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Despite many calls to strengthen connections between health systems and communities as a way to improve primary healthcare, little is known about how new collaborations can effectively alter service provision. The purpose of this paper is to explore how a health authority, municipal leaders and physicians worked together in the process of transforming primary healthcare.

A longitudinal qualitative case study was conducted to explore the processes of change at the regional level and within seven communities across Northern British Columbia (BC), Canada. Over three years, 239 interviews were conducted with physicians, municipal leaders, health authority clinicians and leaders and other health and social service providers. Interviews and contextual documents were analyzed and interpreted to articulate how ongoing transformation has occurred.

Four overall strategies with nine approaches were apparent. The strategies were partnering for innovation, keeping the focus on people in communities, taking advantage of opportunities for change and encouraging experimentation while managing risk. The strategies have bumped the existing system out of the status quo and are achieving transformation. Key components have been a commitment to a clear end-in-view, a focus on patients, families, and communities, and acting together over time.

This study illuminates how partnering for primary healthcare transformation is messy and complicated but can create a foundation for whole system change.

A topic currently receiving significant academic and practitioner attention is called evidence-based management. The purpose of this paper is to suggest that this approach is sometimes over-sold and may be a fad. Additionally, evidence-based management fails to fully recognize the importance of tacit knowledge, what Kahneman calls system 1. Evidence-based management does provide tools to better use what Kahneman calls system 2, rationality. Decision-makers need to take advantage of both rational and beyond rational processes.

This is an essay, it is not a report of a study. At this point in time, this paper needs thinking, reflection, pondering, more than a data-based study.

Advocates promote evidence-based management in part to help avoid fads, yet evidence-based management itself has many of the characteristics of a fad. Evidence-based management is based on an objective rational view of the world and suggests highly rational methods of decision-making. However, a rational fact-based might not give sufficient credit to instinct and feelings. Decision-makers should take into account facts, evidence, when making decisions, but not ignore intuition, hunches and feelings. This study is learning that decisions use a galaxy of approaches, with both cognitive and affective flexibility.

As with any opinion-based paper, this lacks empirical support. Proponents ask us to believe in evidence-based management. Neither we, the authors of this paper, nor the proponents of evidence-based management can empirically support the ideas offered. An additional limitation is that the paper is written in one language, English. Translation into another language might yield different meanings.

There are advantages for scholars and practitioners to look at the best available evidence. There can be disadvantages in overlooking non-quantifiable factors.

Those who use evidence-based management should also take into account feelings, ethics, aesthetics, creativity, for the betterment of society. To solve wicked problems one needs more than facts and rational analysis.

The overwhelming majority of those writing about evidence-based management are supporters. This study offers a different view. This paper brings new ideas and new thinking to both the extensive fad literature and the huge evidence-based management literature. Evidence-based management is discussed widely. Google Scholar lists more than two million papers in 2019, 2020 and 2021 on evidence-based management. Readers of this journal should critically evaluate this popular set of ideas.