Suchergebnisse

Abstract Background Over the past decade, in the province of Quebec, Canada, the government has initiated two consecutive reforms. These have created a new type of primary healthcare – family medicine groups (FMGs) – and have established 95 geographically defined local health networks (LHNs) across the province. A key goal of these reforms was to improve collaboration among healthcare organizations. The objective of the paper is to analyze the impact of these reforms on the development of collaborations among primary healthcare practices and between these organisations and hospitals both within and outside administrative boundaries of the local health networks. Methods We surveyed 297 primary healthcare practices in 23 LHNs in Quebec's two most populated regions (Montreal & Monteregie) in 2005 and 2010. We characterized collaborations by measuring primary healthcare practices' formal or informal arrangements among themselves or with hospitals for different activities. These collaborations were measured based on the percentage of clinics that identified at least one collaborative activity with another organization within or outside of their local health network. We created measures of collaboration for different types of primary healthcare practices: first- and second-generation FMGs, network clinics, local community services centres (CLSCs) and private medical clinics. We compared their situations in 2005 and in 2010 to observe their evolution. Results Our results showed different patterns of evolution in inter-organizational collaboration among different types of primary healthcare practices. The local health network reform appears to have had an impact on territorializing collaborations firstly by significantly reducing collaborations outside LHNs areas for all types of primary healthcare practices, including new type of primary healthcare and CLSCs, and secondly by improving collaborations among healthcare organizations within LHNs areas for all organizations. This is with the exception of private medical clinics, where collaborations decreased both outside and within LHNs. Conclusion Health system reforms aimed at creating geographically based networks influenced primary healthcare practices' both among themselves (horizontal collaborations) and with hospitals (vertical collaborations). There is evidence of increased collaborations within defined geographic areas, particularly among new type of primary healthcare.

Abstract Background Healthcare reforms initiated in the early 2000s in Québec involved the implementation of new modes of primary healthcare (PHC) delivery and the creation of Health and Social Services Centers (HSSCs) to support it. The objective of this article is to assess and explain the degree of PHC organizational change achieved following these reforms. Methods We conducted two surveys of PHC organizations, in 2005 and 2010, in two regions of the province of Québec, Canada. From the responses to these surveys, we derived a measure of organizational change based on an index of conformity to an ideal type (ICIT). One set of explanatory variables was contextual, related to coercive, normative and mimetic influences; the other consisted of organizational variables that measured receptivity towards new PHC models. Multilevel analyses were performed to examine the relationships between ICIT change in the post-reform period and the explanatory variables. Results Positive results were attained, as expressed by increase in the ICIT score in the post-reform period, mainly due to implementation of new types of PHC organizations (Family Medicine Groups and Network Clinics). Organizational receptivity was the main explanatory variable mediating the effect of coercive and mimetic influences. Normative influence was not a significant factor in explaining changes. Conclusion Changes were modest at the system level but important with regard to new forms of PHC organizations. The top-down decreed reform was a determining factor in initiating change whereas local coercive and normative influences did not play a major role. The exemplar role played by certain PHC organizations through mimetic influence was more important. Receptivity of individual organizations was both a necessary condition and a mediating factor in influencing change. This supports the view that a combination of top-down and bottom-up strategy is best suited for achieving substantial changes in PHC local organization.