Grant: Health System Impact Embedded ECR Award - Sex, Gender and Health

Health systems make decisions every day that shape people's care, yet patients, the public, providers, and system leaders are rarely meaningfully involved together in planning, decision-making, and policy development. When engagement does occur, it is often limited, uneven, and constrained by hierarchical structures that make it difficult for diverse voices - particularly those from communities historically marginalized by health systems - to be heard or to influence outcomes. As a result, decisions may lack legitimacy, equity, and relevance to real-world needs. Growing evidence shows that bringing diverse interest-holders together in health system decision-making strengthens trust, improves decision quality, and helps address some of the system's most complex challenges. In close partnership with Unity Health Toronto and a pan-Canadian Network of health system interest-holders (including patients and members of the public) this embedded research project aims to close this gap by co-designing, testing, and refining equity-driven processes and tools to support meaningful multi-interest-holder engagement in health system governance. These tools will be piloted across multiple settings within Unity Health, including organizational governance, primary care, community care, and long-term care. Impact will be assessed using a combination of observations, group discussions, and reflective photo journaling to understand not only whether the tools work, but how they work, for whom, and under what conditions. Evaluation will focus on changes in inclusion, trust, transparency, equity, decision quality, and sustainability. By being embedded within the health system, this research ensures the tools will be practical, responsive to real-world constraints, and aligned with existing governance structures. Findings will directly inform improvements at Unity Health and be shared more broadly through plain-language resources, academic publications, and training initiatives.