Suchergebnisse

Cet article analyse des processus de co-création à l'intérieur de réseaux hybrides. Plus précisément, il se penche sur un dispositif particulier de co-création, en l'occurrence une communauté stratégique mise en place pour expérimenter des nouvelles façons de faire en matière de lutte contre les infections transmises par le sang et le sexe au Québec. Une communauté stratégique est une structure temporaire de collaboration inter-organisationnelle, composée de professionnels, de cadres de premier niveau, d'omnipraticiens, de représentants d'organismes communautaires, etc. dont le mandat consiste à générer, à mettre en pratique et à évaluer des idées nouvelles concernant l'organisation des services. Les résultats de cette étude mettent en évidence les difficultés rencontrées ainsi que les enjeux liés à ces processus de co-création. Remarques à l'intention des praticiens La mise en œuvre de processus-de co-création, impliquant des acteurs du secteur public, privé et communautaire, se confronte à de nombreux enjeux : 1) l'intéressement des acteurs concernés par les problématiques complexes ; 2) la constitution d'espaces réflexifs et d'expérimentation impliquant des acteurs jouant un rôle important au niveau de l'implantation du changement ; 3) la mobilisation d'outils et de facilitateurs pour élaborer une vision commune ; 4) le passage à l'action pour valider les nouvelles façons de faire.

This article analyses co-creation processes within hybrid networks. Specifically, it looks at a particular co-creation mechanism, in this case, a strategic community set up to test new ways of dealing with blood- and sexually-transmitted infections in Quebec. A strategic community is a temporary structure of inter-organizational collaboration, made up of professionals, first-level managers, general practitioners, representatives of community organizations, etc. tasked with generating, implementing and evaluating new ideas about the organization of services. The results of this study highlight the difficulties encountered as well as the issues related to these co-creation processes. Notes for practitioners The implementation of co-creation processes, involving public, private and community actors, has to contend with numerous challenges: (1) the enrolment of the stakeholders concerned by the complex issues; (2) the creation of places for discussion and experimentation involving actors who play an important role in the implementation of change; (3) the mobilization of tools and facilitators to develop a common vision; (4) the action stage to validate new ways of doing things.

This article focuses on multilevel governance applied to health organizations in Québec (Canada). The objective is to understand the action levers that facilitate the adaptation of the services toward migrant populations. This type of population establishes itself as an excellent tracer case to analyze the adaptation process, its fractalization and its involvement with the Environment. The dynamics between the actors and their self-organization takes part in the development of a multilevel governance. Interactions with the Environment—both internal and external—highlight the development of networks that emerge from the field and are then implemented at strategic levels in the organizations. The presence of connectivity actors within the organization and the Environment is established. The context, the bonds of trust between the actors and the credibility of the policymakers are reflected as important factors. However, connectivity actors cannot be successful without the support and contribution of the more "hierarchical" actors. Eight action levers are revealed by the analysis. We categorized them in 3 functions: administrative, enabling, and emerging. The levers of the administrative and emerging functions require that the levers of the enabling function be credible and legitimate and be able to support them for the adaptation to spread throughout the healthcare organization, regardless of the scope or policymaking level. The fractal function facilitates this process, by combining connectivity actors with the implementation of connectivity structures.

Background In 2004, the Québec government implemented an important reform of the healthcare system. The reform was based on the creation of new organisations called Health Services and Social Centres (HSSC), which were formed by merging several healthcare organisations. Upon their creation, each HSSC received the legal mandate to establish and lead a Local Health Network (LHN) with different partners within their territory. This mandate promotes a 'population-based approach' based to the responsibility for the population of a local territory.

BACKGROUND: The advanced access (AA) model has attracted much interest across Canada and worldwide as a means of ensuring timely access to health care. While nurses contribute significantly to improving access in primary healthcare, little is known about the practice changes involved in this innovative model. This study explores the experience of nurse practitioners and registered nurses with implementation of the AA model, and identifies factors that facilitate or impede change. METHODS: We used a longitudinal qualitative approach, nested within a multiple case study conducted in four university family medicine groups in Quebec that were early adopters of AA. We conducted semi-structured interviews with two types of purposively selected nurses: nurse practitioners (NPs) (n = 6) and registered nurses (RNs) (n = 5). Each nurse was interviewed twice over a 14-month period. One NP was replaced by another during the second interviews. Data were analyzed using thematic analysis based on two principles of AA and the Niezen & Mathijssen Network Model (2014). RESULTS: Over time, RNs were not able to review the appointment system according to the AA philosophy. Half of NPs managed to operate according to AA. Regarding collaborative practice, RNs were still struggling to participate in team-based care. NPs were providing independent and collaborative patient care in both consultative and joint practice, and were assuming leadership in managing patients with acute and chronic diseases. Thematic analysis revealed influential factors at the institutional, organizational, professional, individual and patient level, which acted mainly as facilitators for NPs and barriers for RNs. These factors were: 1) policy and legislation; 2) organizational policy support (leadership and strategies to support nurses' practice change); facility and employment arrangements (supply and availability of human resources); Inter-professional collegiality; 3) professional boundaries; 4) knowledge and capabilities; and 5) patient perceptions. ...

Integrated Place-Based Primary Interventions (IPPIs) are considered an innovative response to the challenges and complex issues faced in disadvantaged areas where traditional institutional services have difficulty reaching people in vulnerable situations. IPPIs are an innovative approach to the delivery of in services, conceived as an original community-based local care and service pathways. However, these intervention practices require adaptive modes of governance. In this article, we explore how and to what extent the mode of governance of IPPIs influences the performance of community-integrated pathways. To this end, using a qualitative exploratory multiple-case study design (observation and semi-structured interviews), we describe 4 IPPIs in 3 territories in Quebec. This includes an examination of the levers of action and tensions related to their governance and the performance levels of the community-integrated pathways. We conclude that collaborative and shared multilevel governance, despite its demanding nature, appears to contribute to the longevity of the actions and benefits of IPPIs and could prevent their relevance from being questioned.

L'objectif de l'article est de montrer la nécessité de la reconnaissance de l'intervention de proximité comme pratique professionnelle par une reddition de comptes qui rend visible sa contribution dans la réduction des inégalités de santé et le renforcement du lien social et communautaire sur un territoire donné. À partir d'un devis d'étude de cas multiples qualitatif et participatif de quatre terrains de recherche au Québec, nous proposerons des dimensions qui considèrent l'articulation du « sens » et de la « mesure » pour une reddition de comptes innovante, intégrée et partenariale.