs. And they made a lot of shifts to to bring in better programming for immunization programs in this. Yeah.

SPEAKER_00 19:26

And now there's so much, right? Yeah, and and I think, you know, I mean, specific to immunization, I'd be so curious to see what that bullseye looks like today because I think it might look like a bit different. Because of course, equity isn't the only factor that impacts people's experience. And so, you know, I think right now there's a bunch of factors that are maybe shifting that bullseye to look a little bit wavy around the edges. But um, you know, it stands true, it holds true. Uh, and in multiple parts of the world, this approach has been used to look at health outcomes specifically. And so when I came into my role as a knowledge translation specialist in the public health observatory, that was my job. How do we take all this knowledge we have in public health about where the opportunities are, where the pitfalls are, where we maybe need to put resources right now if we're going to sort of meet our goals as a health system. And so I was brought along to be the translator, and it was the coolest job. Um, because I came in from a very different sort of perspective than, you know, I was surrounded by people who had masters of public health or who were public health doctors or epidemiologists and brilliant people. And they'd already started realizing producing all these data and these big reports wasn't actually changing the health system. Right. So they had started producing things like infographics. And I was brought in at a time just after they'd started trying to communicate this information differently. And they really wanted not only the general public to understand health equity, they wanted healthcare providers to understand health equity. And so it was such a cool opportunity, but it was a really, it was a challenging job because, of course, I mean, this was pre-pandemic. I can't imagine doing with that job now. Although there have been moments I've been like, I want to go back and do that job now. Cause I just now people know, like, can see it more. Yeah. The the things that we I worked and my whole team worked so hard on are starting to be realized, yeah, sort of right now. Yeah. And you know, prior to the pandemic, there wasn't there were little flickers of momentum on equity, but it was such a tough slog. And then when the pandemic I was sort of pulled up into some like meetings with ministry folks and government people about, and I was supposed to bring an equity lens to conversations about how do we cope with what's hitting us. And one of the conversations that really shaped me was we were talking about, you know, what will happen if deaths get so high that we need to start using curling rinks as more. And uh someone from governments, you know, was like, yeah, and we'll need to get ID to pick, you know, claim a body. We'll need to have a process. And I was like, yes. And we'll need to also think about how do people who don't have ID and can't get it because of the pandemic or other barriers, um, how do they claim their loved ones? And and he was like, Are you talking about homeless people? And I said, Some, yeah, we'll be homeless or you know, street involved in other ways. And he um he was like, Who's gonna claim the body of the homeless person? And I had to go off camera because I started to cry. Yeah, I just felt like, I mean, pandemic was really hard for me because I saw a massive opportunity to do equity-oriented work, yeah, healthcare services, you know, when we got immunization, when we were just doing testing. And it felt like it took so long for the system to get around to offering services that were actually accessible to people like those I used to work with every day. And so it was just so hard hearing all these conversations where it's like you clearly don't see these people as people, yeah. Uh, and you do not understand that they still have families, they still have loved ones, they matter to people, and they might not matter to you, but they matter. And you know, those types of conversations happened over and over again.

SPEAKER_01 24:02

And it was do you think it is about because I've had this with a few conversations now where it's like we've created a system that's so disconnected from its humanity, yet it's healthcare, so it is nothing but humanity, and it's I don't know if it's the industrialization. Why do you think that this is such a barrier for people to understand? Because to me, this feels like the essence of why we would be in health care. Right.

SPEAKER_00 24:30

I think a lot of it is that notion of equality that I mentioned earlier. I think that's a big part of it.

SPEAKER_02 24:37

Okay.

SPEAKER_00 24:38

Is that we should treat everyone the same, and that's good care. Okay. But of course, healthcare providers know that's not true.

SPEAKER_01 24:46

Yeah.

SPEAKER_00 24:46

But there's this idea that I can't treat people differently because that's wrong. And I think we were all, many of us, we're socialized in a world where equality was held up as the gold standard. And but when you are someone who hasn't had to fight for healthcare, that's okay. But when you're someone that can't access care or has had terrible experiences of care, and you're treated just like everybody else, like you're gonna wait like everybody else, you're gonna fill out the forms like everybody else. Yeah, we're missing seeing the people in this, right? And their unique context of their lives. That they may have literacy barriers, they may have no supports and be sitting in a waiting area alone. And, you know, and then if they leave without being seen, it's kind of seen as their problem, not our problem. And that's the other thing I see a lot is when people don't do well in our healthcare system, whether that's measurable in outcomes, whether it's about experience of care, whether it's about access to, you know, right care, right time stuff. Um I think sometimes there's this idea that if people just tried harder and made it a priority for them to be healthy or access primary care or some type of preventative care, that you know, we wouldn't be in this mess. And so I think some people feel like they are viewed as the problem. That our systems failing people isn't their fault. And I think particularly for people who face multiple often social barriers to care and who may not behave well when they're in our spaces or you know, receiving care, it gets hard to try to remember those are people who are often dealing with some pretty unthinkable stuff. And they may not be treated well in a lot of spaces in the world. And my vision would be that healthcare is one place they know they can go and be treated with kindness. Yeah, and feel safe. Yeah. Yeah. And and I I think some people are definitely trying really hard to make that happen. I think post-pandemic, it's gotten, especially on the sort of like emergency care side of things and acute care in general, it's gotten so hard. I think, just with this the pressures on the system and the pressures on individual healthcare providers. Yeah. That, you know, I it surprises me a bit that equity is sort of floated to the top now because it requires a change in our thinking and a change in the way we show up and the way we view our work in some pretty big ways. And when people are feeling overworked, unappreciated, unsupported, not the best time to be like, we're gonna put some more expectations on you around changing in some pretty significant ways how we actually work with people.

SPEAKER_01 27:47

So, where are you seeing some bright spots or opportunities? Or how do you see the system changing? Because I want people to have examples of groups or organizations that are changing the way they're doing things. Because it is hard to think about how you create equitable services. That is a fundamental shift in the way we deliver healthcare. Yeah.

SPEAKER_00 28:13

And I think people are frightened a bit. And I would hear this a lot when I was doing a lot of sort of FaceTime work with um frontline healthcare providers, is a lot of fear about uh the unknown, right? Yeah, what does this even look like down the road? Like, I don't, I can't imagine it. And so it's scary. And I think it's also scary because one of the things that has to happen is either more resources or a reallocation of resources to be equity informed. We can't do this in our current model just by shuffling the deck chairs around on the Titanic. We're still gonna sink. Yeah, and so we need to do something big, bold, brave. And um, I mean, there have been examples in Saskatchewan's healthcare system already. I mean, even when you talk about your nursing thesis or your MPH thesis, um, you know, after that, public health opened our neighborhood health center. It was a few years later, but they now have a health center in the core neighborhoods of Saskatoon where several immunization nurses are based out of. And they do drop-in clinics there, they do outreach there. That was a big shift because before it was this model of well, people come to us, we tell them where we are and they come to us. Yeah. And I think we still do that a lot in healthcare is like, well, you know where we are, you figure out how to get to us. And and so, you know, I think there's already been some of those pretty bold moves. Um, and it's just looking at how we scale those up or how we actually sort of feature that is not just something public health can do, it's something that we can do in other areas because that's the other thing I heard is oh, you're so lucky you're in population and public health. Um, they can do stuff like this. We can't. And I think people have convinced themselves that they're, I mean, the health system, especially acute care, so maxed out. How do we ever? And I mean, people are well aware that government isn't gonna drop a bunch of money on something wild at this point, right? So given that budget increases are fairly minimal, not keeping up with demand, I think it makes sense that people go, I can't see where in this equation we're gonna actually be able to do anything significantly different. And I think the fear is we will have to lose before we gain. We'll have to give something up. And and things are already pretty bare bones. What the heck do we give up?

SPEAKER_01 30:51

Yeah.

SPEAKER_00 30:51

Um, but one example that I talk about all the time is um Toronto, okay. Where the one of the, so the one of the health networks in Toronto actually um purchased and renovated an apartment building down the street from one of their busiest emergency departments. And it was pretty radical when they went through the process of getting it approved because it was expensive. It was an untested.

SPEAKER_01 31:20

Yeah. Yeah.

SPEAKER_00 31:21

And it was pretty out there for a lot of people. And so I was watching it quite carefully because I was worried the pandemic was going to derail it and it wouldn't happen. And um, so their sort of concept is, you know, based off of this idea that 20% of people absorb 80% of healthcare services, right? Especially if we look at like acute care ED. And so they were saying, what if we provided something for those 20% of people that actually meets a need that we know is a need? Um, and might sort of divert people from emergency. Or if they show up in emergency, we may be able to support them better down the street. And we can directly refer them down the street to this interprofessional sort of health hub that's on the bottom floor of an apartment building. And I mean, when I worked in public health, um, I shared an office for a long time with um Dr. Maureen Anderson, who was doing her PhD at the time. And she uh was doing her data analysis when we were sharing an office, and she spun around in her chair one day. She's like, Erin, oh my God, I can tell you what is causing all the logdams in emergency departments. And I looked at her and I went, What, housing? And she was so she was like, How did you know? And I was like, I've worked in community for a long time. I could have told, like, are you telling me my PhD was a waste of time? I said, No, because people are gonna listen to your data before they listen to my story. And so, you know, I think so people who brought in more data, especially local, like we have now got Saskatchewan-based studies that say, yeah, when you do all the analyses, ultimately the linchpin of this is housing. Yeah. If people were housed, they wouldn't be as likely to end up in emergency rooms repeatedly.

SPEAKER_01 33:25

Yes.

SPEAKER_00 33:25

And for things emergency rooms can't deal with.

SPEAKER_01 33:28

Yeah.

SPEAKER_00 33:29

And so Toronto said, okay, we know that root cause. Let's actually put resources there and see how this goes. And so far, you know, I think they're seeing some really interesting shifts in people having more accessible care. Now that they have stable housing, they can access a nurse practitioner and a social worker and an addictions worker all in their building. Um, and you know, once folks are kind of stable, they move on.

SPEAKER_01 33:59

Yeah, and they had one, I read that one of the participants, I think, is now an addictions counselor or something. So now he's like working there. Yeah. Yeah. That's amazing.

SPEAKER_00 34:09

Yeah, those are the outcomes that get me excited.

SPEAKER_01 34:12

Yes.

SPEAKER_00 34:12

And I can imagine as someone who's worked in the sort of formal healthcare system and someone who's worked in a very grassroots community-based organization and everything kind of in between. Um, I found, in spite of the discrepancy and pay, community-based work was so fulfilling and so meaningful because we could be responsive and we could be creative and flexible. And that was, it wasn't just encouraged, it was necessary there. Like we had no other choice but to be really creative and go off script all the time because we were filling gaps that often weren't even recognized as gaps yet. And so, you know, when I heard about Toronto's sort of housing project, I was like, this is the direction. This is the future. This is it that we need. And I mean, now, years later, I think the need for that is even greater because right now we're in a housing crisis, we're in a toxic drug supply crisis, and all of that is absolutely pulling the health system apart because our health system wasn't designed for those things. But I think part of what is still happening is there's still too much siloing. And that's what I heard when I started talking about Toronto's proposal. Health systems shouldn't provide housing. Yeah. And I was like, housing is healthcare, folks. And I think some of it is like that's a pretty foreign idea. We can talk about social determinants of health all day long, but actually getting involved in addressing that is a big step. And I think if we could break down some of the disconnects between like housing, healthcare, education, yeah, and try to, you know, and we have in some ways, but I think we've so far to go, especially for people who historically have just had terrible outcomes, terrible experiences of terror, just really terrible access to care. And, you know, I think there's some opportunities that have passed us by that we've missed. Like I was just thinking yesterday about Station 20 West in Saskatoon. I was on the initial steering committee for Station 20 West because Aid Saskatoon was going to be part of it. And that didn't materialize in part because a government commitment to fund the Capitol project was withdrawn from a changing provincial government. And we had had this massive rally on the site where Station 20 now stands. And seeing community come out and support it, and a couple things that were very contentious about this particular building were that there was a plan to have a grocery store that was partially subsidized. And our former premier of Saskatchewan made a notorious comment about how we don't fund malls. And it's like, how can you not see that this is not a mall, right? This is about bringing accessible, better food to the core neighborhoods where people were only able to shop at the time at like giant tiger or 7-Eleven. And so addressing food deserts and actually bringing services in. And so that had to be done through fundraising instead of through government support. And it meant the grocery store wasn't sustainable. And so, you know, that resource that came into the community disappeared. And the other thing that was supposed to be in station 20 was actually a very large multidisciplinary clinic. It was going to be like a one-stop shop for mental health care, which I think is interesting because we're there now as a health system. It's like we shouldn't be referring people out to mental health care. We should bring mental health in to where people's family doc or NPE is. And we had already made a plan for that. And that we're going to be able to connect people with housing because we had a housing provider in the building, and we're going to connect people with early childhood support because that was in the building. And that, yes, there'd be healthcare services, but there'd be all these other supports that we could help people navigate by co-locating. And I just remember feeling so inspired and excited by that that this could change. And across the back, the sort of back of the building was a housing development with a library on the main floor. I was like, we're doing something important right now. And I think, you know, that certainly has in the scaled back version that Station 20 had to become, I think it lost some of that. Yeah. But it still kept on a few pieces, were still maintained. But I think those bold ideas we had in the early 2000s.

unknown 39:01

Yeah.

SPEAKER_01 39:03

I struggle with this because it is like, because I just presented to a group of PhD and master's students this morning, like about my career path and the work that I do and the work that I'm interested in. And I said, research is so valuable and it's so important. But what I'm interested in is why do we need 20 years of research before people will move forward with an idea? Like, how do we accelerate this adoption? Or the because the same thing happened when I worked with ED weights and patient flow. Our answers were all based in the community. Like they were all about community services. It was about alternate level of care, you know, a little bit of what happens in the hospital, but mostly about pulling people back in and keeping them at home. That was 10 years ago that we were introducing those ideas. And now, you know, it's like, hey, what about ALC patients? They shouldn't be here. How do we get them back into the community? So I feel like a lot with improvement work, you are ahead of your time. Like the people that do this work are ahead of their time. And do you have you found any strategies or ways of working that you think could accelerate that?

SPEAKER_00 40:11

I think there's something about large, large bureaucracy. I was thinking the earlier this week about I had to get a new office chair. And it took six months and four appointments to get a new office chair. And I actually was doing the math of how much this was costing taxpayers for me to get a new damn chair. I had to undergo an ergonomic assessment with an occupational therapist. And then I had to meet with a physical therapist and try out different chairs. And I had to be shuttled around the city. And then I had to take a class online about ergonomics and show my certificate to my boss before she could approve the expenditure. And we laughed, but also were so sad about this because if it takes me six months to get a new chair when mine actually was broken, yeah. Like, how long does it take to do complicated things? Like big change.

SPEAKER_04 41:08

Right.

SPEAKER_00 41:08

Um, and I think sometimes we're just created, and I know the amalgamation of all the health regions into what health authority was designed. We've, you know, consolidated and then separated, and and we'll keep doing that, and it's not gonna fix the problem. It's it is rearranging the deck chairs on a Titanic, and it frustrates me. And so I actually, when I was in SHA, just out of sort of the reality of the work, I couldn't get an audience with decision makers, especially senior leaders, very often. Yeah, I had pretty consistent communication, but not enough to actually drive change. I had no power. So I was driving this sort of health equity strategy, but no one was accountable to me. No one was accountable to anyone about it. And I kept pushing and I said, in your metrics, you need to have equity metrics in there. That means you need to start collecting different data. And there was so much resistance to some of that, in part because I think people are just feeling overworked and underappreciated, and so you ask them to change, and it's just too much.

SPEAKER_04 42:20

Yeah.

SPEAKER_00 42:21

And but also there wasn't any clear support consistently from senior leadership. They weren't asking people about equity and therefore they weren't hearing about inequities in care because people were telling them. And so I started going to you know, that sort of bottom-up approach and trying to get time with as many healthcare providers as I could.

SPEAKER_01 42:46

And you know, one by one, just trying to convert those usually.

SPEAKER_00 42:50

I mean, but there were some individuals too that I knew could be champions for this.

SPEAKER_01 42:54

Yeah.

SPEAKER_00 42:55

And that had already been identified by public health leadership as like, we need to find the champions in the system because we're not going to be able to do this on our own. And um so, like, there was a health equity sort of charter that was signed that everybody got really excited about. And we had a little ceremony and it was great, nothing happened, right? And so I think, you know, as much as it would frustrate me a lot of days that going downstream or sort of like talking to emergency nurses, for example, I'd go and do things like trauma-informed training care training or cultural safety training, which, you know, is such a minimal, like it's not changing things, but I was like, if I can at least change a couple nurses' perspectives on their patients or the situation they they see, maybe that's something because it just felt like the whole system felt like a massive boulder. And we used to joke about the pushing the boulder uphill thing. So I'd be doing these front. Trainings that you know I I like doing training, I I find it really enjoyable, people thought they were really helpful and engaging, which was lovely, but I don't think big picture, yeah, me, one person in a system of 40,000 staff is going to change the culture of an entire institution. Because if we have a bunch of unhealthy healthcare providers, um, you know, who have been worked to the bone and you know are feeling unsupported and unseen, this is not a group of people who are champions of change. They are going to fight back. And I've even, you know, done some work with healthcare unions. And, you know, they're often like, in principle, yeah, we are totally with you, but in reality, absolutely not. Right.

SPEAKER_01 44:55

What do you think holds them back?

SPEAKER_00 44:57

That they hear every day, whether it's nurses or social workers, or yeah, they hear every day how awful it is and how one more thing will make people break. Right. So they're like, yeah. Our our members will absolutely lose their minds if we say we're promoting this or we're supporting it. And so there's just layers of this situation, right? I mean, healthcare systems are so complex. And a lot of these solutions aren't that complex. They're pretty simple, but they're a big shift away from where we're at right now.

SPEAKER_01 45:33

Yeah, and they require a lot of bravery and courage. Do you think their willingness is changing, or do you still think you're we're feeling a bit stuck? Maybe it's in pockets, hey?

SPEAKER_00 45:42

Yeah, I think there are some pockets, often sort of peripheral to the health system. Like I think about wellness wheel. I don't know if you've heard of wellness wheel. It's an interdisciplinary clinic that goes out to communities, specifically indigenous communities, um, to do Pepsi and HIV support. And so they were finding people didn't come into their clinics in Regina or Saskatoon. And it was often about transportation or just life is chaotic and I can't get to that appointment. And it's a specialist appointment. So then we have specialists sitting around twiddling their thumbs. And, you know, historically, the system has blamed patients for that, right? They're no-shows. And in some places, I experienced when I worked in the system, people were actually putting stamps and flags and all sorts of things on people's files if they'd historically been a no-show. Because, and I was like, why? So we treat them different now. Well, clearly they uh they aren't committed to their health, they're not in need. Oh, we have all kinds of reasons we can make up about that. But rarely did I hear maybe they couldn't get here. Maybe they didn't have child care that was safe enough to leave their kids. Maybe they're struggling with substance use, and time means nothing to them right now. So a physician from Regina, Dr. Skinner, actually rallied the troops and got uh like he has an interdisciplinary team that goes out with him and they do fun events in the community to try to get kids involved. Like it's magic. I love it. And, you know, they don't just provide health care in the traditional sense, right? Like they'll have a meal to get their clients to come out, right? And and like they have just created this model that makes so much sense and it works so great. And I think it would actually be a great model for all sorts of health services because, of course, their uptake from patients is greater, the impact on patient health is better, staff are happier because they feel like they're actually meeting needs that are real, yeah, and not just churning through the people who can get to us. I just think, yeah, like there's so many opportunities, like everywhere I look in healthcare, I see opportunities.

SPEAKER_01 48:01

This was such a great talk, and I'm so proud of the work that you do all the time. And I'm so glad that you're continuing to do it by teaching the next generation how to do it better than how we did it. And I do hope that you continue to have the conversations with people about equity and bring that to the forefront because wherever we can kind of push that equity conversation in whatever spaces we're in will have a ripple effect. And I think we often underappreciate the ripple effects that we can have just by teaching one person or having one person hear about a project that has an equity focus and how that might spur an idea for something else to happen. So I appreciate you taking the time to talk with me.

SPEAKER_00 48:46

It's always great chatting with you.

SPEAKER_01 48:47

Thanks, Erin.

SPEAKER_00 48:49

Thank you.

SPEAKER_01 48:52

Thank you to Erin for a deeply grounding conversation about advancing equity in healthcare. It's remarkable how far our conversations have come since the station wagon days. And I'm grateful our paths keep diverging and converging around improving health and care. We share the belief that everyone deserves a life where they can thrive, not just survive. Thank you for always reminding me of this, Erin. And now for my first shift shout-out. Today we're giving a shout out to Trillium Health Partners in the Greater Toronto area, which recently held its first AI for better healthcare catalyst challenge. This contest invited staff to pitch AI-driven solutions to improve healthcare, and they received over 60 submissions from frontline teams who know the system challenges best. The challenge winner was Jackie Rodericks, the clinical manager of the emergency department at Credit Valley Hospital. Jackie recognized a massive inefficiency in her department, manually creating staff assignments and schedules, and it was taking their team roughly seven hours every single day. Her innovative solution uses AI to automate and optimize the entire assignment process by integrating workforce data and staff qualifications into the system. And it better aligns the staff skills with the specific needs of the patient in the ER. As Jackie said, the tool isn't just about saving time, it's about putting leadership teams back at the bedside where they can focus on patient care. Because this tool was built in the ER, Trillium Health Partners now plans to scale it across the organization, including to the ICU, mental health units, and inpatient wards. So a massive shout out to Trillium Health Partners for coming up with this innovative way to engage providers and staff in finding solutions to problems and then supporting the spread of it across the organization. I love this challenge concept. In improvement, there's a saying, let a thousand flowers bloom as a metaphor for encouraging a wide variety of ideas, experiments, and projects to emerge. This is a perfect example of that. That's all for today. And as always, I would appreciate you spreading the word about my podcast and encouraging others to listen on Spotify, Apple Podcasts, Amazon Music, or you can also watch the episodes on YouTube as well at Shift Podcast Canada. My email is shiftpodcastcanada at gmail.com, and you can find shift on Facebook and LinkedIn as well. Also, if you have any shift shout outs you want to share, please send them my way and I'll add them to each episode. Thanks, everyone, and remember systems don't change unless we do. This is Shift. See you next time.