Design for Legitimacy and Scale

Nova Scotia Health – Health Beyond Hospital

Context & Challenge
Across Nova Scotia, delayed hospital discharges and fragmented care transitions were driving avoidable hospital stays, patient harm, and system congestion. Responsibility for discharge, home care, mental health, and social supports was split across departments and agencies, creating structural gaps at the point where patients were most vulnerable.

What We Did
Synthetikos, with ShiftFlow as a subcontractor, designed and led a multi-year, multi-agency systems redesign with Nova Scotia Health and the Government of Nova Scotia. The work aligned six co-lead organizations around a shared service delivery framework, mission-level governance, and a portfolio of prototypes spanning governance, pathways, workforce, data, and physical/virtual infrastructure. In parallel, we built the operating model required to move from pilots to province-wide implementation, including scaling logic, evaluation, and decision support.

What Was Different
Rather than optimizing discharge as a hospital process, the initiative reframed it as a whole-system responsibility spanning health, home, and community. Governance, delivery, and data flows were redesigned together, so accountability, incentives, and operations moved in lockstep. Complex change became manageable by working with those most affected to co-design a shared mission, common language, and permission to learn by doing.

Impact & Learning
Health Beyond Hospital established a new, province-wide discharge and transition model, including CareNS Hubs, standardized pathways, escalation management, and integrated data dashboards. Early results include faster case resolution, reduced length of stay, hundreds of additional bed turns annually. An estimated $4.3M in annual ROI has been achieved alone by one of the eight prototypes through rapid escalation and collaborative resolution of long stay cases. The core lesson: durable flow improvements require redesigning the system around where people recover, not around where organizations sit.