André-Pierre Contandriopoulos’

• Université de Montréal

Sommaire Depuis les années 90, la plupart des pays occidentaux se sont dotés de cadres et d'outils d'évaluation de la performance des organisations et des systèmes de santé. Paradoxalement, malgré l'abondance de ces instruments, ce champ reste face à plusieurs enjeux théoriques, méthodologiques et d'utilisation qui sont irrésolus. Conceptuellement,...

In this article, we have proposed a new model of dynamic organizational development and change, which is based on simultaneous consideration of forces for stability and adaptability, and the role of leadership in envisioning and balancing of these opposing forces. The basic premise in our proposal is that organizations progress through continuous a...

Objective: To define a physician classification system based on practice settings and to analyze the service provision associated with those classifications. Design: A cross-sectional, retrospective study. Setting: Province of Quebec. Participants: All GPs in Quebec in 2002 who had been practising for at least 2 years. Main outcome measures...

The growing burden of financing health care systems in the developed worl now means that economic analysis is of prime importance in assisting public decision-makers to use increasingly scarce collective resources efficiently. Health, as a commodity, has some special features from the point of view of economic analysis: it is a high-status commodit...

The article is based on a multidimensional conception of healthcare system performance. Our objectives are to assess the performance of the healthcare systems of 27 Organisation for Economic Co-operation and Development (OECD) countries and to discern the countries' profiles according to the homogeneity of their healthcare systems' levels of perfor...

Theoretically, evaluation should help decision-makers address contemporary health system challenges. Paradoxically, the use of evaluation results by decision-makers remains poor, despite rapid development in the evaluation field. The level of use depends on the evaluator's ability to account for the complexity of health-care systems. The complex na...

Health services utilization has been the object of many books and papers in the literature. Measures associated with utilization are often a function of volume of services. The objective of this paper is to present a comprehensive approach to the evaluation of health services utilization and of associated measures, using databases. Based on the the...

Objectif L’objectif de cette étude était d’évaluer l’efficacité en termes de retour au travail et les coûts-avantages d’un programme de réadaptation mixte (Prévicap), clinique et en milieu de travail, auprès de travailleurs en arrêt de travail pour lombalgies et lésions musculosquelettiques chroniques. Méthodes Cette étude de cohorte, de trois ans...

A global approach to evaluation of health services utilization: concepts and measures Health services utilization has been the object of many books and articles in the literature. Measures associated with utilization are often a function of volume of services. The objective of this article is to present a comprehensive approach to the evaluation of...

To develop search strategies for identifying papers on patient safety in MEDLINE, EMBASE and CINAHL. Six journals were electronically searched for papers on patient safety published between 2000 and 2006. Identified papers were divided into two gold standards: one to build and the other to validate the search strategies. Candidate terms for strateg...

One way to improve quality and safety in healthcare organizations (HCOs) is through accreditation. Accreditation is a rigorous external evaluation process that comprises self-assessment against a given set of standards, an on-site survey followed by a report with or without recommendations, and the award or refusal of accreditation status. This stu...

This article presents and discusses five challenges encountered in conducting a knowledge synthesis on primary healthcare, commissioned by the Canadian Health Services Research Foundation. These challenges are (1) conceptualizing, defining and operationalizing complex interventions; (2) integrating quantitative and qualitative studies and assessing...

Despite increasing interest in health economic evaluation, investigations have shown limited use by micro (clinical) level decision-makers. A considerable amount of health decisions take place daily at the point of the clinical encounter; especially in primary care. Since every decision has an opportunity cost, ignoring economic information in fami...

À l’aide des propos théoriques apportés par Giddens (1994) et Beck (2001) sur la modernisation réflexive, cet article explore les transformations expansionnistes inhérentes à la mondialisation institutionnelle des sociétés modernes et leur influence sur l’intégration organisationnelle de la participation des communautés locales aux décisions d’inté...

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...

In many countries, cigarette consumption has been on a declining trend for over 20 years. However, different patterns of smoking practices have emerged. Our goal is to explore how the patterning of smoking practices occurs and persists over time, and to investigate the factors that could help interpret these patterns. Data were derived from the Nat...

A considerable amount of resource allocation decisions take place daily at the point of the clinical encounter; especially in primary care, where 80 percent of health problems are managed. Ignoring economic evaluation evidence in individual clinical decision-making may have a broad impact on the efficiency of health services. To date, almost all st...

To find out which are the emerging views on hospital performance and to analyze how these views vary among hospital stakeholders. Study setting: Three hospital stakeholder groups (physicians, caregivers, and administrative staff) in a large Paris teaching hospital. Study design: A case study combining a qualitative (interviews of 80 key hospital st...

L’auteur, se basant sur des textes freudiens autour de l’actuel, suit l’idee que cette notion touche surtout un defaut de representation en rapport avec le traumatique. A l’aide d’un cas d’une femme presentant un fonctionnement psychique oriente sur le concret et l’actuel d’une plainte portant sur l’incapacite d’aimer, il met en lien l’actuel avec...

Le complexe forme par les maladies chroniques, les episodes de maladies aigues, les deficiences physiologiques, les incapacites fonctionnelles et les problemes cognitifs est prevalent chez les personnes âgees fragiles. Elles comptent sur l'aide des programmes sociaux et de sante qui, au Canada, sont encore fragmentes. Le SIPA est un modele de servi...

Since the late 1990s, the concept of clinical governance has emerged as an important theme in the search for ways to improve the quality and safety of health care. But within healthcare organisations, clinical governance has proved difficult to implement.We suggest that the characteristics of healthcare organisations influence the qualityand safety...

The papers in this issue allow to better understand the potential and updating conditions of clinical governance in the system and health organizations. Engaging in clinical governance is putting in place new capabilities that allow to know better what we produce, the consequences of our interventions and, ultimately, the benefits of a more concert...

La revue Pratiques et Organisation des Soins a accepté de consacrer un numéro complet au thème de la « gouvernance clinique ». Les réflexions, expériences et analyses présentées dans ce numéro ont été développées lors d’un colloque intitulé « Repenser la clinique et transformer les organisations » tenu dans le cadre des Entretiens Jacques-Cartier,...

In Quebec and in France, as in all developed countries, the combined effect of technological development, enhanced knowledge of life, globalization, demographic evolution and environmental degradation is exerting considerable pressure on the healthcare system, which is responding less and less effectively to the demands of the population. In order...

Objectives: The objective of this pan-Canadian study was to evaluate the feasibility of developing a set of accreditation standards supported by an accreditation process for public health in Canada. Methods: Twenty-four telephone interviews were conducted, recorded, transcribed and analyzed. Results: The scope of public health implied in respondent...

Objectives The objective of this pan-Canadian study was to evaluate the feasibility of developing a set of accreditation standards supported by an accreditation process for public health in Canada. Methods Twenty-four telephone interviews were conducted, recorded, transcribed and analyzed. Results The scope of public health implied in respondents...

The objective of this pan-Canadian study was to evaluate the feasibility of developing a set of accreditation standards supported by an accreditation process for public health in Canada. Twenty-four telephone interviews were conducted, recorded, transcribed and analyzed. The scope of public health implied in respondents' answers included health pro...

This article approaches the challenges posed by the need to conceive and implement a culture of evaluation. For this purpose it discusses the relations and differences between evaluative research, normative evaluation and decision-making. The analysis shows the capacity to institutionalize the evaluation as a tool for improving the health system to...

O artigo aborda os desafios em torno da necessidade de conceber e implantar uma cultura de avaliação. São discutidas as relações e diferenças entre pesquisa avaliativa, avaliação normativa e tomada de decisão. A análise mostra que a capacidade de institucionalização da avaliação como instrumento para melhorar o sistema de saúde é paradoxal, pois su...

Care for elderly persons with disabilities is usually characterized by fragmentation, often leading to more intrusive and expensive forms of care such as hospitalization and institutionalization. There has been increasing interest in the ability of integrated models to improve health, satisfaction, and service utilization outcomes. A program of int...

The aim of this in-depth, longitudinal, qualitative case study was to understand and explain the dynamics of implementing a pilot project to deliver integrated healthcare for type 2 diabetic patients. Data gathering included in-depth, face-to-face interviews with family physicians, nurses and other healthcare providers, managers and policy makers (...

The complex formed by chronic illness, episodes of acute illness, physiological disabilities, functional limitations, and cognitive problems is prevalent among frail elderly persons. These individuals rely on assistance from social and health care programs, which in Canada are still fragmented. SIPA (Services intégrés pour les personnes âgées fragi...

The complex formed by chronic illness, episodes of acute illness, physiological disabilities, functional limitations, and cognitive problems is prevalent among frail elderly persons. These individuals rely on assistance from social and health care programs, which in Canada are still fragmented. SIPA (Services intégrés pour les personnes âgées fragi...

Aims: The crisis in the medical paradigm was seen at the end of the 20th century in the variability of practices, uncertainty of medical-decision making and difficulties in defining normality. Using changes in knowledge production as a marker, our aim was to characterize this paradigm crisis and to foresee its evolution. Methods: We reviewed Medlin...

Evaluation practitioners encounter various questions while conducting evaluation projects. First, how can the evaluator define the intervention which is to be evaluated? Second, how should the evaluator consider the change? Third, how can use of the evaluation be encouraged? All three preoccupations have found answers in the theoretical development...

Based on an implementation analysis of an experimentation of a system of integrated care for frail elderly (in the province of Quebec, Canada), this paper initiates reflections about the introduction of reforms in health care systems. It highlights the advantages of decentralized, participatory change strategies, based on social experimentation. Th...

The accreditation system introduced into the French healthcare system in 1996 has five particular characteristics: (1) it is mandatory for all healthcare establishments; (2) it is performed by an independent government agency; (3) surveyors have to report all instances of non-compliance with safety regulations; (4) the accreditation report is deliv...

Introducing change in health care Systems from Quebec: how to benefit from social experimentation? Based on an implementation analysis of an experimentation of a System of integrated care for frail elderly (in the province of Quebec, Canada), this paper initiates reflections about the introduction of reforms in health care Systems. It highlights th...

Objective: This study examines the dynamics of change that operated following accreditation preparations in a healthcare establishment in France. Design & Method: The study was conducted from May 1995 to October 2001 in a university hospital center, after the introduction, in 1996, of compulsory accreditation. An embedded explanatory case study sou...

Based on observations of the government's vital role in enhancing rural health care accessibility, in this article, we analyze solutions implemented by Quebec's public health system by highlighting the limitations in incentives used to remedy the dearth of rural medical resources and the consequent interest in ameliorating health care accessibility...

Based on observations of the government's vital role in enhancing rural health care accessibility, in this article, we analyze solutions implemented by Quebec's public health system by highlighting the limitations in incentives used to remedy the dearth of rural medical resources and the consequent interest in ameliorating health care accessibility...

Cet article présente les enseignements en matière de conduite du changement tirés de l'étude de trois opérations de recomposition de l'offre hospitalière intervenues ces dernières années en France. Après avoir rappelé brièvement le contexte institutionnel et politique dans lequel elles s'inscrivent, les grandes étapes de leur déroulement sont décri...

Gerir um sistema de saúde requer, entre outras coisas, conhecimentos sobre a realidade sanitária e a administração. É recomendável, portanto, a utilização de conhecimentos científicos pelos gestores da saúde. Todavia, o processo de formulação de políticas e o fazer científico interpõem obstáculos ao uso de pesquisas. Certos empecilhos decorrem de v...

Management of a health system requires knowledge of the health situation and administration, among other factors. The use of scientific knowledge by health policy-makers is thus recommendable. However, policy-making processes and scientific practices themselves often appear to pose obstacles to the actual utilization of research results. Many such...

The premise of this paper is that comprehensive health care is a major component in the investigation and evaluation of health services and systems, structured as inter-organizational health care networks articulating clinical, functional, normative, and systemic dimensions in their operationalization and based on the understanding that no organiza...

Examines the dynamics of change that operated following preparations for accreditation. The study was conducted from May 1995 to October 2001 in a university hospital center in France after the introduction in 1996 of mandatory accreditation. An embedded explanatory case study sought to explore the organizational changes: a theoretical framework fo...

The Côte-des-Neiges diabetes pilot project strove to conceptualize, implement, and assess an integrated health care system for Type 2 diabetes. Using a disease management and population-based approach, a multidisciplinary team sought to (1). organize health care in an integrative framework, (2). promote behavior changes in patients to foster self-c...

This paper examines the relative effect of both individual and societal factors that impinge directly on smoking behaviour of women and men. The societal factors are cigarettes price, tobacco control legislation, newspaper coverage of tobacco issues, overall economic factors, and social milieu characteristics. Three Canadian provinces are studied,...

The premise of this paper is that comprehensive health care is a major component in the investi- gation and evaluation of health services and systems, structured as inter-organizational health care networks articulating clinical, func- tional, normative, and systemic dimensions in their operationalization and based on the un- derstanding that no or...

To explore one aspect of the external validity of the randomized controlled trial (RCT), specifically how being selected for inclusion in a trial and having participated has influenced the use and cost of asthma-related health services. Services used by asthmatic users of inhaled corticosteroids (iCSTs) having previously participated in an RCT (TS,...

In recent years, short-term geriatric care units that operate using an interdisciplinary approach have been established in Quebec and elsewhere, in order to provide frail elderly persons with better health care. The purpose of this study is to determine criteria that target the greatest number of individuals most likely to benefit from hospitalizat...

QOL improvements, which can in many cases reflect the overall effect of a health intervention, are frequently measured. It would therefore be useful to define the monetary value of QOL improvements in order to subsequently estimate the value of a given intervention on the basis of its impact on QOL.Objective: To explore the feasibility of assessing...

At the beginning of the 1990s, health service reforms were implemented in public health institutions in most African countries South of the Sahara. In the Ivory Coast, the imposition of user fees for public services was adopted in 1994. Such fees require each person to have adequate financial resources in order to access modern health care services...

This article explains the ways in which the integration of care represents a potential solution to the dysfunctional aspects of health care systems. Briefly defined, integration involves organizing sustainable consistency, over time, between a system of values, an organizational structure and a clinical system so as to create a space in which stake...

Many convergent factors explain the crises that afflict many countries health systems, among which Canada is not an exception. The current crisis deals not only with questions of an operational and economic order, but also raises fundamental ethical questions. Indeed, an analysis of the diverse conceptions of health systems reveals that they includ...

Why is it So Hard to Do What Needs to be Done? If they are to remain true to the values of the citizens they represent, and thus preserve the very foundation of their legitimacy, modern democracies must change the current course of their healthcare system, which is increasingly out of touch with citizens’ needs. Furthermore, it can be noted that ev...

In a previous article, we described a set of 15 potential models of ambulatory centres, created through the merger of several independent university hospitals. In this article, we estimate the plausible performance of such models, using the Parsonian approach to social systems. We have also taken several dimensions concerning organizational perform...

The authors examine the possible forms that an ambulatory care centre associated with a university hospital system — created through a merger of several independent hospitals — might assume. Part 1 describes potential models; part 2 estimates the plausible performance of each of these potential models using the Parsonian approach to social systems.

This article describes an experience of integration of services to people with mental health disorders on a local basis. The experience took place in a rural region between 1998 and 2001 and was funded by the Fonds pour l'adaptation des services de santé (FASS). The authors describe th specific context of the experience, the intervention model whic...

The report on the future of the health care system in France focuses on the challenges facing the system and the changes needed to implement new policies. These challenges are similar to those faced by other O E C D countries. However, the implicit operating model of the health care system that structures the «Horizon 2020» report does not provide...

Cet article rend compte d'une experience locale d'integration des services aupres d'une clientele souffrant de troubles mentaux. L'experience s'est deroulee dans une region rurale entre 1998 et 2001 et a ete financee par le Fonds pour l'adaptation des services de sante (FASS). Les auteurs decrivent le contexte particulier de l'experimentation, le m...

This study aims to validate the Hospitals and Hostels Practices Profile Schedule (HHPPS) in the French version according to the statistical requirements of factor analysis and internal consistency, and to arrive at as parsimonious a version of the questionnaire as possible. As no validation of the original English instrument exists to our knowledge...

Since the 80's, outmigration of physicians from Quebec is steadily increasing. About 46 percent of outmigrating doctors explain their move by factors related to their occupational life (higher income, greater opportunity in the academic career, larger amount of resources devoted to the health care system). Nearly 40 percent relate their decision to...

During the period 1986-1999, about 16% of the annual average number of active physicians in Quebec have left for the US or an other Canadian province. The absolute number was 2367. During the same period, 661 would have returned to Quebec. The majority of the outmigrating doctors were graduated from the anglophone university of the Province (althou...

During the period 1986-1999, about 16% of the annual average number of active physicians in Quebec have left for the US or an other Canadian province. The absolute number was 2367. During the same period, 661 would have returned to Quebec. The majority of the outmigrating doctors were graduated from the anglophone university of the Province (althou...

Since the 80's, outmigration of physicians from Quebec is steadily increasing. About 46 percent of outmigrating doctors explain their move by factors related to their occupational life (higher income, greater opportunity in the academic career, larger amount of resources devoted to the health care system). Nearly 40 percent relate their decision to...

OM-85 BV, an immunostimulant made from bacterial extracts, has been shown to reduce the risk of hospitalization for acute exacerbation in patients with chronic obstructive pulmonary disease, as well as to reduce the length of stay for all hospitalizations. In conjunction with a placebo controlled, randomized clinical trial, a cost effectiveness ana...

The practice of evaluation has existed in one form or another for as long as one can remember and is central to all processes of learning. Today, evaluation is a popular concept grouping together multiple and diverse realities. This article aims to propose a conceptual framework for evaluation that is broad and universal enough to allow all those c...

Article original Ruptures, revue transdisciplinaire en santé, vol. 8, n° 2, 2001, pp. 93-108. Résumé : Ce texte présente les principaux enseignements de l'évaluation de l'implantation d'un modèle intégré de services dans une région rurale du Québec. L'intervention se voulait une tentative d'intégrer les services de santé pour l'ensemble de la popul...