Jean-Louis Denis

• Chair at Université de Montréal & CRCHUM

Empirical research in law is thriving, contributing to the creation of new knowledge and providing jurists with innovative ways to study issues and phenomena. Embracing empiricism is no easy task, but the authors of this article have taken the plunge to shed light on such research. By developing two distinct methods (for two projects), they tested...

En plein essor, la recherche empirique en droit participe à la création de nouvelles connaissances et ouvre aux juristes d’autres voies pour étudier une question, un phénomène. Oser l’empirisme n’est pas chose aisée, mais les auteurs du présent article ont pris ce virage et proposent d’en exposer le récit. En construisant deux méthodes distinctes (...

Digital health technologies hold promises for reducing health care costs, enhancing access to care, and addressing labor shortages. However, they risk exacerbating inequalities by disproportionately benefitting a subset of the population. Use of digital technologies accelerated during the Covid-19 pandemic. Our scoping review aimed to describe how...

Access to primary healthcare is an important challenge in many countries, posing significant problems for population health and health equity. While family physicians' (FPs) dedication is considered essential to increase access to primary care, several indications of a certain demobi-lization, even a deeper disengagement, among FPs has emerged. Usi...

The paper focuses on the role of the World Health Organization (WHO) in promoting a healthy world population as a generative and robust idea within health policy. The WHO’s health credo transcends national boundaries to promote health globally. It is embedded in norms, values, and standards promulgated by the organization and contributes in shaping...

Health systems in most jurisdictions are facing an unprecedented workforce crisis, manifesting as labour shortages, high staff turnover, and increasing rates of absenteeism and burnout. These issues affect professional and occupational groups in both health and social care and individuals at early and later stages of their career. The intensity and...

Collegiality is the modus operandi of universities. Collegiality is central to academic freedom and scientific quality. In this way, collegiality also contributes to the good functioning of universities’ contribution to society and democracy. In this concluding paper of the special issue on collegiality, we summarize the main findings and takeaways...

Background In 2016, two Canadian hospitals participated in a quality improvement (QI) program, the International Acute Care for Elders (ACE) Collaborative, and sought to adapt and implement a transition coach intervention (TCI). Both hospitals were challenged to provide optimal continuity of care for an increasing number of older adults. The two ho...

Background There is growing interest from health researchers in the governance of Health in All Policies (HiAP). Furthermore, the COVID-19 pandemic has re-ignited managers’ interest in HiAP governance and in health prevention activities that involve actors from outside health ministries. Since the dynamics of these multi-actor, multi-sectoral polic...

Research on governance often assumes that governance requires combinations of hierarchical, market and network co-ordination. However, governance versatility – understood as the existence of a repertoire of different modes of coordination – is not a characteristic of all instances of governance. The aim of this paper is to offer a more thorough ana...

Introduction: One family medicine group (FMG) in Quebec has commenced a 5-year pilot project, which is herein referred to as the Archimède model, to implement a patient-centred model based on interprofessional care and the optimal use of healthcare providers' practice scopes. A research project will be conducted to: (1) assess this model's effect...

Background: In 2015, the Government of Quebec undertook a vast reorganization of its health and social services network. This reform mainly aimed to promote and simplify access to services for the population, contributing to the improvement of the quality and safety of care, and increasing the efficiency and effectiveness of the network. Since 2016...

Aim: To foster equity and make health systems economically and environmentally more sustainable, Responsible Innovation in Health (RIH) calls for policy changes advocated by mission-oriented innovation policies. These policies focus, however, on instruments to foster the supply of innovations and neglect health policies that affect their uptake. O...

This article examines how existing primary care services were transformed in Québec during COVID-19 to better serve the most vulnerable individuals for whom inequities and access difficulties increased during the pandemic. In the context of a research project, six particularly promising practices to respond to these challenges were identified withi...

Background: The health workforce is central to healthcare systems and population health, but marginal in comparative health policy. This study aims to highlight the crucial relevance of the health workforce and contribute comparative evidence to help improve the protection of healthcare workers and prevention of inequalities during a major public...

Introduction: Health systems around the world are being redesigned to address issues of poor care coordination, weak information flows, increase in care spending, disparate safety and quality, and inequitable population health outcomes. In the past decade, Accountable Care Organizations (ACO) have risen in the health policy landscape as promising i...

This Chapter presents a comparative analysis of medical politics and health reforms within three empirical cases in Canada and England. The aim is to understand the medical doctors–healthcare reform nexus and to test the theoretical model’s ability to explain key variations and points of convergence across the cases. The chapter first examines the...

This chapter presents the conceptual framework underpinning the research undertaken. It looks at elements of the legal and political context that have had an influence on the role of medical doctors in healthcare reforms. It also provides an overview of scholarly work on the sociology of professions and the interface between professions and organis...

This chapter lays out the book’s research methodology. The authors discuss the methodological questions arising from exploring empirically the role of medical doctors in healthcare reforms and the related policy changes. The chapter also explains the methodological choices around the data set, the context-specific elements, and the role of jurisdic...

Medical doctors play a crucial role in the allocation and use of resources in health care systems. They shape capacities to renew policy orientations and innovate models of care. However, little attention has been paid to their specific role in health reforms. This book explores this aspect by looking at the role of the medical profession in health...

This chapter comprises two main sections. First, the authors discuss the evidence and theoretical contributions of their analysis. They articulate such contributions around different themes: governance, governmentality and the medical profession; law as an instrument for policy change; and medical politics and healthcare system reforms. The challen...

This Chapter provides a case narrative of the role of medical doctors in healthcare reforms in the England, starting with the creation of the NHS (1948), up until the Coalition government reforms and their aftermath (2010-2020). The focus is on the two main policy actors and their complex relationship over time. As for the Canadian case study, the...

This Chapter provides a case narrative the role of medical doctors in healthcare reforms in the two most populated Canadian provinces of Quebec and Ontario. While healthcare systems across Canada share some similarities, they remain mostly independent and thus need to be studied as such. The narrative tracks the evolution of the system from its inc...

Introduction chapter outlines how this comparative study assesses the role of medical doctors in reforming publicly funded health services in England and Canada. Respected authors from health and legal backgrounds on both sides of the Atlantic consider how the high status of the profession uniquely influences reforms. With summaries of developments...

Our study examines the empirical case of the political leadership response to Covid-19 in England. It shows that, rather than the ideal configuration of leadership suggested by theory, within which individualistic and collective leadership blend, a less balanced configuration emerged that can be characterised as incoherent. In England, an individua...

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.

The federal context The federal context in Canada warrants attention as it influences the negotiating space for provincial governments and medical doctors. While healthcare services are mostly under provincial jurisdiction (Section 92, Constitution Act 1867), the federal government plays an important role, particularly by using its spending power t...

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.

This chapter presents the conceptual framework underpinning our research. It looks at elements of the legal and political context that influence the role of medical doctors in healthcare reforms. It then analyses scholarly work on the sociology of professions and the interface between professions and organisations in order to better understand the...

For a better understanding of the historical role played by medical doctors in the NHS healthcare reforms, we need a few preliminary words on the process of law-making to reform the healthcare system in England. Usually, the reformative process is ignited by an inquiry or policy proposal. In the early years of the NHS, the government established Ro...

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.

The objective of empirically exploring the role of medical doctors in healthcare reforms and policy changes raises a number of methodological questions. What data set should be considered? What is the appropriate period of study (that is, when should analysis of reforms start and end our)? What context-specific elements, whether jurisdictional or s...

In this section, we present a set of analytical themes and considerations derived from our analysis of the three empirical cases in England and Canada. The intent is to elucidate the implications of our research on how we understand the medical doctor– healthcare reform nexus and to test our theoretical model's ability to explain key variations and...

Part 1: Research and theoretical contributions Governance, governmentality and the medical profession Influence in the mediated space of reforms Healthcare is central to the functioning of contemporary states, so much so that political scientists have coined the term ‘mature healthcare states’ (Tuohy, 2012; Ferlie and McGivern, 2013). Our research...

This Introduction defines our research objectives and the key concepts underpinning our inquiry. We look at reforms in contemporary welfare states, which include England and Canada (Denhardt and Denhardt, 2000; Bejerot and Hasselbladh, 2011; Ferlie and McGivern, 2013) and on their implications for the potential roles and manifestations of the agenc...

The objective of this study was to describe and assess the quality of the direct-to-consumer medical teleconsultation landscape in three Canadian provinces. An environmental scan of primary care teleconsultation platforms was conducted in January 2022 to identify medical teleconsultation platforms in Quebec (Qc), Ontario, and British Columbia (BC)....

In its Strategic Plan 2021-2026, the Canadian Institutes of Health Research - Institute of Health Services and Policy Research (IHSPR) convincingly expresses its desire to expand capacity for applied health services and policy research (HSPR) and better mobilize research results for health system transformation geared toward the Quadruple Aim and h...

Introduction: Responsive, integrated and sustainable health systems require that communities take an active role in service design and delivery. Much of the current literature focuses on provider-led initiatives to gain community input, raising concerns about power imbalances inherent in invited forms of participation. This paper provides an alter...

Objectives Public and patient engagement (PPE) is increasingly recognized in policy statements as essential to achieving transformation towards patient-centred, value-based, integrated care. Despite extensive research over two decades, important gaps and questions remain around how the efforts invested in engagement drive the changes needed to meet...

Recent 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 e...

Purpose The purpose of this paper is to explore the appropriation of control rooms based on value-based integrated performance management tools implemented in all publicly funded health organizations in Quebec (Canada) as a form of legitimate sociomaterial work. Design/methodology/approach Multi-site organizational ethnographic case studies in two...

Responsible Research and Innovation (RRI) seeks to steer innovation towards important societal challenges and, by doing so, calls for entrepreneurial activities that create economic, social, and environmental value. Nonetheless, little is known about the way different types of organization can produce responsible products and services and the chall...

Background: The National Health Service Institute for Innovation and Improvement Sustainability Model (NHS SM) is recommended and used by several organisations to implement sustainable healthcare innovations. Although several knowledge syntheses have been conducted about sustainability models in general, none have focussed specifically on the NHS S...

Background As part of reforms in 2015, the Ministry of Health and Social Services in Quebec, Canada mandated the national implementation of control rooms, making health system actors accountable for implementing value-based performance management. Objective To explore how do organizational actors appropriate control rooms as managerial tools to in...

Purpose: Artificial intelligence (AI) raises many expectations regarding its ability to profoundly transform health care delivery. There is an abundant literature on the technical performance of AI applications in many clinical fields (e.g. radiology, ophthalmology). This article aims to bring forward the importance of studying organizational readi...

Over the past few months, our fellow citizens have heard more about public health than ever before. The SARS-CoV-2 pandemic has shed light on the vital role played by public health for health protection and provided telling evidence about current public health capacity as well as the corrective measures to be taken and milestones to be achieved in...

In publicly funded health systems, reform efforts have proliferated to adapt to increasingly complex demands. In Canada, prior research (Lazar et al ., 2013, Paradigm Freeze: Why is it so Hard to Reform Health Care in Canada? , McGill-Queen's Press) found that reforms at the end of the 20th century failed to change the fundamentals of the Canadian...

In recent years, a longstanding research agenda has developed around the appropriation of management tools to tackle the journey and impact of tools in contemporary healthcare organizations. Management tools are defined as sets of technologies, processes and technical or synthetic systems that are used to guide collective action. Drawing on an exte...

A growing body of literature suggests combining organizational ethnography and case study design as a new methodology for investigating complex organizational phenomena in health care contexts. However, the arguments supporting the potential of organizational ethnographic case studies to improve the process and increase the impact of qualitative re...

There is a growing recognition among oncologists that older patients differ from other cancer patients. Older patients present age-specific issues affecting the prevention and management of their cancer. Over the years, this has led to the development of the discipline of geriatric oncology, which is the set of practices elaborated to evaluate, tre...

As the increasingly employed concept of “governmentality” refers to diverse ideas, the authors present a state of the science assessment of its use in the study of healthcare networks. The review covers 17 databases over a 42-year period between 1975 and 2017 and identifies 1673 records, of which 98 are fully assessed and 38 meet inclusion criteria...

This chapter aims to understand how organizational actors in Academic Health Centres (AHCs) mobilize transformative capacities through the process of expanding the academic mission across the care continuum in the enactment of a policy reform. Using a realist evaluation approach, a single qualitative embedded case study was conducted in Quebec, Can...

Health systems worldwide are grappling with the challenge of coordinating difference in an increasingly complex care environment. In response this book features the latest research on organizational studies in healthcare and explores the relationship between strategic and organic change and what this means for the way we organize health work. Focus...

BACKGROUND Elderly patients discharged from hospital experience fragmented care, repeated and lengthy emergency department (ED) visits, relapse into their earlier condition, and rapid cognitive and functional decline. The Acute Care for Elders (ACE) program at Mount Sinai Hospital in Toronto, Canada uses innovative strategies, such as transition co...

Background: Elderly patients discharged from hospital experience fragmented care, repeated and lengthy emergency department (ED) visits, relapse into their earlier condition, and rapid cognitive and functional decline. The Acute Care for Elders (ACE) program at Mount Sinai Hospital in Toronto, Canada uses innovative strategies, such as transition...

Introduction: Integrated care models for older adults are increasingly utilised in healthcare systems to overcome fragmentations. Several groups of stakeholders are involved in the implementation of integrated care. The aim of this study is to identify the main concerns, convergences and divergences in perspectives of stakeholders involved in the...

Background: People living with and beyond cancer (PLC) receive various forms of specialty care at different locations and many interventions concurrently or over time. They are affected by the operation of professional and organizational silos. This results in undue delays in access, unmet needs, sub-optimal care experiences and clinical outcomes,...

We were very glad to read the six commentaries about our scoping review on the needs and challenges of health systems that Responsible Innovation in Health (RIH) could address. The commentators offered great suggestions to further research on RIH and health systems. We provide clarifications to their queries and explain why revisiting the relations...

Innovation has the potential to improve the quality of care and health service delivery, but maximising the reach and impact of innovation to achieve large-scale health system transformation remains understudied. Interest is growing in three processes of the innovation journey within health systems, namely the spread, sustainability and scale-up (3...

Introduction: Integrated care models for older adults are increasingly implemented in modern healthcare systems. They usually involve complex coordination and collaborations between multiple actors operating at different levels of the healthcare system. Several groups of actors such as policymakers (at the strategic level), managers (at the tactica...

This article relates institutional theory to the concept of organizational legitimacy with cognitive, moral, and pragmatic dimensions, to analyse how a Dutch national policy reform – aimed at expanding the social responsibility for sick leave and disability toward non-state organizations – is understood and enacted locally. Based on interviews in 5...