Background: Healthcare harm continues to occur in our health and social care systems. In Canada, adverse events in healthcare occur every minute and eighteen seconds, resulting in 28,000 deaths per year. Not only does healthcare harm include traditional adverse events, but it includes racism, discrimination, lateral violence amongst healthcare providers, and a culture that lacks relational practices. Our current health human resource challenges contribute to patient safety, relationships between providers, and health system culture. Harm can impact patients, providers, or organizations and can include physical harm, psychosocial, discrimination, compounded harm, communication, and institutional/system factors. A restorative approach is a relational approach, based on a set of key principles that has the potential to address healthcare harm and wellbeing. The use of a restorative approach moves away from a more traditional approach to healthcare harm (transactional, punitive and risk-aversion) to repairing relational harm, supporting just relations and building or re-building trust. Furthermore, it supports learning for current and future harms. Restorative justice approaches have been used in Canada and internationally in the justice system and education for many years. In healthcare, adapted versions of restorative justice with a more appropriate title, restorative approach, is a relatively new approach and has been successfully used in New Zealand (surgical mesh harm), Australia (Canberra Restorative Community) and the UK (Restorative Just and Learning Culture) in various formats. In British Columbia (BC), Canada, the concept of a restorative approach has been socialized through a leadership symposium, several training options including the development of a course in Foundations of a Restorative Approach, and a feasibility study is currently underway.

Approach: Objectives include: 1) to define key concepts of a restorative approach; 2) how a restorative approach could be used in healthcare; and 3) key initiatives in BC.

Results: Key components of a restorative approach will be shared and international examples will be provided. BC has undertaken various activities (training events, leadership symposium, and Foundations of a Restorative Approach course) to socialize and move towards the use of a restorative approach in healthcare. Finally, we will share key components of our protocol for our feasibility study (using a restorative approach in the health system) to be undertaken in one of our health authorities in BC.

Implications: A restorative approach has the potential to improve outcomes for patients, community members, healthcare providers and healthcare organizations. Building and (re)building trust through health system transformation is a key to facilitating integrated care.

Background
Complex needs of citizens are characterized by support questions in different but interconnected domains of daily life, such as social participation, psychosocial health, meaning to life and physical condition. Personized care focuses on those different interacting components that respond to the needs in these different domains. This personalized approach contrasts with the current services of separate care organizations that mainly focus on providing care in one life domain. Dynamic networks with both formal and multiple informal caregivers seem more suitable to provide personized care.

Approach
Patients, communities and formal caregivers, managers, administrators, supervisors, funders and master students are actively involved in the practice projects.
• At micro-level, with all stakeholders we co-created and collaborated with clients, informal carers and various professionals in dynamic networking.
• At meso-level, with all stakeholders we organized and managed dynamic networks.
• At macro-level, we still search how accountability and financing of dynamic network care can be structured.

Results
• At micro-level, we found that especially informal care givers can be motivated to cooperate when they are challenged about their talents.
• At meso-level, we found that participants often take generic roles in the dynamic networks, such as the ‘organizer’, the ‘direct supporter’ and the ‘indirect supporter’.
• At macro-level we found that the network is held responsible as a whole by accountability bodies (government, insurers, etc.) for accountability for the care provided. However, the individual members (certainly the informal care providers) cannot be held responsible for the whole. Existing approaches of accountability appear to be unsustainable and should be shift to a more societal approach.

Implications
First insights for setting up dynamic and fluid organizational forms for providing person centred care on micro-level, meso-level and macro-level.
We work on:
• identifying more requirements for organising dynamic care networks;
• identifying accountability features for dynamic network care;
• on gaining insight in how policy can be made at local, regional, national and European level for facilitating dynamic micro network care.

The Best Practice Spotlight Organization® (BPSO®) Program - spearheaded by the Registered Nurses' Association of Ontario (RNAO) - has fostered a social movement of science to implement evidence-based Best Practice Guidelines (BPGs) across health care organizations since 2003. Now in place at 1,600 health organizations, the program has mobilized more than 150,000 BPSO Champions worldwide to drive continuous quality improvement in care delivery, yielding impactful outcomes for staff, patients, organizations and health systems. In 2019, the BPSO program expanded to include integrated systems of care - starting with four Ontario Health Teams (OHTs) as founding partners - implementing two priority RNAO best practice guidelines: Person- and Family-Centered Care (2015) and Transitions in Care and Services (2023).
Approach
East Toronto Health Partners (ETHP) Ontario Health Team (OHT) was selected as one of the inaugural BPSO OHT candidates, uniting organizations from primary care, home care, rehabilitation, community service sectors and acute care. Cross-sectoral teams, including patient and caregiver partners, collaboratively reviewed BPG recommendations and identified key joint projects to improve care outcomes. ETHP developed e-learning modules and resource toolkits to support these efforts, enhancing communication and continuity of care within the OHT, particularly during care transitions.
The BPSO OHT committee structure was pivotal to its success. The steering committee established relationships across partners' professional practice departments, supported by the OHT's operational and governance frameworks. This structure evolved to include strong community leadership, with community members co-leading BPSO OHT committees and championing evidence-based care initiatives.
RNAO's four-year framework, tailored to meet OHT needs, provides tools for engaging champions, selecting guidelines, identifying practice gaps, coaching, and tracking key performance indicators. This structured approach, guided by RNAO's Leading Change Toolkit (fourth edition) ensured alignment among partners and equipped them with the essential tools for successful BPG implementation.
Results
The BPSO OHT initiative enabled ETHP to shift from quality programs operating "within" organizations to an integrated improvement approach "across" organizations. Frontline providers from several disciplines and sectors have become champions for both evidence-based practice and integrated care. ETHP also undertook three RNAO Advanced Clinical Practice Fellowships, where early-career fellows - mentored by OHT nursing leaders - conducted a qualitative study on care journeys using RNAO's quality improvement methodology. These fellowships deepened fellows' understanding of integrated care, generating insights that benefit the broader community and the OHT. ETHP's 2024 "designation" as a BPSO OHT, after completing RNAO's established milestones over a four-year "pre-designation" period, positions ETHP to offer mentorship to other OHTs in earlier stages of their journey.
Implications
The BPSO OHT program advances collaborative approaches to evidence-based care across integrated systems of care by powering frontline providers as champions. The initiative demonstrates that effective implementation of best practices requires adherence to guidelines, along with a commitment to collective action and shared accountability across systems of care. ETHP's experience as a BPSO OHT can guide future efforts to enhance integrated care, promote a culture of continuous improvement, and strengthen resilience in healthcare teams. Collaborative strategies will be crucial for sustaining our workforce and addressing complex population needs.

Background
In the UK, Integrated Care Systems (ICSs), were formed on July 1, 2022, consisting of 42 ICSs across the country. They play a key role in implementing the National Health Service long-term plan. The 42 ICSs are local partnerships that bring health and care organisations together to develop shared plans and joined-up services. The Bedfordshire, Luton, and Milton Keynes Integrated Care System (BLMK ICS) one of the 42 ICSs serves a diverse population within the aforementioned areas with the main aim to provide better and efficient care to their system users.
The University of Bedfordshire is one of six Anchor Institutions in the East of England, funded directly by National Health Service England (NHSE) to form a ‘Hub’ to practically support integrated care initiatives. The resulting entity, known as BLMK ICS Research and Innovation Hub, works closely and under a joint governance framework with the BLMK Integrated Care Board (ICB) to develop trusted evidence base as well as health and social care interventions to improve the health and care of the BLMK population.

Approach
The University of Bedfordshire's BLMK ICS Research and Innovation Hub joined an extensive network of system partners that included 27 Primary Care Networks, comprising 95 primary care practices, four Healthwatches, local Councils, and NHS organisations like hospitals, community, mental health, and ambulance trusts. The overarching aim of the partnership between the University of Bedfordshire and BLMK ICS is to facilitate research and innovation activities with particular emphasis on:
1. Ascertaining user needs and addressing health and social care inequalities
2. Supporting and developing the workforce to provide integrated population care
3. Building capacity and capability for research and innovation
4. Providing subject matter expertise to research and innovation projects

Results
The BLMK ICS Research and Innovation Hub in the University of Bedfordshire is host to 17 implementation studies that are ongoing and will provide the regional stakeholders with the much needed evidence to make tangible steps towards integrating services for efficacy and efficiency. In addition to relying on a multidisciplinary team of 33 academics the Hub makes good use of the joint governance framework that we developed with regional stakeholders and commissioning to ensure that the research we do addresses regional priorities. This is an innovative approach for the UK which has started yielding benefits in terms of relevance and applicability of findings, as the University has started having an input in the transformation work that is ongoing in the region.

Implications
The Hub's multifaceted integrated care approach brings together various stakeholders to address complex clinical, social, organisational, commissioning, administrative issues, allowing community to participate in the planning, implementation, and assessment of the work that happens regionally. The planned and established advancements of the discussed partnership might serve as a benchmark for creating framework and a platform commissioners, health and social care providers to work with Universities to provide improved and efficient health and social care.

Introduction and aims
In the evolving and complex healthcare landscape, understanding how various stakeholders, such as healthcare professionals, managers, regional officers, and decision-makers, perceive and understand person-centred integrated care is critical to its enactment and implementation. This study explores the sense-making processes of these key actors regarding their roles and daily practices within a stroke care and rehabilitation trajectory of different care providers, organisations and levels of care. The study examined factors influencing the stakeholder's understanding and application of person-centred integrated care. The following research questions were addressed:
- How do healthcare professionals, managers, regional civil servants, and policy-makers make sense of their role, daily practice, and the stroke care trajectory, and what influences their understanding of and use of person-centred integrated care?
- What are the barriers and facilitators to implementing person-centred integrated care in different healthcare contexts, and how can these be addressed to promote more widespread adoption of person-centred integrated care?

Methods
An ethnographic field study was conducted, involving healthcare professionals and leaders within different parts of the stroke care trajectory to capture perspectives from a micro and meso level, i.e. acute stroke units, geriatric wards, primary healthcare centres, specialised rehabilitation facilities, and nursing facilities. Regional civil servants and policy-makers were included in order to include the macro perspective. Observations, individual interviews, and interviews in dyads or focus groups were carried out with healthcare professionals, managers, civil servants and policy-makers regarding their role and daily practice, sense-making and views on and conditions for practising and implementing person-centred integrated care. Data is analysed thematically (ongoing) and draws on a sense-making approach to elucidate how participants interpret and operationalise person-centred integrated care.

Results
Findings (preliminary) from 110-hour observations and 38 interviews reveal significant variability in perceptions of person-centred integrated care and how it should be operationalised. The sense-making process highlights an interplay between factors such as identity, values, and one's view of one's role and responsibility for contributing to an integrated care trajectory. Further, organisational, cultural, and systemic constraints are important in facilitating or hindering a person-centred integrated care trajectory. Key barriers identified include fragmented communication channels, misaligned incentives, and a need for more support for individual and collective development. Facilitators encompass interdisciplinary collaboration, a culture of coordination, the integration of feedback mechanisms between levels of care, and dialogue based on benevolence.

Conclusion
The study contributes insights into important factors to consider when aiming for person-centred integrated care and rehabilitation both within and across organisations and levels of care. The knowledge generated can promote a broader operationalisation of person-centred integrated care. The implications extend to policy-makers, healthcare leaders, and practitioners/professionals, who must collectively foster environments that facilitate meaningful relationship building between individuals, organisations and levels of care.