It was on a plane in 1998 that John Cole used his napkin to map out a revolution for Northern Ireland's health-care system.
Mr. Cole, an executive in Northern Ireland's Department of Health, Social Services and Public Safety, was on his way home to the outskirts of Belfast after a visit to the Codman Square Health Center, which provides a mix of medical services, classes, counselling and other activities to one of Boston's poorest and most notorious neighbourhoods.
When the centre first arrived and asked residents what it could do to help improve their lives, they asked that the burned wrecks of cars be hauled away from neighbourhood corners. The gesture helped to inspire community confidence in a new way to think about health care.
Codman Square brought doctors and nurses to patients, taught workers how to prepare their taxes, taught people how to cook better food and gave families a place to swim and teenagers a place to do their homework.
Mr. Cole had been grappling with problems that threatened to engulf Northern Ireland's health-care system – scarce hospital beds, packed emergency rooms, a shortage of doctors and an aging population with multiple chronic illnesses.
After visiting Boston, he realized that Northern Ireland had been doing things backward: Instead of bringing people to cold, clinical institutions to be fixed after they had become sick, the future would hinge on keeping people out of hospitals.
He was met with a wall of political opposition and skepticism. The health community was hesitant to abandon the traditional hospital model in favour of a focus on prevention and promoting health by designing buildings around the needs of patients.
People were unsettled by the idea of spending vast sums of money to treat outpatients and those needing to enter hospital in an environment that might have more in common with a spa.
Now, as Canada is facing its own health crisis of shortages and rising demand, a growing number of leading authorities say the new Northern Irish system is exactly what is needed here.
It would make patient care a priority by putting everything from doctor's offices to physiotherapists and speech therapy under one roof and combining them with fitness centres, libraries, financial and legal advisers and meeting spaces for community groups.
These health-and-well-being centres, as they are known, have large, open atriums that make it easy for residents to find their way around, ample natural light, community artwork covering the walls and gardens where visitors can escape for a quiet moment.
What they do not have is beds. In fact, since Mr. Cole's plan was put in motion, Northern Ireland has begun closing community hospitals to make way for the new centres, where patients can get access to everything they need under one roof.
Those who have chronic illnesses or need continuous care can be visited at home by health-care workers who will help manage their illness. Those who need to be admitted to hospital are sent to a larger regional centre that specializes in their condition.
Although it's only a few years old, the model is attracting attention from around the world. The new centres have won a slew of prestigious international design awards and delegations from Australia, Japan, Sweden and Norway, among others, have visited to learn from what Mr. Cole has been able to accomplish.
But in Canada, there are fears that unless the health-care rhetoric can move beyond political fighting over budgets and services to focus on how to design a better system, no major improvements will ever be made.
Today's hospitals are not built for today's patients
Canadian hospitals are the epitome of contradiction, according to Howard Abrams, the division head of internal medicine at Mount Sinai Hospital in Toronto.
Specialized wings that house cardiology, transplants, neurosurgery and cancer care are often beautiful, state-of-the-art facilities that have no problem playing host to politicians making health-care announcements.
Then there are the general wards, with two or more patients per room separated by thin curtains, as well as an overflow of patients lying on stretchers in hallways and constant noise from visitors, staff and the overhead announcement system.
“If you walk into Princess Margaret [Hospital, one of the world's top cancer centres] it looks like a five-star hotel,” Dr. Abrams says. “If you walk onto a ward at the Toronto General, for general internal medicine, you feel like you're in the Third World.”Report Typo/Error