The COVID-19 global pandemic had a profound impact on many aspects of Canada’s social life. In the healthcare sector, patient access to, and delivery of, medical services became distanced and virtual to meet stringent and mandatory health and safety requirements, while many design projects were either stalled or rescheduled.
What have we learned from this experience? Adopting digital healthcare and patient-centred approaches has accelerated in the wake of these delivery methods. We are now witnessing an unprecedented embrace of digital healthcare. It has become increasingly convenient to access our medical information online and open ourselves up to these evolved services, much like any other consumer services now at our fingertips. The focus now is on ensuring prompt and accessible healthcare when it is needed. This has become the new priority.
Nevertheless, our healthcare system faces significant challenges, such as a surging aging population, the overdose crisis, growing mental health issues, and structural weaknesses. These factors highlight the urgent need for profound change and modernization at a systemic level.
The Panel
Today’s presentation, “Healthcare Resiliency,” looks at these questions with our panel of experts from different fields of healthcare. They include Yordanos Woldemariam, Dr. Ariel Dalfen, Colleen Young and Yoshi Perera.

Yordanos Woldemariam, MDes
Senior Project Manager, Canadian Institute for Social Prescribing, Canadian Red Cross
Yordanos is an accomplished public health and social service professional with expertise in community health, health equity, mental health and chronic health conditions with a specialization in design thinking and design research methodologies. She has extensive experience in managing and collaborating with diverse stakeholders to solve complex population health problems and driving forward change in the health and social service sector.
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Woldemariam is a senior project manager with the Canadian Institute for Social Institute for Social Prescribing, part of a collaborative for the Canadian Red Cross. It comprises several partners across Canada who are implementing social prescribing or working within social disparities across the country.
As a starting point, in May 2023, the US Surgeon General’s office released an advisory report declaring loneliness and isolation a public health emergency. According to the report, a lack of social connection can lead to an increased risk for premature death as much as smoking 15 cigarettes a day, increased risk of disease (heart disease – 29%; stroke – 32%), and increased risk for both anxiety, depression and dementia. During the pandemic, there was a huge reduction in social connection and an increase in social isolation that posed a significant risk to the health of Canadian communities, as well as our access to shelter, community inclusion and the built environment.

What is social prescribing? In a nutshell, “it’s something you might already be doing in your personal lives through volunteer work or by supporting your friends and family,” she says. It is a collaboration between our health and social systems as practitioners and individuals. Social prescribing focuses on what individuals need and exploring a community-led approach to improve health. It tracks connections and follows outcomes and interventions to address the gaps and needs within the community.
From a primary care perspective, the social prescribing pathway looks like the entry point (or points) for social prescribing of community, health and rehabilitation services. It is creating an intentional connection between our primary healthcare systems and community systems by way of an elite worker or “community connector.” Their role is to provide a personalized point of contact for individuals who are engaging with the healthcare system and other places within out health and social systems. What they do is provide active listening and work towards developing and co-producing goals and solutions that focus on an individual’s needs and strengths. They also provide culturally appropriate and population-specific resources that are connected to the community. This can empower individuals to have more control over their healthcare once they have received the support that they need.
Another key component is participating. Once individuals are linked to a community connector, they’re able to access services within the community to improve their well-being. In Ontario in 2018, there was a a community health pilot project focused on social prescribing, and connecting individuals to community supports. Data reveal individuals who participated in social prescribing initiatives showed long-term improvement (49%) in their sense of loneliness and mental health over a one-year period.

Dr. Ariel Dalfen
Co-founder Bria
Dr. Ariel Dalfen is a psychiatrist with over 20 years of experience treating women of all ages: from those trying to conceive through to the perimenopausal population. Ariel co-founded Bria (www.betterbria.com) after running the largest perinatal mental health program in Ontario for 12 years and starting the first of its kind – Perinatal Mental Health Telemedicine Program – in Canada, way before virtual care became popular!
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First, some background on “Bria,” her organization and how it was founded. “Bria is not an acronym,” she says. “In Hebrew, it’s the feminine word for “health“ and in Gaelic, it means “strong and knowledgeable,” so it really captures our goals and mission to bring mental health to women, people who are going through different reproductive stages.” Most of the people Bria sees identify as women, but they are open to anybody, however, they want to define themselves, if they need help as they go through different planning stages, such as fertility, pregnancy postpartum and perimenopause.
This is the Bria origin story, what they have achieved, what they do now and how they are hoping to expand in the future.

After working in a big academic hospital seeing people who were pregnant, postpartum and struggling with a range of mental health issues, we wondered how we could make it better for people. We wanted to design something better that would meet the needs of our patients and their families. Eventually, we started a telemedicine program because our offices were located in downtown Toronto and we were seeing people coming from all over the province because of our obstetrical expertise and it made more sense to use video technologies to see our patients remotely. Eventually, we started a telemedicine program that enabled us to see patients from across the province.
With the advent of COVID, all of our services had to go virtual and this was the primary motivator to make virtual healthcare for women a reality.
“We knew that for personal care to work, we needed to bring people together, to make them accessible to people from all over the province and all over the country as well. And to give them really good people with specialization in these reproductive life stages,” Dalfen says.
The next step was to recruit people. This involved hand-picking specialists for our network of therapists that we built. Then we created Bria, which is a virtual mental health journey for women to get the care they need when trying to conceive, their pregnancy and postpartum. We opened our doors in May 2022 for our patients and their families.

Colleen Young
Community Director, Mayo Clinic Connect
Colleen Young (@colleen_young) is a social innovator and online community strategist. She is internationally recognized for her expertise in building online health communities that thrive. Clients include Mayo Clinic, College of Family Physicians Canada, Canadian Virtual Hospice, Heart & Stroke Foundation of Canada, Dartmouth-Hitchcock Health, EURODIS and more. Using strategic community management approaches, Colleen has developed a proven framework to help not-for-profits, especially health and patient organizations build online communities that work.
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Management of chronic conditions usually happens outside of the clinical setting. Conditions like heart failure, diabetes, cancer, stroke and COPD are treated by physicians and their teams. However, successful recovery and continuing management of chronic conditions is largely done by patients and their families at home. Being able to connect online is a useful and exciting advance in today’s patient-led health environment because health and care happen everywhere.
“That’s why Mayo Clinic hosts an online patient-to-patient forum,” Young says. “It’s a safe, welcoming and moderated space where patients connect, share experiences and expertise, and build circles of trust and form relationships to improve their health.” Mayo Clinic Connect is a community of communities, with over 75 groups based largely on condition or health needs, like transplants or brain tumors or a demographic like caregivers or LGBTQIA health. Content in the community is user-generated, which is vital for success. “Conversation is our currency,” she says, “if no one is talking, you don’t have community.” When members feel seen, heard and validated, they engage. And when they engage, they get more value than they contribute.

With the arrival of COVID-19 in 2020, Mayo Clinic, like many trusted health sources, acted quickly to provide expert and evidence-based information responsive to the emerging situation. On Connect, we opened a support group dedicated to COVID-19 with discussions to inform and foster connections and reduce fear and isolation. The moderating team was also supported by Mayo Clinic News Network, a consumer channel that creates videos and articles on topics of the day for traditional and social media. Eventually, the COVID-19 support group shifted to help people with long COVID and in their post-COVID recovery.
A well-managed, engaged community is not only indispensable to its members but also to Mayo Clinic itself. Patient engagement – and distinguishing between different types of engagement – can be translated into better health outcomes, health system innovation and financial value. With Connect member loyalty, Young can recruit patient and caregiver participants faster and more targeted than traditional methods. This in turn bolsters community-building efforts and deepens member commitment to the community, empowering patients and caregivers to collaborate, co-create and provide solutions to help the Mayo Clinic generate products and ideas that lead to innovation in care.

Yoshi Perera, MDes, MPH, MBBS
Yoshi Perera identifies as a queer, South Asian settler on this land. He goes by he/him pronouns and is a healthcare disruptor at heart. Equipped with formal education in Public Health and Clinical Medicine, he has navigated a variety of experiences supporting health communications, primary healthcare delivery and community health promotion programs. His experiences are shaped by the importance of centring community voices and working with communities to support health equity gains.
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COVID-19 was a significant disruption that required programs and projects to pivot substantially in order to meet the specific needs of different individuals. The pandemic occurred in the presence of other epidemics, such as substance use, loneliness among others, resulting in a syndemic. Considering the impact of climate change, stigma and discrimination, equity-owed communities experience unique challenges that only people with lived experience can inform.

Co-designing care requires a full appreciation of what keeps someone “well.” Few programs and systems have the capacity and structure to address the intersectional needs and concerns of people. The pandemic was a catalyst for projects and programs to begin considering multiple factors consistently when engaging in the delivery of care. From a quadruple-aim perspective, the quality of health care is dependent on population health, cost, and patient and provider experiences. As patients seek out reliable and accurate health care information in a post-pandemic era prevalent in misinformation, meaningful dynamics between the health care provider and client is more important than ever.
“This is a key factor impacting informed health care decision-making,” says Perera. “With singular stories on social media perpetuating powerful narratives, people may find it more difficult to objectively consider health care expertise leading to poorer health outcomes.”
Meaningful engagement of people and organizations with lived and shared experiences is a process, not an event. Therefore, ongoing participation with clients and patients through stakeholder engagement catalyses the development of resilient programs, products and policies. One co-design resource highlighting the importance of engaging people with lived experiences with a practical road map is the Project Heart toolkit which can be found at: https://projectheart.ca.
Conclusion
Healthcare Resiliency explores the real impact of COVID-19 on Canada’s healthcare system and examines the process of adaptation that lies ahead of us, to inform our co-design strategy and develop the process for building strength and resilience in the face of these structural changes.
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