Coast to Coast to Coast

Listening, Researching, Solving Complexity

Ecoutez, Recherche, Resoudre la Complexite

About Us

Dr. Ashton is Executive Vice‐President, Co‐founder and Senior Consultant of HarbourFront Health Group Inc. (HFHG). He is a nationally recognized health care executive with a demonstrated record of progressive achievement and outstanding leadership.

Dr. Ashton provides consulting expertise in the areas of health system development, Health Human Resources (HHR) planning, under serviced and population health, business administration and health economics.

Dr. Ashton has many years of experience in rural practice and emergency medicine, with proven business skills in senior management, project management and evaluation, finance, and planning. He possesses highly tuned networking skills in the corporate, public, and academic sectors, in addition to specific expertise in health care trends, evaluative techniques, and developing multidisciplinary programs and large scale systems.

Le Dr. Ashton est Vice‐Président exécutif, Co‐Fondateur et Consultant en Chef du HarbourFront Health Group Inc. (HFHG). Il est un exécutive nationalement reconnu des soins de santé dans l’ensemble du pays, qui à son compte de magnifiques réussites et qui a fait preuve de leadership exceptionnel.

Dr. Ashton offre de la compétence en consultation dans le développement du système de santé, dans la planification des Ressources Humaines de Santé, dans la santé de la population mal servie et dans l’administration des affaires et du côté économique de la santé.

Dr. Ashton possède plusieurs années d’expérience dans la pratique de la medicine rurale et d’urgence. Il a fait ses preuves en affaires dans l’administration supérieure, l’évaluation, le financement et la planification de projets. Il possède des habiletés très importantes dans les secteurs sociaux, publics et académiques. De plus, il fait preuve d’une compétence particulière dans les tendances des soins de santé, dans les techniques d’évaluation, dans le développement des programes multidisciplinaires et dans des systèmes de grande envergure.

Denise Duffie‐Ashton, a native of New Brunswick, is President, Co‐Founder and a Senior Consultant of HarbourFront Health Group (HFHG), a consulting firm dedicated to the advancement of health care delivery systems in Canada. Denise brings a successful history of concise and effective project management and expertise gleaned from years in the Consulting and Information Technology industries, along with graduate level education in business management to optimally assist healthcare clients seeking excellence.

Fluent in meeting the challenges of the new economy through comprehensive knowledge of large scale project initiatives, Denise ensures best practices are applied to her consulting practice in healthcare to produce optimal, sustainable results for clients. A referent leader and systems thinker, the concepts of effective project management with definition of attainable objectives, tasks, risk and resource management are brought forward to clients to maximize success of initiatives.

Denise is proficient in both official Canadian languages and with her expertise in multi‐media communications and marketing, Denise brings exemplary communications expertise to clients similarly advancing the health of Canadians.

To optimally meet client needs, Mrs. Duffie‐Ashton has demonstrated expertise in areas as Healthcare Research, Strategic Business Planning, Stakeholder Engagements, Project Management Best Practices, Marketing and Competitive Positioning Strategies, Web‐based Strategic Information Management, Leadership and Team Building, Change Management and Public Relations.

Mme Denise Duffie‐Ashton, à Grand‐Sault, Nouveau‐Brunswick est Présidente, Co‐ Fondatrice et une Consultante active du HarbourFront Health Group (HFHG), une entreprise qui se consacre à la promotion de la livraison des soins de santé au Canada.

Denise met en évidence une histoire de réussite dans l’administration concise et efficace des projets. Cette expertise elle l’a obtenue dans les Industries de Technologie en Consultation et en Information. Elle a également reçu une formation dans la direction des affaires afin d’assister les clients en soins de santé qui recherchent l’excellence.

Denise, ayant la tenacité de releves les défis de la nouvelle économie, a acquis une vaste connaissance dans l’initiation des projets de grande envergure. Elle s’assure également que les meilleures techniques soient appliquées à ses consultations dans les soins de santé afin d’obtenir pour ses clients des resultants durables. Puisqu’elle est une directrice référante et une penseuse systématique, elle fournit à ces derniers (aux clients) des notions efficacies d’administration, des objectifs accessible, des tâches, des risques et des ressources afin de porter au maximum le succès des initiatives.

Denise parle couramment les deux langues officielles du Canada et avec sa compétence dans les communications et le marketing, elle fournit aux clients une expertise examplaire en relations, ainsi les aident à promouvoir la santé au Canada.

Afin de subenir aux besoins des clients de la meilleure manière possible, Mme Denise Duffie‐Ashton a fait preuve d’aptitude dans les domains, tels que les Recherches en Soins de Santé, la Planification des Affaires Stratégiques, les Relations entre les Dépositoires d’Enjeux, les Meilleures Pratiques d’Administration des Projets, les Stratégies de Marketing et d’un Avantage Compétitif, l’Administration de l’Information Stratégique, l’Organisation du Leadership et des Équipes, la Direction des Changements et les Relations publiques.

Our Principals are C. W. Ashton, M. Simon, G. Walsh, D.L.A. Duffie, P. Walker, J.E. Tucker, D. Somers, S. Kioke and J. Watt. Our nation‐wide network of associates is vast and expert.

We are consistently at the frontier of new best practices. Together with our clients, we create state‐of‐the‐art solutions.

For medical doctors, we are experienced in all aspects of physician careers, both the highs and lows. Let us help you protect the investment you have made becoming an medical doctor and help you make the best choices to protect, optimize or transition in your working life and practice.

In health and wellness, we are intimately knowledgeable regarding every element of the system from the provider‐client interface, to supporting infrastructure, to all levels of management and governments that act as the stewards of resources.

For economic development, we've worked in the communities, on the seas, in the forests, and in the manufacturing plants, both low and highest tech. We know how to get you the resources you need.

To support decision making, our researchers will gather, analyze and condense the information you need to create success.

Having worked in nearly 50 Aboriginal communities, we are also willing to partner as a qualified set‐aside when needed.

Our clients call us essential to success, super‐consultants, writers like no other, best minds in the room, the people who really get it and fun to work with.

Our consultants are Chairmen of Boards, former CEOs, physicians, nurses, First Nations leaders, engineers, MBAs, finance specialists, PhDs, natural resource specialists, builders, accountants, PMPs, mental health specialists, LEAN Sigma's and educators. Each have proven to be best in class.

Featured National Projects

Remote Community Paramedicine Delivery

Tuktoyuktuk, NWT

Working to provide necessary health care delivery solutions for remote communities of Canada.

Executive Summary
Preliminary Costing

Horizon Health Network, Community Health Needs Assessments

Inspired by the Provincial Government's release of A Primary Health Care Framework for New Brunswick, the Community Health Needs Assessments for NB examine and assess community health from a broad perspective. In addition to considering healthcare system performance, communities and stakeholders look at the big picture of health to examine factors both inside and outside the health care system which affect the health of their population. In addition to designing the methodology, comprising participatory action and mixed methods, HarbourFront performed community engagement, data collection, analysis and working with Horizon and Community Advisory Committees to facilitate decision making based on health needs determined.

Canadian Public Health Association

Through literature review, HFHG performed an assessment of priority public health issues, key informant interviews and an environmental scan of current and promising practices to develop a business case to support an additional $500M increase to the Public Health Agency of Canada's (PHAC) annual budget. HarbourFront developed optimal advocacy strategy, business case and communications platform to develop effective 'asks' to fulfill PHAC's original vision to address the gaps in public health as identified in Health Canada's Naylor Report, commissioned following the SARS crisis.

Canadian Institute for Health Information (CIHI)

As lead consultant of a multidisciplinary team, HarbourFront developed a business case and architecture for a web-based e-query tool with embedded analytics. This tool development formed an important, initial phase for CIHI's strategy to become a more public facing enterprise.

Counties of Simcoe, Grey-Bruce and Huron - Strategic Planning for Emergency Medical and Ambulance Services

In collaboration and consultation with Chiefs of three paramedic services as well as municipal staff and leaders, HFHG developed a strategic plan for efficacious, cost effective amalgamation of services over this large rural area of Ontario. Key success factors included an understanding and acknowledgement of Ontario standards for EMS response times and capabilities of personnel as well as retrospective, detailed analysis of utilization data across all three Counties to ensure needs were met and maintained sustainably. Additionally, understanding of the funding mechanisms in place and available allowed for greater capital purchases to upgrade Emergency Response infrastructure.

Economic Impact of Community Paramedicine Services - A Randomized Control Trial Exploring Urban and Rural Applications in Renfrew and Hastings Counties

Our team was recently the lead research and analyst support for this multi-stakeholder project aimed at assessing the global economic impact of community paramedicine services in urban and rural settings in Hastings and Renfrew County. HFHG's role as designing and supporting the project methodology for this randomized controlled trial was critical to its success. The use of randomized controlled trial methods as well as economic impact using the EuroQol's group EQ-5D-3L represented a 'first' in the field of health services in Canada.

Surgeon General of Canada - Recruitment and Retention Strategy for Medical Officers

At the height of Canada's involvement in the Afghanistan conflict, the Canadian Forces Health Group (CFHG) found itself with a cadre of Medical Officers (MOs) of only 50% of its mandate. Through consultations with CFHG executive staff, environmental scanning nationally and internationally, Dr. Ashton developed a multi-tiered approach to recruitment and retention including creating new career paths for MOs. This strategy was so successful that MO manning levels reached 100% within 2 years of implementation and ensured this level would be sustained for at least the next decade.

First Nation & Inuit Projects

Health Canada/Mi'kmaq and Maliseet First Nations of New Brunswick

On request of Chief and Council and Elders at Esgenoôpetitj First Nation, led a fourteen month developmental process to design and create a federal/provincial sponsored pan-provincial, community based program to address addictions and mental health needs of Mi'kmaq and Maliseet communities and members.

Department of Health and Social Services (DHSS), Government of Nunavut

Performed a comprehensive review to support renal care of Nunavummiut. With current end stage renal disease (ESRD) clients facing the choice of leaving the Territory permanently to receive dialysis services in the south, HarbourFront was called upon to develop solutions to bring ESRD care to the North. A cross-Canada and Australian outback survey of remote dialysis services led to a number of viable options to bring dialysis to Nunavut. Included, from HFHG's experience in Chronic Disease Prevention and Management (CDPM), were recommendations to curb the tide of emerging CKD and diabetes.

A key end product of this work was HFHG's development of a public private partnership (PPP) for Nunavut with the global leader in hemodialysis services.

Department of Health and Social Services (DHSS), Government of Nunavut

Performed a comprehensive Territorial functional audit and assessment to support appropriate funding for DHSS's $350M annual budget. To assist the Department in contending with escalating costs, HarbourFront was retained to analyze five areas of concern: agency nurses, out of Territory (OOT) physician services, OOT hospital services, mental health and addictions residential care and medical transport costs. The interrelationships among these areas were articulated with specific recommendations geared towards achieving cost stabilization while improving healthcare service delivery for Nunavummiut.

Esgenoôpetitj First Nation at Burnt Church

Retained by this second largest in Atlantic Canada First Nations community to address major health status disparities, grow their economic base and definitively address the social determinants of health. In depth community consultations and analysis was performed to develop a strategic plan addressing community needs. Working closely with community leadership in consultation with federal and provincial stakeholders a number of programs and activities including mental wellness and addictions, community governance and infrastructure development were developed. A renewed community plan to promote holistic community wellness was created. As a result of advocacy efforts by HFHG and the acuity of this strategic plan, significant financial resources were allocated to Esgenoôpetitj, creating high impact infrastructure renewal.

Peterborough Regional Health Center / Central East Local Health Integration Network (LHIN)

HarbourFront was hired to provide the necessary leadership and expertise for a priority project in chronic kidney disease (CKD) management for First Nations People in three communities. Through comprehensive literature review, HFHG developed the screening tool and project algorithm and successfully implemented this in a multi-stakeholder environment with the regional health authority hospital, local specialists and family physicians and First Nations health professionals from Alderville, Curve Lake and Hiawatha. HFHG and the team achieved 83% population screening for the communities in 9 months, a dramatic improvement upon the results achieved in the two years prior to HFHG's engagement. The successes of this project were instrumental not only in increasing access to needed care for clients with CKD, it also served as an effective vehicle to develop improved working relationships among First Nations, the health authority and local health providers.

Health Canada / Batchewana First Nation of Ojibways

Developed a successful $6M Plan for Capital Funding and a framework for a new, innovative Primary Healthcare System and Facility for the Native population of the North Eastern Ontario Region. In collaboration with Band Council, the existing Health Services department and their staff members, HarbourFront forged key strategic partnerships with the Northern Ontario School of Medicine (NOSM), the Aboriginal Cancer Care Unit and the Northern Diabetes Network. Human resources plan were developed with recruitment, training and retention of physicians and support staff for the Clinical Teaching Unit. Change management and training plan formulated for community stakeholders to adapt to renewed service delivery. HFHG's participation in this facility of healing and health ensured excellence in Aboriginal care, teaching and research for this large under serviced Native population.

Department of Health and Social Services (DHSS), Government of Nunavut

Performed comprehensive review of case management, telehealth and specialist services for Baffin region through documentation review and visits with both community stakeholders and Elders. Case management processes and professional staff capabilities was also assessed. Numerous gaps in service delivery and processes were identified as presenting issues to clients and the Department. Recommendations and solutions were given to improve and modernize current resource usage as well as identify and effectively remedy gaps in local infrastructure and health service processes. As a by-product of this review, HFHG was the first group to identify the emergence of Type II Diabetes among the Inuit, allowing for initiation of appropriate prevention and management strategies.

Our performance optimization and finance specialists will ensure you gain maximum return along your journey to success.

From community engagement to organizational data to big data analytics, no tasks fall outside our capabilities.

Peer-Reviewed Publications

Rapports des évaluations des besoins de la collectivité en matière de santé

Saint John, Moncton, Petitcodiac, St Stephen 2013-2014

CSA Group: Health In the North: The Potential for Community Paramedicine in Remote and/or Isolated Indigenous Communities

2018/19 Pan-Canadian North

Canada's North is a sparsely populated area, representing approximately 40% of Canada's landmass, but fewer than 200,000 people call it home.

Poor determinants of health, such as overcrowded housing, high unemployment, and unsafe drinking water, are cited as contributing to poorer health outcomes.

This report presents the rsults of an exploratory study following CSA Group's earlier research report (Canada's North published in 2017), outlines the numerous health and healthcare issues in Northern communities, and provides recommendations for the potential role of community paramedicine in addressing these issues.

Community Health Needs Assessments (CHNAs) for New Brunswick: Moncton, Saint John, Petitcodiac and St Stephen

2014 Southern New Brunswick

Conducted in a bilingual environment, these four unique CHNAs focused on exploring the social determinants of health, providing solutions using an inter-sectoral approach.

A Clinical Pathway through Substance Use Disorder, First Episode Psychosis and Post Traumatic Stress Disorder on the Basis of HPA Axis Dysfunction

May 20, 2015, Journal of Diabetes, Metabolic Disorders and Control

Associations as well as similar behaviors and symptomatology among people with addiction, post traumatic stress disorder (PTSD) and first episode psychosis (FEP), either in combinations or for single entity diagnosis, are clinically significant. The typical care for a client who experiences a FEP in recovery from addiction is to treat as a concurrent disorder. When exploring neuroendocrine dysfunctions in clients with these conditions, it is apparent that addiction may well predispose clients to experiencing a discrete psychotic episode in recovery. Treating this scenario as a concurrent disorder may, among other pitfalls, fail to address the psychological trauma of the FEP. This, in turn, may lead to longstanding post traumatic stress and poorer recovery outcomes.

The trajectory of healthcare utilization for chronic disease: findings from the economic value of community paramedicine study

Jan 19, 2017, International Journal of Diabetes and Clinical Diagnosis

This article reports on a four year trend of healthcare utilization by a group of 200 participants , all of whom had one or more of CHF, COPD, DM, Stroke who enrolled in an RCT on community paramedicine. Recommendations are given and insights on when best to more actively assist in care in this group.

Conserving Quality of Life through Community Paramedicine

Aug 14, 2017, Healthcare Quarterly, Longwoods

The Economic Value of Community Paramedicine Programs Study was a randomized controlled trial (RCT) in two Eastern Ontario communities - one urban and one rural, to determine whether Community Paramedicine services (the intervention through home visits) would have a positive economic impact through influencing self-perceived quality of life and determining a monetized value. Study results suggest that while quality of life scores decreased for all groups, those receiving Community Paramedicine service demonstrated significantly less reduction in their scores. Suggestions to further increase cost efficiency of this novel service are given.

Community Health Evaluations Completed Using Paramedic Services (CHECUPS): Design and Implementation of a New Community-Based Health Program

Aug 14, 2017, Journal of Health and Human Services Administration, Long Island, USA

The study was conducted in the County of Renfrew, Ontario, Canada where a Community Resilience Program expanded to include the CHECUPS Program. The evaluation of the CHECUPS program has addressed impacts to three domains: 1) patient overall health and satisfaction; 2) primary care integration; and 3) paramedic resource utilization. The results included a total of 222 patients that demonstrated a 24% reduction in 911 activation; 20% reduction in repeat ED visits; 55% decrease in patients that were admitted post ED visits; and all patients indicated that they were either satisfied or very satisfied with the care provide by community paramedics.

A Consideration Of Food Insecurity and Nutrition In New Brunswick Communities

Dec 25, 2014 International Journal on Diabetes and Clinical Diagnosis

This paper speaks to the likelihood of poor nutrition food and insecurity creating significant current and downstream negative health impacts. From the perspective of children and youth, developmental delays are argued to be a direct consequence of poor nutrition, leading to a negative cascade of poor learning, cognitive and emotional deficits, all pointing to more difficulties and less fulfilling adults lives.

Chronic Kidney Disease in Canada's First Nations: Results of an Effective Cross Cultural Collaboration

Jun 2, 2011 Healthcare Quarterly

Chronic kidney disease (CKD) is a serious and growing threat to our First Nations Peoples' health. Current evidence indicates more rapid progression of CKD in First Nations populations, leading to markedly increased morbidity and mortality. To address this serious health issue, three First Nations communities, Alderville, Hiawatha and Curve Lake, partnered with the Central East Local Health Integration Network (LHIN), the Peterborough Regional Health Center (PRHC), and local family and specialist physicians.


The Missing Link in Aboriginal Healthcare: Resource Accounting

May 8, 2009, Longwoods, Healthcare Quarterly

This paper makes the case for better planning, delivery and outcomes for Aboriginal People through allowing Federal Funds to be transferred to communities and managed through accruals accounting principles rather than the current cash accounting system

Physician Assistants: A Solution to Wait Times in Canada

May 5, 2007, CCHSE Healthcare Forum

Access to medical care is limited in most of Canada, and the population often endures lengthy waiting times to see a physician. The use of new and varied health care providers has been suggested as a means to alleviate the shortage of physicians. This paper reviews the history and role of the Physician Assistant (PA), both in Canada and internationally, and outlines the clinical competencies currently held by this provider to fill the role of a physician extender in our country. PAs' experiences are reported in the Canadian Forces (CF), where they have been employed for many years, and in Manitoba, where they are used as surgical assistants. The potential for the PA to be incorporated into our provincial health care systems will be considered in light of common barriers to Health Human Resources (HHR) strategic implementation.

A Guide to Culturally Safe Care

Ontario Metis Family Records Center/Painted Feather Woodland Metis, Special Edition 2010

This guide is geared to educate healthcare providers working in aboriginal communities to understand the culture, traditions and the experience of the First Nations and Metis People as these impact the provision of appropriate, acceptable healthcare for the People.

Harbourfront Group is a bona-fide Center of Excellence. We practice, research and teach.

HFHG has completed projects, published documents, and presented at noted conferences throughout the nation.

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