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Publications (88)
Les technologies numériques jouent un rôle central dans les stratégies visant à améliorer l’accès, la qualité et l’efficience des soins et des services de santé. Toutefois, de nombreux projets en santé numérique n’ont pas réussi à devenir pérennes et être diffusés dans les organisations et systèmes de santé. Cette situation est en partie attribuabl...
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...
Background:
Although integrated care is drawing considerable attention from health care policy makers, little is known about integration of oral health care services into primary care in Quebec. Therefore, the objective of this study was to compile information and compare the aspects of primary oral health care in two public health care organizati...
Background
Despite its importance, the integration of oral health into primary care is still an emerging practice in the field of health care services. This scoping review aims to map the literature and provide a summary on the conceptual frameworks, policies and programs related to this concept. Methods
Using the Levac et al. six-stage framework,...
Recently, new models for the integration of oral health into primary care have been proposed. However, these models may be adopted by a variety of health care systems, and will reach successful outcomes only if they can be adapted to suit the local context. To this end, the objective of this study was to explore the perceptions of Quebec primary he...
Interview guide: Non-dental providers.
(DOC)
Objective
This scoping study has been conducted to map the literature and provide a descriptive synthesis on the barriers and facilitators of the integration of oral health into primary care.
Methods
Grounded in the Rainbow conceptual model and using the Levac et al six-stage framework, we performed a systematic search of electronic databases, org...
Aim:
The aim of this study was to describe the process of how nurse and physician managers in formalized dyads work together to address clinical management issues in the surgical division of one hospital setting.
Background:
Nurse and physician managers are uniquely positioned to co-lead and transform healthcare delivery. However, little is know...
Background:
Depression is a major cause of work absenteeism that general practitioners (GPs) face directly since they are responsible for sickness certification and for supervising the return to work (RTW). These activities give GPs a key role in preventing long-term work disability, yet their practices in this regard remain poorly documented. The...
Context: The literature on the challenges raised by the implementation of telehealth often highlights the difficulties encountered in the implementation, deployment and sustainability of its use. The slow increase in the use of ICTs in the health sector is often denounced. Yet progress has been made. What is it based on? Objectives: This article ai...
Purpose
The purpose of this paper of inter-professional networks is to analyze the evolution of relationships between professional groups enacting new forms of collaboration to address clinical imperatives.
Design/methodology/approach
This paper uses a case study based on semi-structured interviews with physicians and nurses, document analysis and...
Contexte
Ces dernieres annees, les troubles de sante mentale comme la depression sont devenus l’une des principales causes d’absenteisme au travail. Dans le systeme medico-administratif canadien, ce sont les medecins generalistes qui doivent certifier l’absence-maladie et determiner les conditions du retour au travail. Ces responsabilites les place...
Background:
the collaboration between geriatricians and cancer specialists holds significant potential for improving care outcomes for older cancer patients. The realisation of this collaboration partly depends on cancer specialists involving geriatricians in caring for their older patients. Yet only a few studies have focused on understanding the...
Background:
Although diabetes is a frequent complication of cystic fibrosis (CF), patients' behaviors tend not to comply with best practice recommendations. Using Leventhal's Common-Sense Model, we address this issue by exploring patients' representations of CF-related diabetes (CFRD) to better understand the discrepancy between patients' expected...
Contexte
Les écrits sur les défis posés par l’implantation de la télésanté mettent souvent en évidence les difficultés rencontrées pour l’implantation, le déploiement et la pérennité de l’utilisation. La lenteur de la progression de l’utilisation des TIC dans le domaine de la santé est souvent dénoncée. Pourtant, des progrès sont réalisés, notamme...
This study was designed to analyse the adaptive strategies used by primary care professionals to provide more adapted and continuous services to patients with more than one chronic disease.
A qualitative case study was conducted in a primary care structure (GMF in Québec). Data were derived from two sources: semi-structured interviews and documents...
The needfor integrated services to treat co-occurring disorders is now recognized. Specialised clinics have now been created for this purpose. This study analysed the integration process that occurred in a particular clinic in order to identify the strategies and means used and their overall impact.
We conducted a longitudinal case study. Data coll...
This article draws on recent developments in institutional theory to better understand the managerial efforts implicated in the implementation of government-led reforms in public sector services. Based on a longitudinal study of a massive reform effort aimed at transforming the province of Quebec’s publicly-funded healthcare system, the article app...
Purpose:
Governments everywhere are implementing reform to improve primary care. However, the existence of a high degree of professional autonomy makes large-scale change difficult to achieve. The purpose of this paper is to elucidate the change dynamics and the involvement of professionals in a primary healthcare reform initiative carried out in...
The aim of this paper is to illustrate and discuss how healthcare organisations can act as institutional entrepreneurs in a context of change.
The authors conducted an in-depth longitudinal case study (2005-2008) of a healthcare organisation in the province of Quebec, Canada. Data collection consisted of real-time observations of senior managers (n...
Objective: Over the past 15 years, considerable time and energy has been devoted to implementing integrated services for individuals with dual disorders. While the key factors in the successful implementation of such services have been documented, applying them remains a challenge. What are we missing? In this article we attempt to answer this ques...
The purpose of this study was to understand how home telecare technologies can be used to improve services for people with chronic diseases.
Canadian elders with at least one of the targeted chronic diseases (COPD, heart failure, hypertension, diabetes) were asked to use telehomecare equipment. The data needed to assess the implementation process a...
There has been considerable effort in recent years to link and integrate professional services more closely for patients with comorbidities. However, difficulties persist, especially at the clinical level. This study aims to shed light on these difficulties by examining the process of sensemaking in professionals directly involved in this integrati...
Aim. This article describes a new conceptual framework for acute care nurse practitioner role enactment, boundary work and perceptions of team effectiveness.
Background. Acute care nurse practitioners contribute positively to patient care by enacting an expanded scope of practise. Researchers have found both positive and negative reactions to the i...
Mergers as a type of organizational change call attention to questions of identity. In this article, the authors ask: How do people collectively reconstitute their group identities for themselves and others, and in particular, how do they renegotiate understandings of sameness and difference called into question by merging? The authors draw on qual...
In many countries, acute care nurse practitioners contribute to patient care through an expanded scope of practice that includes nursing and medical activities. There have been calls across nations to establish better understanding of how nurse practitioners enact their roles in healthcare teams. The 2006 introduction of cardiology nurse practition...
This article is a report of a study of boundary work following the introduction of an acute care nurse practitioner role in healthcare teams.
Acute care nurse practitioners enacting their roles in healthcare teams have faced a number of challenges including a mix of positive and negative views of the acute care nurse practitioner role from healthca...
: Health care transformations often involve the development of networks to ensure smooth and safe patient flows throughout the care continuum. However, more empirical information is needed on the workings of health networks and on how their structures, processes, and systems influence access to high-quality patient care.
: Using Miller's concept of...
This article summarizes the results of an extensive review of the organizational and health care literature of advanced practice nursing (APN) roles, health care teams, and perceptions of team effectiveness. Teams have a long history in health care. Managers play an important role in mobilizing resources, guiding expectations of APN roles in teams...
Background: Over the past decade, practice standards have recommended that people experiencing both mental and substance use disorders receive integrated treatment. Yet few institutions offer integrated services, and patients are too often turned away from psychiatric and rehabilitation services.Aim: To identify key enhancing elements for integrati...
Over the past decade, practice standards have recommended that people suffering from both mental and substance use disorders receive integrated treatment. Yet, few institutions offer integrated services, and patients are too often turned away from psychiatric and addiction rehabilitation services.
The purpose of this study was to identify key facto...
In 2004, the Quebec government undertook a major reorganization of its health care system by integrating public health more formally into local governance structures. In all, 95 new organizations - Health and Social Services Centres (CSSS)--were created and given a population-based responsibility. This mandate required that CSSSs broaden their rang...
The article examines various healthcare systems reform projects in Canada and some Canadian provinces and reveals some tendencies in governance renewal. The analisis is based on the hypothesis that reform is an exercise aiming at the renewal of governance conception and practices. In renewing governance, reform leaders hope to use adequate and effe...
The term governance is used more and more often in the formulation, implementation, and evaluation of public policies. The purpose of this paper is twofold: to shed light on its meaning, and to study its applicability for the study of recent public health policies in Latin America. After discussing the differences between governance and the close c...
Electronic medical records (EMRs) have the potential to foster a safer, more effective and more efficient healthcare system. However, their implementation in primary care practice remains a challenge.
This study aims at exploring factors that have influenced the successful implementation of an EMR system in a family medicine group (FMG) in the Prov...
The term governance is used more and more often in the formulation, implementation, and evaluation of public policies. The purpose of this paper is twofold: to shed light on its meaning, and to study its applicability for the study of recent public health policies in Latin America. After discussing the differences between governance and the close c...
El artículo propone un examen de diferentes proyectos de reforma de los sistemas de salud de Canadá y de algunas provincias canadienses. Indica ciertas tendencias en la renovación de la gobernanza. El análisis se apoya sobre la hipótesis de que una reforma es per se un ejercicio de renovación de la concepción y de las prácticas de gobernanza. Al bu...
Drawing on a longitudinal study from the early years of implementation of health-care networks in Quebec, this article describes how public-sector managers deal with complex challenges when both organizational structures and organizational strategies are radically transformed simultaneously. The new organizations studied had to completely re-shuffl...
Introduction: In 2004, a new reform was launched with the aim to create 95 local health networks across the Qubec’s health care system. At the core of these networks are the Health and Social Services Center (HSSC), which resulted from the structural integration (merger) of all community health clinics, long-term care hospitals in a specific geogra...
This study aimed to understand how different types of knowledge have influenced the decision making process regarding the implementation of telehomecare in the organization of regional healthcare services in the Province of Quebec (Canada). A case study was conducted in order to explore how scientific evidence was integrated in the decision-making...
The quest for greater efficiency in health systems encourages governments to bring together two fields of practice that have largely developed in parallel in industrialized countries: public health and healthcare. Current healthcare reform in the province of Quebec formally integrates these two fields within a common governance structure. The objec...
Purpose – On 10 September 2007 the world was stunned by the news that Anita Roddick – the founder of The Body Shop – was dead at the age of 64. Everyone recognizes the success of The Body Shop, but it is not easily explained using traditional strategic thinking. This paper aims to shed new light on Anita Roddick's entrepreneurial and managerial fla...
The quest for greater efficiency in health systems encourages governments to bring together two fields of practice that have largely developed in parallel in industrialized countries: public health and healthcare. Current healthcare reform in the province of Quebec formally integrates these two fields within a common governance structure. The objec...
The purpose of the study was to analyze the development of nursing practice in family medicine groups (FMGs). The two-year case study consisted of 73 semi-directed interviews ofnurses, physicians and managers in five FMGs. The findings led to three main observations: nursing practice varies considerably from one FMG to another, the development of n...
E-health is increasingly valued for supporting: 1) access to quality health care services for all citizens; 2) information flow and exchange; 3) integrated health care services and 4) interprofessional collaboration. Nevertheless, several questions remain on the factors allowing an optimal integration of e-health in health care policies, organisati...
This paper presents some initial results from a longitudinal study of two major hospital mergers (involving three large institutions each). After examining the context of the two mergers and the cultures that must be integrated, we describe the processes of pre-merger negotiation, leadership development, strategic framing and operationalization. De...
The search for greater efficiency of health systems encourages governments to bring closer two fields of practice which have largely developed in parallel in the industrialized countries: public health services and health care.The current reform in Quebec province, Canada, more formally integrates these two fields within a commongovernance structur...
Configuration is an appealing concept to help understanding the complex arrangements that guide organizations' actions and contribute to their coherence. Although health care organizations are often described as professional bureaucracy a deep understanding of their structure and systems is still lacking. In this article, we draw on empirical data...
The co-occurrence of mental health and substance use disorders is becoming increasingly recognized as a single problem, and professionals recognize that both should be addressed at the same time. Medical best practices recommend integrated treatment. However, criticisms have arisen, particularly concerning the difficulty of implementing integrated...
The use of telehomecare has the potential to facilitate access to healthcare services for vulnerable populations. However, evidence on the implications of telehomecare on various aspects related to patients, healthcare professionals, organizations, and healthcare systems is still limited. Assessing the various effects of telehomecare for these diff...
Over the last decades, development of home care services is an important component of ongoing health care systems reforms. However, their full integration into hospital or primary care services is still progressing slowly. It appears that telehomecare (THC) could help create networks of services between hospital and primary care providers. Even tho...
The purpose of this study is to explore the influence of hospitals' organisational characteristics on telehealth adoption by health-care centres involved in the extended telehealth network of Quebec (French acronym RQTE) DESIGN/METHODOLOGY/APPROACH: The article is based on a review of the literature and a questionnaire, which was administered via t...
Human and organizational factors are central to the adoption of various telehealth technologies and influence their diffusion into integrated networks. The aim of this paper is twofold. Firstly, a conceptual framework for assessing organizational factors that condition telehealth adoption by hospitals is proposed. Secondly, the results of an explor...
Physicians' acceptance of telemedicine constitutes a prerequisite for its diffusion on a national scale. Based upon the Theory of Interpersonal Behavior, this study was aimed at assessing the predictors of physicians' intention to use telemedicine in their clinical practice. All of the physicians involved in the RQTE, the extended provincial teleme...
English
This article argues that process research provides a way of adding depth and perspective to our understanding of organisational change in healthcare and in other fields. We present a three-dimensional model of the research process and argue for the importance of all three dimensions in building useful process knowledge that will have releva...
The main objective of the study is to comprehend the dynamics of interactions between partners (caregivers, promoters, consultants, patients and managers) involved in the implementation process of an integrated delivery system designed to support the treatment of women with breast cancer. Preliminary findings permit to identify adoption/resistance...
The Pursuit of Integrated Service Networks: A Call for Renewed Governance
Over the past three decades, Quebec’s healthcare system has undergone a series of reforms aimed at improving the accessibility, continuity and quality of services, as well as their adaptation to the needs of citizens. However, the objectives targeted by these reforms have yet...
In this article, we draw on five case studies in health care organizations to develop a process theory of strategic change in pluralistic settings characterized by diffuse power and divergent objectives. The creation of a collective leadership group in which members play complementary roles appears critical in achieving change. However, collective...
The effect of clonazepam on the restless legs syndrome was studied in a group of 6 patients. Following a drug-free period, 3 patients received clonazepam for 4 weeks followed by placebo for 4 weeks thereafter and 3 patients received the same medication and for the same length of time but in reverse order. The effectiveness of the medication was eva...
Evaluation of new information and communication technologies (ICTs) in health care constitutes an essential condition in order to assert their added value for health care services delivery. Furthermore, evaluation should provide a primary source of information for decision-making with respect to technology development and diffusion. ICT projects ha...
Présentation Quelles sont les conditions et dynamiques liées à une gestion du changement qui favorise l'intégration des technologies au continuum de soins et services? Nature du changement induit par les technologies Dynamique d'évolution de ce changement Enjeux pour la gestion du changement Cette présentation a été effectuée le 26 octobre 2006, au...
