Halifax, Nova Scotia – More than 135 CHIEF members and guests gathered in Halifax in June 2026 to explore some of the most pressing questions facing Canadian health systems. Across discussions on regional collaboration, accountability, international models of digital health transformation, and the future of clinical AI, a common theme emerged: many of healthcare’s most pressing challenges can no longer be addressed by organizations acting alone. Progress at system scale requires collaboration, shared accountability, and a willingness to make difficult choices together.
The opening session, Stronger Together: What Collective Action Unlocks at System Scale, explored the progress being made through collaboration across Atlantic Canada. Leaders described how sustained executive commitment, shared priorities, and trust have enabled the four Atlantic provinces to work together on common challenges in procurement, workforce, data, and artificial intelligence. The discussion reinforced that collaboration is not simply about sharing information. It requires governance, accountability, and a willingness to move beyond organizational boundaries in pursuit of shared goals.
Participants spoke candidly about the friction that inevitably accompanies collaboration and reflected on the importance of early wins, trusted relationships, and a focus on practical action to maintain momentum. Ultimately, the session demonstrated that regional collaboration can accelerate progress when leaders commit not only to a common vision, but also to doing the difficult work required to achieve it.
The second session, The Accountability Gap: When Risk, Authority, and Incentives Don’t Align, challenged participants to consider how accountability is evolving in increasingly interconnected health systems. Much of the discussion focused on cybersecurity, with participants emphasizing that cyber risk can no longer be viewed as solely an IT responsibility. Rather, it must be understood as a business, clinical, and patient safety issue requiring shared accountability across organizations and sectors.
Broader discussions highlighted the challenges that arise when responsibility, authority, and incentives are misaligned, particularly in areas such as patient flow, capacity, and system risk. Participants reflected on the need for new governance models, greater transparency, and stronger collective approaches to managing risk. A recurring theme was that health systems cannot improve if organizations are unable or unwilling to learn from one another’s experiences.
International perspectives from the United Kingdom, Finland, and Australia offered members an opportunity to examine the strategic decisions that have shaped digital health transformation in other jurisdictions in the session Global Perspectives: The System Decisions Others Made and Canada Still Weighs. Although each country has taken a different path, several common themes emerged.
Successful transformation requires clarity of purpose, sustained leadership, stable standards, and a willingness to make difficult decisions and stay the course. Speakers highlighted the importance of national architectures, clearly defined interfaces, interoperability standards, and dedicated mechanisms to support innovation. Equally important was the recognition that strategy is as much about deciding what not to do as it is about identifying new priorities. The discussion prompted members to reflect on which system decisions Canada continues to defer and what conditions may be necessary to move forward.
The Symposium concluded with a thought-provoking debate on whether Canadian healthcare should prioritize foundational data infrastructure and data quality over further investment in clinical AI at this stage. With the resolution “Be it resolved: Canadian healthcare should prioritize foundational data infrastructure (and data quality) over further investment in clinical AI at this stage,” the debate highlighted a tension that many leaders are currently grappling with.
On one hand, there was broad agreement that high-quality, interoperable data is essential to scaling AI safely and effectively. On the other, participants argued that delaying AI adoption until perfect foundations exist risks missing opportunities to address immediate workforce and capacity challenges. The discussion made clear that these are not sequential activities. Foundational infrastructure and AI implementation must advance together, with practical implementation helping to expose gaps, demonstrate value, and inform future investment decisions. While there was no consensus on where investments should be concentrated, there was agreement that both infrastructure and innovation are necessary if Canada is to realize the full potential of digital health transformation.
The discussions in Halifax reinforced the value of bringing senior leaders together to share experiences, challenge assumptions, and learn from one another. As the CHIEF Executive Forum continues to evolve, these conversations will remain essential in helping leaders navigate the difficult choices required to advance health system transformation across Canada.
Thank you to all speakers, moderators, Advisory members, and attendees who contributed to an engaging and thought-provoking Symposium. We look forward to continuing the conversation at the next CHIEF Executive Forum in Toronto on January 21, 2027.