
CAHSPR’s mission is to improve health & health care by advancing the quality, relevance, + application of research on health services and health policy. #CAHSPR
Joined October 2011
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CAHSPR retweeted
If we are trying to change a system, how do we know if the system is actually changing?
A framework I use often in my change practice is the “Water of Systems Change” from @johnvkania & colleagues. It says that to understand the problems in a system, we should explore six interdependent “conditions” that typically hold the problem in place. These relate to structural conditions (policies, practices & resource flows), relational conditions (relationships/connections; power dynamics) & transformational conditions (mental models - the deeply held beliefs & assumptions that influence our actions).
Now Drew Koleros & colleagues have produced a “Practical Guide to Evaluating Systems Change Efforts”, based on this framework. They translate the six conditions into levels of change. They conclude that efforts to measure whether a change intervention is actually making a difference will more often focus on surface level “structural changes”, because these explicit changes have established indicators & data sources. If we really want to know if a system is changing, we also need signs of change related to relational & transformational changes. These require deliberately developed indicators, multiple methods & validation with the people involved in the change, rather than being treated as secondary or invisible.
Six actions for leaders of change who want to show their efforts are actually changing the system, based on the practical guide:
1) Map the system with the people in it. Agree its boundaries & check whose perspectives are missing, especially people with the least power.
2) Name where your change enters the system. Translate each entry point into the structural, relational & transformational changes you expect. Relationships & mental models" take longer to shift, so set timescales to match.
3) Co-design the signs of change. For each system change, ask those involved: what would it look like if this was changing? What would we expect to see? How would we know? People trust measures they helped to shape.
4) Pair leading & lagging signs. A leading sign of shifting power might be people reporting greater trust or influence. A lagging sign might be people with less formal power shaping decisions, visible in who speaks & who decides in key meetings.
5) Bring numbers & stories together. Performance data & staff surveys show the scale of change. Interviews & focus groups show what it means to the people living it. Make sense of the evidence together, continuously.
6) Review progress with a diverse group.Rrefine the signs as you learn, use a simple measure of progress (emerging, advancing, embedded) & share findings at regular points to adapt the work as it unfolds.
It’s highly unlikely that one change initiative (or one team) will shift all six conditions alone. We will make the strongest case for impact if we describe our efforts, show what changed as a result, across multiple levels & draw plausible links to where the system is heading.
Links and useful resources:
The recent article from Medium that inspired my post titled “How Do You Know When a System Is Changing? : Measuring the signs of systems change” by Drew Koleros, Emmanuel Saint-Phard & Shu Phua: medium.com/@undp.innovation/….
Their “Practical Guide to Evaluating Systems Change Efforts”: drive.google.com/file/d/1-KI….
About the Water of System Change framework created by John Kania, Mark Kramer & Peter Senge: fsg.org/resource/water_of_sy…
The Water of System Change Action Learning Exercise: dev-fsg-advisors.pantheonsit… (I use this exercise often with groups).
An in depth video that explains the Water of System Change framework very effectively from @CIForumTweets : fsg.org/resource/water_of_sy….
CAHSPR retweeted
How should CIHR’s Project Grant program evolve for a sustainable future? Our discussion paper explores options to manage application pressure, strengthen peer review and improve program design. We want your feedback. Read + take the survey: ca1.voxco.com/S2/?st=f3oOQBc…
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Advise on research gaps & priorities, shape funding opportunities and mentor the next generation of genetics researchers.
Apply to become the next Scientific Director of CIHR-IG: cihr-irsc.gc.ca/e/54791.html…
Closing date: September 15, 2026
CAHSPR retweeted
Looking for health research funding? Explore CIHR’s current opportunities: researchnet-recherchenet.ca/…
Newly launched:
•Team Grant : National Cancer Data and Bio-Resource Coordinating Hub
CAHSPR retweeted
Calling all researchers! Take a look at CIHR’s current funding opportunities: researchnet-recherchenet.ca/…
Launched this week:
- CIHR Strategic Master’s Award
- Catalyst Grant : Analysis of CLSA Data
CAHSPR retweeted
Looking for health research funding? Explore CIHR’s current opportunities: researchnet-recherchenet.ca/…
Coming soon:
•Team Grants: National Cancer Data and Bio-Resource Coordinating Hub cihr-irsc.gc.ca/e/54777.html…
New:
•Pan-Canadian Single Research Ethics Review Initiative
CAHSPR retweeted
The Fall 2026 Project Grant competition is underway.
CIHR is making targeted updates to strengthen peer review, clarify committee mandates and support a growing research community.
Broader changes will be co-developed with the community.
Read more: cihr-irsc.gc.ca/e/54778.html…
CAHSPR retweeted
Looking for health research funding? Explore CIHR’s current opportunities: researchnet-recherchenet.ca/…
New:
•Project Grant : Fall 2026 and Spring 2027
•Project Grant : Fall 2026 Priority Announcement (Specific Research Areas)
CAHSPR retweeted
Looking for health research funding? Explore CIHR’s current opportunities: researchnet-recherchenet.ca/…
New:
•TRANSCAN-4 JTC “Translational Research on Cancer Metabolism: Multidisciplinary Approaches for Diagnosis and Treatment”
•Team & Operating Grants: Youth Mental Health
CAHSPR retweeted
CIHR is consulting the research community on improving peer review in the Project Grant competition. Webinars will explore system challenges and options such as shifting to one competition per year: cihr-irsc.gc.ca/e/45096.html…
CAHSPR retweeted
June marks National Indigenous History Month. Join us as we honour the stories, achievements and resilience of First Nations, Inuit, and Métis Peoples.
cihr-irsc.gc.ca/e/54739.html…
#NIHM2025
Congratulations to Dr. Daisy Singla and team —2026 @ihspr_isps_cihr-#CAHSPR Article of the Year Award recipients —for their research, “Task-sharing and telemedicine delivery of psychotherapy to treat perinatal depression,” in @NatureMedicine. Read at: nature.com/articles/s41591-0…
Our closing plenary #CAHSPR26 at 10:30 this morning is going to be a discussion about the importance of health services and policy research, the impacts and the influences! We have a fantastic panel that includes those with lived experience and those who have studied the impacts
Thank you to everyone who connected with the Commission at #CAHSPR26—including those who joined the consultation lunch on integrating mental health into primary care. Great conversation, thoughtful questions & real momentum—thank you #MentalHealth #PrimaryCare #MentalHealthPolicy
Don’t miss the Commission/CAHSPR panel on integrating mental health into primary care today at 2:30. Featuring Cheryl Pollard (MHCC Hallway Group) bringing lived & living experience, with Ivy Bourgeault & Matthew Menear #CAHSPR26 #PrimaryCare #LivedExperience #MentalHealthCare


















