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 presents, through the example of health care systems, a theoretically founded analysis of learning processes in the context of reform implementation. Following a critical assessment of the two most prominent approaches to knowledge management—mechanistic and organic—we propose another approach, which consists in coordinating the learning of interdependent actors. The potential of this approach is illustrated through an empirical case study of the implementation of a Quebec program to combat cancer.

BACKGROUND: Patient participation in decision-making has become a hallmark of responsive healthcare systems. Cancer networks in many countries have committed to involving people living with and beyond cancer (PLC) at multiple levels. However, PLC participation in network governance remains highly variable for reasons that are poorly understood. This study aims to share lessons learned regarding mechanisms that enable PLC participation in cancer network governance. METHODS: This multiple case study, using a qualitative approach in a natural setting, was conducted over six years in three local cancer networks within the larger national cancer network in Quebec (Canada), where PLC participation is prescribed by the Cancer Directorate. Data were collected from multiple sources, including individual and focus group interviews (n = 89) with policymakers, managers, clinicians and PLC involved in national and local cancer governance committees. These data were triangulated and iteratively analysed according to a framework based on functions of collaborative governance in the network context. RESULTS: We identify three main mechanisms that enable PLC participation in cancer network governance: (1) consistent emphasis on patient-centred care as a network objective; (2) flexibility, time and support to translate mandated PLC representation into meaningful participation; and (3) recognition of the distinct knowledge of PLC in decision-making. The shared vision of person-centred care facilitates PLC participation. The quality of participation improves through changes in how committee meetings are conducted, and through the establishment of a national committee where PLC can pool their experience, develop skills and establish a common voice on priority issues. PLC knowledge is especially valued around particular challenges such as designing integrated care trajectories and overcoming barriers to accessing care. These three mechanisms interact to enable PLC participation in governance and are activated to varying extents in ...

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. ...

SETTING: We investigate the capacities of an organization responsible for bridging top-down instructions emanating from a law on public health with the bottom-up realities of health service providers working on population-based health. This article traces the implementation of this law, which requires service-provider organizations to base their actions (planning, prevention, and curative activities) upon the expressed and non-expressed needs of the local population. We investigate a case in the province of Québec that took place over more than 10 years. INTERVENTION: The state strategy involved a key structure: an intermediary organization named IPCDC/KSCDI. We first describe how the organization emerged; the expertise involved from the academic, service, and policy domains; the support provided to service-provider organizations; and the achievements. We then highlight the critical capacities the intermediary organization had to nurture. OUTCOMES: We identify five critical capacities of the intermediary organization: the business intelligence to read and adjust to the given environment of certain organizations, a dedication to collective means, a win–win mentality, scientific connectivity, and the animation of safe havens. IMPLICATIONS: It may be important to focus attention on a capacity approach to intermediary organizations. These capacities can potentially enable governmental organizations to compile a stock of resources that can be mobilized and transferred to support future implementations of other reforms. They could also benefit public health partners in the community who collaborate with service providers and actors who aspire to become intermediary organizations. Finally, the performance measurement of implementing reforms in a non-directive manner could be based on indicators related to these five critical capacities.

Based on the example of the evaluation of service organization models, this article shows how a configurational approach overcomes the limits of traditional methods which for the most part have studied the individual components of various models considered independently of one another. These traditional methods have led to results (observed effects) that are difficult to interpret. The configurational approach, in contrast, is based on the hypothesis that effects are associated with a set of internally coherent model features that form various configurations. These configurations, like their effects, are context-dependent. We explore the theoretical basis of the configuration approach in order to emphasize its relevance, and discuss the methodological challenges inherent in the application of this approach through an in-depth analysis of the scientific literature. We also propose methodological solutions to these challenges. We illustrate from an example how a configurational approach has been used to evaluate primary care models. Finally, we begin a discussion on the implications of this new evaluation approach for the scientific and decision-making communities.