why systems change is so hard

I have been thinking a lot about systems change — and why it's so hard.

Real systems change requires sustained bravery and commitment. It means fundamentally reorienting how we work, even when it's uncomfortable.

In January, the Alliance to End Homelessness Ottawa hosted a series focused on ending homelessness in Ottawa. It featured two incredible advocates: Michael Lethby, Executive Director of The Raft — someone whose work I have followed for close to twenty years — and Sandra Clarkson, Executive Director of the Calgary Drop-In.

Both presentations showed how their organizations fundamentally reoriented their view of emergency shelters' role in the continuum of care, and both have seen significant reductions in shelter use and length of stays. But for some, including people within their own organizations, this was uncomfortable. Staff had to adjust to a new way of working. Services were moving out of shelters, and that was initially seen as a reduction in what they were providing, rather than a step forward.

This pattern of resistance isn't new.

One of the most exciting systems change initiatives I worked on during my time in the public service was the Government of Canada's shift to a Housing First policy. Coming off foundational research by the Mental Health Commission of Canada and more than a decade of evidence from the United States, Housing First was both effective and cost-efficient. After years of no new investments and a maintained status quo, the shift was monumental.

Up to that point, the Government's response to homelessness had been a mix of capital investments, emergency and prevention supports, community planning, and data. Housing First represented a significant departure from that approach. During our policy and program design work, we were acutely aware of the impact this could have on the shelter system. We worried providers wouldn't see themselves in the new policy and would be anxious about what the shift meant for their organizations and their staff. We knew change management was essential and we tried to get ahead of it. But change management requires sustained effort. It's not a one-and-done thing.

Since its implementation, Housing First in Canada has been met with mixed reviews. I have long questioned how much of that reflects implementation and fidelity to the model, rather than any flaw in the model itself. If we don't invest in helping organizations actually change, we are not delivering the policy or having the impact that we want to have.

One of the realities of government funding is that it can be remarkably shortsighted. Funding capacity development or change management isn't a compelling political story. It doesn't win elections. Politicians want to talk about direct impact — and as a taxpayer, I understand that. We want to hear about lives changed. But when most of the money goes directly to service provision while the work of supporting change is neglected, we undermine the very outcomes we're trying to achieve.

At Matthew Perry House, we're engaged in this same difficult work of systems change with our friends at CAPSA Canada. We know it requires reorienting systems that have worked a certain way for a long time. We know it will be uncomfortable.

The framework we work from is substance use health: understanding a person's relationship with substances — alcohol, nicotine, cannabis, opioids, cocaine — as a component of their overall well-being. Rather than viewing substance use as a binary of "addiction" or "abstinence," this approach sees it along a spectrum, ranging from non-use to lower-risk use to, at one end, substance use disorders.

We all have substance use health.

But for systems built on abstinence models, on crisis intervention, systems that have been rooted in shame, this is a fundamental shift. It means centering our work in dignity and continuity. It means meeting people where they are, on their own timeline.

What Sandra and Mike shared really stayed with me. They both spoke about how, over time, staff began to see that the discomfort of the transition as being worth it. By relocating services outside of their shelter, they were able to accompany guests to services in the community. They were helping them build social connections, develop networks, and create self-sufficiency. The short-term discomfort gave way to long-term impact.

Here in Ottawa, I've been proud to watch similar work take shape. The Alliance to End Homelessness Ottawa has championed hard conversations that are moving us closer to ending homelessness. There has been remarkable work started on similar projects on shelter diversion at Shepherds of Good Hope and the Youth Services Bureau of Ottawa — work that is already showing promising results. Hard work that is worth doing because it is the right thing to do.

This is what sustained commitment looks like.

I am continually motivated by Matthew's legacy. Matthew Perry dreamed of a place that centered the needs of the individual. A place that made substance use a health journey, not about shame and stigma, but about dignity and continuity, especially when it was most needed.

Building that place requires the same kind of sustained bravery we've seen in these other systems change efforts. It requires believing that even when change is uncomfortable, even when it challenges how things have always been done, it's worth it.

 That's the work we're committed to.