Policy Jurisdictions Research Articles

Blockchain technology integration in tax policy: Navigating challenges and unlocking opportunities for improving the taxation of Ghana's digital economy

In an era marked by a profound digital transformation of economies worldwide, Ghana stands as a vivid example of a nation at the crossroads of taxation evolution. The country's tax policies are undergoing a significant shift to adapt to the burgeoning digital economy, with a keen focus on capturing and regulating the ever-expanding revenue streams generated through online enterprises. This research explored the potential of integrating blockchain technology with tax policy. Unstructured and semi-structured interview questions were designed to obtain insight into the problem. A survey was conducted to obtain views on the variables that explained the potential of integrating blockchain technology with tax policy to enhance the effectiveness of taxing online enterprises in Ghana. The study used correlation analysis to confirm propositions derived from preliminary interview and the review of literature. It was found that while blockchain offers significant advantages in bridging the gap for effective online taxation in Ghana, there are challenges which include institutional and regulatory conformity issues, technical integration and alignment incompatibility, and inadequate stakeholder engagement. This result may be useful in the design of tax online tax policy in Ghana and other jurisdictions with similar socio-economic environment.

Scaling-up sustainable commodity governance through jurisdictional initiatives: Political pathways to sector transformation in the Indonesian palm oil sector?

Voluntary systems of sustainable commodity governance have come under intensified criticism for failing to catalyse transformative change beyond directly regulated supply chains. In response, there has been a surge of efforts to ‘scale-up’ sustainability impacts through governance interventions at landscape and jurisdictional scales. While these ambitious, scaled-up approaches are attracting significant interest, such approaches demand substantial changes to established repertoires of policy interventions and associated understandings of the pathways through which these contribute to sustainability outcomes. Drawing theoretical insights from scholarship on multi-stakeholder sustainability governance together with findings from a qualitative study of jurisdictional governance experiments in the Indonesian palm oil sector, this paper explores how emerging jurisdictional initiatives are promoting change pathways towards more sustainable commodity production, and how the political, environmental governance and economic contexts in which these interventions are implemented influence these pathways. Analysis shows that by integrating a distinctive mix of market and policy-driven interventions, jurisdictional approaches are contributing to three core pathways of change, centred respectively on network and coalition-building, collaborative governance, and resource mobilisation. However, which of these pathways are most influential, how interventions are sequenced and operationalised, and how the pathways interact in shaping change is highly sensitive to varied subnational implementation contexts, with important implications for the impact and resilience of jurisdictional programs. These findings highlight the need for jurisdictional policy interventions to respond flexibly to contextually-variable configurations of actor interests, coalitions and power relations within contested multi-scalar processes of sustainable commodity governance.

Optimizing rural healthcare through improved team function: a case study of the Rural Surgical Obstetrical Networks programme

ABSTRACT We explored enablers and mechanisms of optimal team function within rural hospital teams, and the impact of these factors on health service sustainability in British Columbia. The data were drawn from interviews and focus groups with healthcare providers and administrators (n = 169) who participated in the Rural Surgical Obstetrical Networks (RSON) initiative to support low-volume rural surgical and obstetrical services in British Columbia, Canada. The 5-year programme (2018–2022) provided evidence-based system interventions across eight rural sites with the objective of providing sustainable, quality health services to meet population needs. To explore the impact of RSON interventions on local team function, we performed a scoping review, to assess the current literature surrounding enablers of effective rural hospital teamwork. Through inductive thematic analysis of interview data, we identified five enablers of good team function at RSON sites, including emphasis on local leadership, shared direction, commitment to sustainability, respect and solidarity among colleagues, and meaningful communication. The RSON project led to a shift in team culture in participating sites, improved team function, and contributed to improved clinical processes and patient outcomes. The findings have implications for rural health policy and practice in British Columbia and other jurisdictions with similar health service delivery models and geographic contexts.

The Transition to a Circular Built Environment in Australia: An Analysis of the Jurisdictional Policy Framework

The construction industry significantly impacts the built environment throughout its lifecycle from design, construction, operation to end-of-life considerations and decisions. In Australia, the industry generates almost 3 tonnes of waste per-capita, and this is expected to increase in the near future based on past trends. This paper focuses on understanding and analysing the various jurisdictional policy frameworks across Australia to support circular transitions in the built environment. Policy and regulatory leadership can enable and support grounding circular economy practices at national and state levels. The analysis found that circular economy frameworks rely heavily on recovery and recycling of construction waste, while there is minimal focus on designing out waste. This highlights that waste elimination within the policy setting is viewed as an end-of-pipe solution of minimising waste to landfill rather than a design led strategy. The focus on recycling within circular economy policies can led to public misconceptions about circularity, which can be a major barrier if systemic transitions are to be achieved.

Explaining the allocation of legislative specialization

Abstract This article explains why there is important variation in the degree of concentration of legislative specialization across legislative parties. Greater concentration of legislative specialization leads parties to concentrate their legislative efforts on a smaller set of policy jurisdictions. Through enhancing their concentration of legislative specialization in certain policy areas, parties might more clearly signal their policy concerns and interests to voters. This study argues and shows that party size alters the concentration of legislative specialization. In particular, I find that a U-shaped curve defines the relationship between party size and the degree of concentration of legislative specialization: niche parties and the largest parties choose higher levels of concentration of legislative specialization.

Provincial policies affecting resident quality of life in Canadian residential long-term care

BackgroundThe precautions and restrictions imposed by the recent Covid-19 pandemic drew attention to the criticality of quality of care in long-term care facilities internationally, and in Canada. They also underscored the importance of residents’ quality of life. In deference to the risk mitigation measures in Canadian long-term care settings during Covid-19, some person-centred, quality of life policies were paused, unused, or under-utilised. This study aimed to interrogate these existing but latent policies, to capture their potentiality in terms of positively influencing the quality of life of residents in long-term care in Canada.MethodsThe study analysed policies related to quality of life of long-term care residents in four Canadian provinces (British Columbia, Alberta, Ontario, and Nova Scotia). Three policy orientations were framed utilising a comparative approach: situational (environmental conditions), structural (organisational content), and temporal (developmental trajectories). 84 long term care policies were reviewed, relating to different policy jurisdictions, policy types, and quality of life domains.ResultsOverall, the intersection of jurisdiction, policy types, and quality of life domains confirms that some policies, particularly safety, security and order, may be prioritised in different types of policy documents, and over other quality of life domains. Alternatively, the presence of a resident focused quality of life in many policies affirms the cultural shift towards greater person-centredness. These findings are both explicit and implicit, and mediated through the expression of individual policy excerpts.ConclusionThe analysis provides substantive evidence of three key policy levers: situations–providing specific examples of resident focused quality of life policy overshadowing in each jurisdiction; structures–identifying which types of policy and quality of life expressions are more vulnerable to dominance by others; and trajectories–confirming the cultural shift towards more person-centredness in Canadian long-term care related policies over time. It also demonstrates and contextualises examples of policy slippage, differential policy weights, and cultural shifts across existing policies. When applied within a resident focused, quality of life lens, these policies can be leveraged to improve extant resource utilisation. Consequently, the study provides a timely, positive, forward-facing roadmap upon which to enhance and build policies that capitalise and enable person-centredness in the provision of long-term care in Canada.

MACAU 2.0: New Gaming Law and its Implications for Casino Market

This article discusses the new gaming law in Macau with emphasis on the critical aspects concerning the gaming operators, concession regime, and other regulatory obligations.1Thanks to the gaming liberalization commenced in 2001,2 Macau has experienced tremendous economic growth. The past two decades have seen the rapid development of large-scale integrated resorts, and Macau now ranks among the world's major gaming jurisdictions.3 Policy and regulatory challenges have also emerged along with the growth of the junket-driven VIP business in casinos.4 With the recent amendment of Law No. 16/2001 and the subsequent enactment of Law No. 16/2022, Macau has strengthened the legal underpinnings of its system of gaming regulation to oversee various groups involved in casinos and their industry practices. The present study is among the first to review the scope and impact of the revised gaming law, and associated managerial and operational implications for Macau casinos. Topics covered include policy directions, concession requirements, industry participants, gaming taxes, and fair business practices. This study could provide insights into the “Macau 2.0” project and how casinos are to be operated and managed over the next decade. This article could also provide practical guidance for policy makers charged with formulating gaming policy and regulation in other jurisdictions.

Central bank policy formulation under COVID-19 in Ghana: A fit-for-purpose?

<p><big>This paper evaluates the fit-for-purpose of the monetary policy measures implemented by the Bank of Ghana in response to the COVID-19 pandemic. We examine the effectiveness of the BoG’s policy interventions in the context of vector autoregressions augmented with macroeconomic and financial indicators. We demonstrate that the BoG’s monetary policy measures have had nominal, real, and financial effects. The monetary interventions have been successful, as evidenced by the gradual reduction in the sovereign spread, improved financial stability, and increased real economic activity. Our findings suggest that balance sheet actions are less effective and should be moderated in the conduct of monetary policy in jurisdictions without zero lower bound constraints. However, the analysis indicates that in times of crisis, central banks should deploy both standard and non-standard tools to stabilize dysfunctional financial markets and avoid a deflationary spiral. The historical and variance decomposition of the data reveal that monetary policy shocks have historically made the largest contributions to the targeted macro-financial aggregates during the pandemic episodes.</big></p>

Jurisdictional approaches to reducing emissions from deforestation and forest degradation in Brazil: Why do states adopt jurisdictional policies?

Although the role of subnational governments in multi-level climate governance is recognized by scholars and policymakers, we still know little about whether and why some subnational jurisdictions in the Global South decide to engage in decentralized climate action. This article yields new insights on this question by explaining variations in the decision of Brazilian states to establish legal frameworks for jurisdictional REDD+, enabling them to receive transnational climate finance, in the early stages of the emergence of REDD+ in Brazil between 2007 and 2017. We draw on key informant interviews with policy entrepreneurs and actors to understand the roles played by (1) the transnational pathways of influence associated with the regime complex for REDD+ and (2) the strategies adopted by state-level policy entrepreneurs in subnational REDD+ readiness policy processes in Brazil in five case studies (Amazonas, Acre, Mato Grosso, Pará and Amapá). According to respondents, credible market incentives were the key influence for state governors to adopt a jurisdictional framework to channel REDD+ funds, but transnational norms and material assistance played important mediating roles. The perceived credibility of market incentives was influenced by: (1) the presence of policy entrepreneurs at the state level; (2) the timing of strategies employed by policy entrepreneurs; (3) the policy beliefs held by the governor regarding environmental issues; and (4) evidence regarding availability of REDD+ finance for states.

A systematization of voter registration security

Abstract Voter registration is an essential part of almost any election process, and its security is a critical component of election security. Yet, despite notable compromises of voter registration systems, relatively little academic work has been devoted to securing voter registration systems, compared to research on other aspects of election security. In this paper, we present a systematic treatment of voter registration system security. We propose the first rigorous definitional framework for voter registration systems, describing the entities and core functionalities inherent in most voter registration systems, the jurisdictional policies that constrain specific implementations, and key security properties. Our definitions are configurable based on jurisdiction-specific parameters and policies. We provide a template for the structured presentation of detailed jurisdictional policy information, via a series of tables, and illustrate its application with detailed case studies of the voter registration systems of three US states and Panama. Throughout our research, with the aim of realism and practical applicability, we consulted current and former US election officials, civil society, and nonprofits in the elections space. We conclude with a list of critical questions regarding voter registration security.

Australian high-level public policy preparedness for population-based triage during the pandemic

The COVID-19 pandemic brought attention to scarce clinical resource allocation via secondary population-based triage (S-PBT) throughout the international healthcare community. Experiences overseas highlighted the importance of coordinated and consistent approaches to allocating resources when facing overwhelming demand, particularly for critical care. Noting the importance of consistency and the system of devolved governance deployed in Australia, this study aimed to identify and analyse sources of high-level policy that affect Australia’s health system preparedness for the operationalisation of S-PBT. Of the 39 documents reviewed, 17 contained potential references to S-PBT. There was a lack of clear recommendations and guidance to inform S-PBT operationalisation and, where provided, advice conflicted between documents. Many jurisdictions did not detail how S-PBT would be operationalised and failed to delineate stakeholder responsibilities. These results are important as they reveal a lack of high-level jurisdictional policy preparedness for coordinated and consistent S-PBT operationalisation. These results offer insights and opportunities for enhanced disaster preparedness as clinicians, policymakers and academics critically reflect on pandemic responses. The results show a need for enhanced preparedness around the management of overwhelming demand and clinical resource management in Australia.

An equitable vaccine delivery system: Lessons from the COVID-19 vaccine rollout in Canada.

The COVID-19 pandemic exacerbated existing health disparities and disproportionately affected vulnerable individuals and communities (e.g., low-income, precariously housed or in institutional settings, racialized, migrant, refugee, 2SLBGTQ+). Despite their higher risk of infection and sub-optimal access to healthcare, Canada's COVID-19 vaccination strategy focused primarily on age, as well as medical and occupational risk factors. We conducted a mixed-methods constant comparative qualitative analysis of epidemiological data from a national database of COVID-19 cases and vaccine coverage in four Canadian jurisdictions. Jurisdictional policies, policy updates, and associated press releases were collected from government websites, and qualitative data were collected through 34 semi-structured interviews of key informants from nine Canadian jurisdictions. Interviews were coded and analyzed for themes and patterns. COVID-19 vaccines were rolled out in Canada in three phases, each accompanied by specific challenges. Vaccine delivery systems typically featured large-venue mass immunization sites that presented a variety of barriers for those from vulnerable communities. The engagement and targeted outreach that featured in the later phases were driven predominantly by the efforts of community organizations and primary care providers, with limited support from provincial governments. While COVID-19 vaccine rollout in Canada is largely considered a success, such an interpretation is shaped by the metrics chosen. Vaccine delivery systems across Canada need substantial improvements to ensure optimal uptake and equitable access for all. Our findings suggest a more equitable model for vaccine delivery featuring early establishment of local barrier-free clinics, culturally safe and representative environment, as well as multi-lingual assistance, among other vulnerability-sensitive elements.

Jurisdictional Competition: Domestic Courts or Arbitral Tribunals? Lessons from the CJEU Judgments on EU’s Economic Agreements with Non-EU States

Abstract Summary A judgement by a domestic court in an international economic dispute, where the parties have agreed on an International Dispute Settlement Mechanism (IDSM), may be legitimate from the perspective of domestic law. However, it might entail concerns from the perspective of third states and Public International Law (PIL). Such concerns might be aggravated by the broadening of delicate foreign relations elements and protections for investors woven into international economic agreements. In the absence of clear PIL rules for conflicts arising from overlapping jurisdictional claims, such jurisdictional issues are subject to the discretion of the domestic court. A tendency to adjudicate such claims is strongly demonstrated in the caselaw of the EU Court of Justice (CJEU). The CJEU’s jurisdictional attitude towards competing IDSMs is examined in the context of the recent CJEU caselaw on disputes under bilateral and multilateral investment treaties involving non-EU states and investors, where the parties have committed to arbitration. The analysis then focuses on CJEU judgments on disputed EU trade agreements with non-EU states controlling Disputed Territories (DTs), in particular, trade with Israeli controlled DTs, where the parties have agreed on an IDSM. These judgements present substantial competing jurisdictional issues, that were scarcely dealt with in the literature. Consequently, the CJEU’s jurisdictional policy provides an excellent basis on which normative conclusions can be drawn regarding the profound effect it may have on third states, foreign investors and on the development of rules for the resolution of international economic conflicts.

Can carbon pricing counteract renewable energies’ cannibalization problem?

Support payments for renewable energies (RE) are a key climate-change policy in many jurisdictions globally. However, RE feed-in lowers the wholesale electricity price, thus cannibalizing their own market values. Despite steep cost degression, cannibalization endangers the hopes that RE may eventually survive in the market independently from subsidies. We apply a flexible econometric model to quantify the cannibalization effect together with influential factors that may counteract the problem. Our data are for the German electricity market, which is characterized by a high and increasing share of intermittent RE. We show that wind and solar infeed significantly cannibalize their own market values and that a meaningful carbon price can substantially counteract this problem. Thus, market-based climate policy may significantly boost RE’s integration. This is also relevant for other countries’ climate agendas. However, once power generation is fully decarbonized, support from carbon pricing will lapse and the design of the energy market will need to be reconsidered.

Commentary on Glanz et al.: Longer buprenorphine treatment duration is associated with lower rates of opioid overdose, but can we address barriers to staying in treatment?

Glanz et al. examine the association between treatment duration and outcomes including all-cause mortality and overdose, demonstrating that treatment of at least 12 months is associated with lower opioid overdose rates. We now need to understand why people leave treatment after shorter periods of time, and what can be done to improve treatment retention. Opioid dependence, and particularly untreated opioid dependence, places an enormous health and economic burden on individuals and society. As opioid-related deaths in North America have continued to increase, and increase more steeply [1], the provision of evidence-based treatments such as buprenorphine has been increasingly critical. The study by Glanz et al. [2] addresses one key aspect of providing buprenorphine treatment for which there is currently limited information—optimal treatment duration. The study examines buprenorphine discontinuation with different treatment durations in relation to the critical outcomes of all-cause mortality and overdose. The study provides evidence that risk of opioid overdose may be greater following discontinuation of treatment episodes of shorter duration relative to treatment of 12 months duration or longer, with the authors concluding that their findings did not support limitations on treatment duration. It is well established that short-term treatments are ineffective for most and that longer-term treatments such as opioid agonist treatment are critical in reducing mortality [3]. This new study represents an addition to the limited evidence on how long opioid agonist treatment should continue. Clinical guidelines vary, but often propose that there should not be a hard limit on how long treatment continues. The World Health Organization guidelines state that opioid agonists treatments can be continued indefinitely, and for some patients this may be optimal [4]. For patients who may seek advice regarding ‘how long is long enough?’, providing a clear answer based on the existing evidence is currently challenging, but the work by Glanz and others helps to address this evidence gap. Questions regarding how long treatment should be continued become particularly important where access to treatment is restricted to arbitrary periods of time due to limitations placed by national or jurisdictional policies, health insurers or treatment providers. Despite the evidence that longer treatment with opioid agonists produces better outcomes, philosophical debates continue to arise regarding whether staying on opioid treatment for extended periods of time represents a poor outcome [5]. There is also a range of critical factors that can influence treatment cessation, which often centre on barriers to remaining in treatment. These include cost, attendance requirements, requirements to disclose treatment to employers and lack of family support. Glanz et al. speculate that treatment contracts and requirements for frequent and expensive urine drug screening, psychotherapy and follow-up visits may influence treatment discontinuation. Other studies examining the perspectives of people who receive treatment have identified cost to patients and the inconvenience of travelling for regular supervised dosing as critical factors in treatment discontinuation [6, 7]. Experiences of stigma and discrimination that are commonplace when receiving opioid agonist treatment can also contribute to decisions to leave treatment or perhaps shift to treatment modalities that are less ‘observable’ [8, 9]. Individually and combined, these factors can often influence treatment duration despite evidence suggesting that treatment cessation will increase overdose and other risk. Importantly, the majority of these factors are not inherent to the treatment itself but pertain to how treatment is delivered, and represent modifiable factors that could be addressed to improve treatment retention. Future research may be able to further unpack these individual circumstances and complexities and determine how we might increase treatment retention. Ultimately, it is critical that our treatment systems are set up so that people are able to remain in treatment for as long as they need, which would be determined by the patient and their treatment provider. These decisions should not be driven by arbitrary policies or due to treatment systems that make remaining in treatment too difficult. Open access publishing facilitated by Monash University, as part of the Wiley - Monash University agreement via the Council of Australian University Librarians. S.N. is a named investigator on an implementation trial of depot buprenorphine funded by Indivior. S.L. has received untied educational grant funding from Indivior. Suzanne Nielsen: Conceptualization. Sarah Larney: Conceptualization.

Comparative inequalities in child dental caries across four countries: Examination of international birth cohorts and implications for oral health policy

Child dental caries (i.e., cavities) are a major preventable health problem in most high-income countries. The aim of this study was to compare the extent of inequalities in child dental caries across four high-income countries alongside their child oral health policies. Coordinated analyses of data were conducted across four prospective population-based birth cohorts (Australia, n = 4085, born 2004; Québec, Canada, n = 1253, born 1997; Rotterdam, the Netherlands, n = 6690, born 2002; Southeast Sweden, n = 7445, born 1997), which enabled a high degree of harmonization. Risk ratios (adjusted) and slope indexes of inequality were estimated to quantify social gradients in child dental caries according to maternal education and household income. Children in the least advantaged quintile for income were at greater risk of caries, compared to the most advantaged quintile: Australia: AdjRR = 1.18, 95%CI = 1.04-1.34; Québec: AdjRR = 1.69, 95%CI = 1.36-2.10; Rotterdam: AdjRR = 1.67, 95%CI = 1.36-2.04; Southeast Sweden: AdjRR = 1.37, 95%CI = 1.10-1.71). There was a higher risk of caries for children of mothers with the lowest level of education, compared to the highest: Australia: AdjRR = 1.18, 95%CI = 1.01-1.38; Southeast Sweden: AdjRR = 2.31, 95%CI = 1.81-2.96; Rotterdam: AdjRR = 1.98, 95%CI = 1.71-2.30; Québec: AdjRR = 1.16, 95%CI = 0.98-1.37. The extent of inequalities varied in line with jurisdictional policies for provision of child oral health services and preventive public health measures. Clear gradients of social inequalities in child dental caries are evident in high-income countries. Policy related mechanisms may contribute to the differences in the extent of these inequalities. Lesser gradients in settings with combinations of universal dental coverage and/or fluoridation suggest these provisions may ameliorate inequalities through additional benefits for socio-economically disadvantaged groups of children.

Expanding local sales restrictions on flavoured tobacco products to include menthol: retail sales changes in two Minnesota cities

BackgroundIn 2018, Minneapolis and St. Paul, Minnesota, expanded existing local sales restrictions on flavoured (non-menthol/mint/wintergreen) tobacco products (‘flavour policies’) to include menthol/mint/wintergreen-flavoured tobacco products (‘menthol policies’). All policies included exemptions...

Who’s fit for the job? Allocating ministerial portfolios to outsiders and experts

AbstractWhy do parties appoint outsiders and experts to ministerial positions? Extant research offers explanations based on institutional arrangements and external shocks (e.g. political or economic crises). We go beyond such system-level variables to argue that the characteristics of ministerial appointees are a function of the portfolio they are being appointed to. Drawing on theories of political delegation, we argue that outsider and expert appointments to ministerial office are affected by a portfolio’s policy jurisdiction, its financial resources and appointment powers, and the partisan leanings of the ministerial bureaucracy. We test these arguments on all appointments of senior and junior ministers in Austria between 1945 and 2020. The analysis shows that outsiders are more likely to be appointed to ministries with greater party support in the bureaucracy, while experts are more likely appointed to portfolios dealing with high-salience issues.

Experience and perspectives of infection prevention staff of the COVID-19 response in Australian hospitals

BackgroundHospital infection prevention and control (IPC) staff have played a key role in adapting and implementing jurisdictional COVID-19 policy during the current pandemic. We aimed to describe the experiences of IPC staff in Australian hospitals during the COVID-19 pandemic to inform future pandemic preparedness plans.MethodsA cross-sectional study involving an online survey distributed to IPC practitioners employed in Australian hospitals. Survey content was informed by in-depth interviews, and addressed work conditions, redeployed workforce, personal protective equipment, communication, and guidelines. Participants were recruited through the mailing lists of Australasian College of Infection Prevention and Control and the Australasian Society of Infectious Diseases.ResultsWe received fully or partially completed responses from 160 participants, including 38 (24%) and 122 (76%) with nursing and medical backgrounds, respectively. Respondents reported access to sufficient information about PPE (75%, 114/152), PPE was of sufficient quantity (77%, 117/152) and was of sufficient quality (70%, 106/152). Barriers to infection prevention guideline implementation included frequently changing guidelines (57%, 84/148), timing of updates (65%, 96/148) and contradictory sources of information (64%, 95/148). Respondents described a need for better communication channels from government authorities to hospital IPC teams. All respondents described an increase in workload leading to difficulty completing work (63%, 97/154) and feeling burnt out (48%, 74/154).ConclusionsThese data identify avoidable barriers to implementation of COVID-19 infection prevention guidance in Australian hospitals. These findings can inform future national preparedness strategies.

Changing Care: Applying the Transtheoretical Model of Change to Embed Equity, Diversity, and Inclusion in Long-Term Care Research in Canada

Healthcare policy reform is evident when considering the past, present and future of long-term care (LTC) in Canada. Some of the most pressing issues facing the LTC sector include the changing demographic composition in Canadian LTC homes, minimal consideration for the role of intersectionality in LTC data collection and analysis, and the expanding need to engage diverse participants and knowledge users. Using the Transtheoretical Model of Change (TTMC) as a framework, we consider opportunities to address intersectionality in LTC research. Engaging diverse knowledge users in LTC (e.g., unpaid caregivers, paid care staff), community (e.g., advocacy groups, service providers) and policy decision-makers (e.g., provincial government) is crucial. Empowering individuals to participate, modifying environments to support engagement, and facilitating ongoing partnerships with knowledge users are critical aspects of change efforts. Addressing structural barriers (e.g., accessibility, capacity, jurisdictional policies, and mandates) to research in LTC is also essential. The TTMC offers a framework for planning and enacting individual, organizational, and system-level changes for the future of LTC.