Suchergebnisse

Health and legal experts from England and Canada consider the influence of medical doctors on reforms in this comparative study. With reflections on participation since the inception of publicly funded healthcare systems, they show how the status of doctors affects change.

<i>The Transformation of the Role of Regional Authorities in the Quebec Health Service.
The Case of Regional Government Control in Montreal-Centre </i>

The System of health care in Quebec has undergone important changes since its reform in 1991. The reform was carried out within a legislative framework and with regard to particular political and administrative traditions. With the objective of curbing expenditure on health care, securing equal access to services and maintaining the political means for redistribution of collective resources, the reform is an attempt at compromise between a technocratie desire to maintain control over the System and a discourse of decentralisation.

This paper aims to draw attention to the social and micropolitical dimensions of attempting to implement improvements within healthcare organisations. It is argued that quality improvement initiatives, like other forms of organisational innovation, will fail unless they are conceived and implemented in such a way as to take into account the pattern of interests, values and power relationships that surround them. Drawing on examples, it is suggested that innovators can intervene more successfully if they understand how the benefits and costs of interventions are likely to be distributed among stakeholders within their setting, how different but equally legitimate value sets may structure peoples' understanding of them and how the nature of the interventions themselves (and, in particular, the shape of their hard core and soft periphery) might provide scope for redesigning or adapting interventions in ways that are likely to make them both more effective and politically feasible.

AbstractRecent work on health system strengthening suggests that a combination of leadership and policy capacity is essential to achieve transformation and improvement. Policy capacity and leadership are mutually constitutive but difficult to assemble in a coherent and consistent way. Our paper relies on the nested model of policy capacity to empirically explore how health reformers in seven Canadian provinces address the question of policy capacity. More specifically, we look at emerging representations of policy capacity within the context of health reforms between 1990 and 2020. Based on the exploration of the scientific and grey literature (legislation, annual reports of Ministries, agencies and organizations, meeting minutes, press, etc.) and interviews with key informants (n = 54), we identify how policy capacity is considered and framed within health reforms A series of core dilemmas emerge from attempts by each province to develop policy capacity for and through health reforms.