Why Healthcare's Capacity Crisis is a Design Problem – An Interview with Shannon Kenrick-Rochon
Shannon Kenrick-Rochon is a Canadian nurse practitioner, healthcare founder, researcher, and academic leader whose work focuses on rethinking how healthcare uses its people, technology, and clinical resources. Through Prosper Health, Move Medicine, and her academic work, she has built and tested care models that challenge traditional assumptions about professional roles, team-based care, and how capacity is created. In this interview, she explores why healthcare's capacity crisis cannot be solved through recruitment alone and why meaningful reform requires health systems to rethink how care is actually designed.
Shannon Kenrick-Rochon, Healthcare Systems Innovator & Entrepreneur
What first made you realize that healthcare's capacity problem was also a systems design problem?
For me, it came from watching the same problem repeat itself in different parts of healthcare. We would identify a capacity issue, and the solution was almost always some version of "we need more people." More physicians, more nurses, more funding for another position. At the same time, I was watching highly trained clinicians spend huge amounts of time doing work that did not require their level of training, while other healthcare professionals were not being used anywhere near the full extent of their skills.
That disconnect became very hard to ignore. Healthcare absolutely has real workforce shortages, particularly in rural, remote, and underserved regions like Northern Ontario, but this is not uniquely a Canadian problem. Hiring more people into a poorly designed system does not automatically create better access. Sometimes, it simply makes an inefficient system larger and more expensive.
I started asking different questions: What actually needs to happen for this patient? Who is qualified to do each part? What can be standardized or automated? Where is advanced clinical judgment genuinely required? Those questions led me away from thinking only about workforce numbers and toward system design.
What have Prosper Health and Move Medicine taught you about building care models differently from the ground up?
The biggest lesson has been not to start with traditional job descriptions. Start with the patient journey and work backward. What information do we need? What requires clinical assessment? What requires prescribing? What can be addressed through education, monitoring, rehabilitation, or follow-up? Then decide who on the team is best positioned to do each part.
In healthcare, we often do the opposite. We inherit a structure, usually one built around historic funding models and professional roles, and then try to fit patients into it. With Prosper Health and Move Medicine, I have had the opportunity to test what happens when you design the workflow first and then build the team around it. That means creating systems where healthcare professionals are working within their competence and authorized scope, with clear pathways for escalation when a patient requires a different level of expertise.
It has also taught me that a model is not innovative if it only works because everyone is overfunctioning. Better care should improve access for patients while also making the work more sustainable for the people delivering it.
How has working as a clinician, founder, researcher, and academic changed the way you approach healthcare reform?
Those roles make it almost impossible for me to look at healthcare reform from only one perspective. As a clinician, I ask whether something will work with a real patient. As a founder, I ask whether it is sustainable. Research forces me to separate evidence from enthusiasm, and academia makes me think about preparing future clinicians for a very different system.
Some of my most important leadership lessons have also come from outside healthcare. The Homeward Bound STEMM leadership expedition to Antarctica reinforced the value of diverse expertise and perspectives, as well as challenging assumptions. Volunteering in youth sport through coaching, team roles, and board governance in hockey and fastball has shown me how strongly systems determine who gets opportunities, whose voice is heard, and whether good people can succeed.
Across those settings, I have become skeptical of models that depend on committed people compensating for poor design. We often call that resilience. I am more interested in building systems where people can do excellent work without extraordinary personal sacrifice because if a model is not sustainable for the people delivering it, eventually it fails the people it is meant to serve.
Where do you see healthcare professionals being most underused because of outdated roles or workflows?
I think we underuse people throughout the system because we still organize care around rigid ideas about professional roles. Nurses, nurse practitioners, pharmacists, physiotherapists, chiropractors, social workers, and other healthcare professionals often have more capability than the workflows around them allow them to use. At the same time, physicians and advanced practice clinicians spend significant time on routine information gathering, repetitive education, administrative work, or follow-up that could safely happen elsewhere in a well-designed team.
Using people to their full capability also requires genuine knowledge of and respect for our colleagues' expertise. It cannot become a conversation about replacing one profession with a cheaper one. I do not believe a nurse practitioner should be viewed as a discounted version of a physician. If I competently perform the same defined clinical task, an injection, for example, the value of that service does not decrease because a nurse practitioner performed it.
Where appropriately qualified clinicians deliver the same service to the same standard and carry comparable responsibility, the work should not be artificially discounted because of professional title. Once scope discussions become professional turf wars, objectivity disappears. The focus has to remain on competence, accountability, patient need, and the value of the work.
Which parts of healthcare should artificial intelligence handle so clinicians can focus more on judgment and human connection?
I want artificial intelligence (AI) handling the work around the clinical encounter that does not require a clinician to be the one doing it. Healthcare professionals spend an enormous amount of time finding information, organizing it, documenting it, transferring it between systems, and recreating work that has already been done somewhere else. That is a very expensive use of clinical time.
There is real opportunity in chart preparation, documentation support, routine patient education, data extraction, quality improvement, workflow tracking, summarizing information, and administrative triage. I use AI heavily in my own work, but I am very clear about where I think the boundary needs to be. Clinical judgment, uncertainty, consent, complex risk-benefit discussions, and the human parts of care still matter enormously.
A patient does not only need information. Sometimes they need someone to notice that the story does not quite fit, to ask another question, or to understand what is not being said. AI should create more room for that. I am not interested in using technology to remove clinicians from care. I am interested in removing work that keeps clinicians from actually practising.
What is the first workflow problem you look for when a clinic is struggling with capacity?
I usually look at what the clinician is doing before I assume the clinic needs another clinician. If the most highly trained person in the workflow is spending the first ten minutes of every appointment searching for records, confirming medications, collecting information that could have been gathered earlier, or arranging routine next steps, there is probably a design problem before there is a staffing problem. I also look at how often the same information is being collected and how many handoffs a task goes through.
Healthcare creates a surprising amount of work by making the same patient tell the same story multiple times or by having several people touch a task before anyone actually completes it. Most struggling clinics are not short on busy people. Everyone is already busy. The question is whether the work is happening at the right point in the pathway and with the right person.
Sometimes, the fastest way to create capacity is to redesign everything that happens before and after the clinician enters the encounter. That protects clinical time for the decisions that actually require that level of expertise.
How can interdisciplinary teams expand access without simply adding more people to the system?
Putting several professions in the same building does not automatically create interdisciplinary care. I have seen plenty of "teams" where everyone is still working in parallel. The opportunity comes when you design the pathway as a team and decide where each person adds the most value. That requires knowing and respecting what our colleagues are trained and authorized to do.
Who gathers the history? Who provides education? Who manages rehabilitation? What follow-up can happen using a protocol? When does someone need a prescriber or advanced diagnostic expertise? When should care be escalated? When those expectations are clear, people can practise with more autonomy, and patients move through care more efficiently.
The harder part is that this only works if we move beyond professional protectionism. If expanding one profession's contribution is automatically seen as a threat to another, the discussion is no longer centred on designing the best care. Scope expansion also cannot become a mechanism for obtaining the same clinical work at a lower price. If healthcare professionals take on greater responsibility and use more of their expertise, remuneration should reflect the skill, accountability, and value of that work. Respect for scope and respect for value have to move together.
What does your principle of "evidence over hype" require from you when healthcare trends move faster than the research?
It requires being willing to say, "We do not know yet," which is not always a popular answer. Healthcare trends now move incredibly quickly. Patients can hear about a new treatment online long before there is good clinical evidence, and clinicians are often expected to give a definitive yes or no answer when the real answer is much more nuanced.
For me, evidence over hype means being clear about the difference between what has been demonstrated, what looks promising, what is biologically plausible, and what is still largely anecdotal. Those are not the same thing. It also means not dismissing new ideas simply because the evidence base is immature. Some worthwhile innovations begin before we have years of data. The responsibility is to be transparent about that uncertainty and to understand the potential risks.
I also think expertise requires a willingness to change your mind. If better evidence comes along, my practice should change with it. I am very interested in innovation, but innovation still has to tolerate scrutiny. New does not automatically mean better, and traditional does not automatically mean correct.
If healthcare leaders changed one assumption about how care should be delivered, which would make the greatest difference?
I would change the assumption that healthcare should be organized around the professional hierarchies, funding models, and workflows we inherited. I would rather start with the work that needs to be done.
What does this patient population need? Which parts require advanced clinical judgment? Which can be standardized? Which can be handled by another appropriately qualified healthcare professional? Where can technology help? What level of skill, complexity, and responsibility does each task require, and what is that work worth?
Once you answer those questions, you can design the workforce around the care rather than forcing care into a structure that may no longer make sense. That also means questioning remuneration models. Where appropriately qualified professionals deliver the same defined service to the same standard and with comparable responsibility, we should be able to explain why the value assigned to that work would differ based primarily on professional title.
I do not think healthcare has a shortage of committed people. We have spent years depending on committed people to compensate for poor design. The next step is to value expertise, reduce professional silos, use technology intelligently, and design systems around the best interests of patients and the people providing their care.
Read more from Shannon Kenrick-Rochon
